Valvular Diseases Flashcards
What are the normal heart sounds?
S1 - LUB - closing of AV valve, start of systolic contraction of vessels - prevent back flow in atria
S2 - DUB - closing semilunar valves, once systolic is complete - prevent back flow in ventricles
What is the third heart sound?
S3 - LUB DE DUB
Rapid ventricular filling - chordae tendinae pulled all the way down then fling back (think elastic band)
What is the fourth heart sound?
S4 - LE LUB DUB
Heard before S1
Indicates stiff/hypertrophic ventricles
Caused by turbulent flow from atria that is contracting against a ventricle that is non-compliant and does not want to fill with blood - ventricles stiff and atria trying to fill with blood
Where do you auscultate for the pulmonary area?
2nd intercostal space - left sternal border
Where do you auscultate for the aortic area?
2nd intercostal space - right sternal border
Where do you auscultate for the tricuspid area?
5th intercostal space - left sternal border
Where do you auscultate for the mitral area?
5th intercostal space - midclavicular line - apex area
What are the features of a murmur?
SCRIPT
Site
Character
Radiation
Intenstity
Pitch
Timing
What is the grading to murmurs?
1 - difficult to hear
2 - quiet
3 - easy to hear
4 - easy to hear with palpable thrill
5 - hear with stethoscope barely touching
6 - hear without stethoscope touching chest
What is valvular disease?
Valves not functioning
Stenosis - restriction
Regurgitation - backflow of blood
Hypertrophy - ventricular walls thicker
Dilatation - ventricular walls thinner and the ventricle expands
What is aortic stenosis?
Narrow aortic valve
Left ventricle pushes on left aortic valve and ends up with left ventricular hypertrophy
As blood flows through valve in systolic contraction you’ll get turbulence of blood flow
What murmurs are heard with aortic stenosis?
Ejection systolic mumur - when blood ejected form left ventricle
High pitched - high velocity, in systole
Cresendo-decresendo - loud to quiet due to different speeds
Systolic murmur in between S1 and S2 - sounds like BURRR DUB
Radiates to carotid
What are the symptoms of aortic stenosis?
Dyspnoea - increased LV end diastolic pressure - not enough blood is being squeezed out, LV has to pumo harder
Angina - hypertrophy due to increased volume, high O2 consuptiom but not supples
Syncope
What are the causes of aortic stenosis?
Degenerative AV disease
Calcification (including idiopathic age calcification)
Bicuspid AV - might have 2 cusps instead of 3
Rheumatic valve disease
What are the treatments for aortic stenosis?
Replacement
Trans catheter AV replacement
What is aortic regurgitation?
Aortic valve incompetence
Blood back to LV from aorta in diastole (okay in systole)
What does aortic regurgitation often result in?
Heart failure - due to pressure caused by build up of blood in LV that needs pumping out
What is the murmur for aortic regurgitation?
Early diastolic murmur and soft - LUB TARRR
Austin flint murmur - caused by blood flowing back through aortic valve and over mitral valve causing mitral leaflet to vibrate
What are the symptoms of aortic regurgitation?
SOB – blood does not leave the ventricles causing pressure increase in LA
What signs do you get?
Early diastolic murmur
Difficult to accentuate the murmur – go to the left eternal edge and get patient to sit forward in and expiration
Displayed apex beat towards axilla (LV dilatation)
Collapsing pulse
Wide pulse pressure
Corrigan’s sign in necklaces – a bouncing rapid carotid pulse appears and disappears as blood is pumped out into ventricles and immediately starts flowing back through aortic valve - characterised by rapid systolic rise and rapid diastolic collapse
What are the signs of aortic regurgitation?
Corrigans - Neck pulsation
De Mussets - Head bobbing in time with cardiac cycle
Duroziezs sign - Diastolic murmur head over femoral pulses when partly occluded below stethehscope
Muellers sign - Uvula pulsation
Quinckes sign - Capillary pulsation in nail bed
Traubes sign - Pistol shot systolic sound in femoral arteries – sound when ausculated
What are the causes of aortic regurgitation?
Valve
Aorta – usually dilatation – think about the aorta, what are the problems with the aorta that will link to valve
Congenital (bicuspid, unicuspid, quadricuspid AV)
Connective tissue disorder – difficulty in creating dense connective tissue leading to weakness of valve leaflets
Marfans / Ehlers Danlos syndrome
Degeneration
Hypertension
Endocarditis
Ehlers Danlos
Rheumatic fever
Osteogenesis imperfecta
Trauma
Annulo-aortic dysplasia
Radiation
Following radiotherapy
Drugs
Cabergoline, fluoroquinones, chemotherapy
Idioathic age related weakness
What are the treatments for aortic regurgitation?
Watchful waiting – serial of echos / seen in clinic
If symptoms or LV dysfunction (severe) - surgical aortic valve repair or replacement
What is mitral stenosis?
Mitral valve narrowed
What is the murmur for mitral stenosis?
Causes mid diastolic low pitched rumbling murmur – due to low velocity of blood flow – blood flowing through narrow area it flows slowly
Loud S1 – thick valves and need large systolic force to shut valve so valves shut suddenly when force is high
LUB! DUB DURRRR
Palpate tapping apex beat
What are the symptoms for mitral stenosis?
SOB
Left atrial hypertrophy - LA pushing against mitral valve
What is mitral stenosis associated with?
Assoicated with malar flush – flushing of cheeks – due to back pressure of blood into pulmonary system causing a rise in CO2 and vasodilation
Associated with AF – due to keft atrium struggling to push through to left ventricle and causing disruption to electrical signals
What is the treatment for mitral stenosis?
Replacement
Balloon mitral comisurotomy - percutaneous
What is mitral regurgitation?
Incompetent mitral vlave
Leaky valve – blood flowing back through mitral valve into left atrium during systolic contraction of left ventricle – left atrium dilatiation
What is mitral regurgitation associated with?
Associated with congestive cardiac failure – elaking valve causing reduced ejection fraction – backlog of blood waiitng to be pumped from right side
May hear a this heart sound if heart failure present
What is the murmur for mitral regurgitation?
Pan systolic murmur – during systole blood flowingbackwards through valve, so is present rhoguhout systolic period
High pitch – high velocity of blood flow
Sounds like BURRRR (enitre way through systole)
Listen at axilla – tends to radiate to left axilla
What are the causes for mitral regurgitation?
Idiopathic weakening with age
Icheaemic heart disease
Infectivity endocardiditis
Rhematuic heart disase
Connective tissue disease: Marfan’s, elhers-danles syndrome
What is the treatment for mitral regurgitation?
Repair / replacement
Transcatheter therapies
