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FFP SOB > Valvular heart disease > Flashcards

Valvular heart disease Flashcards

1
Q

What is the first heart sound

A

Just at the beginning of systole

  • Due to closure of mitral and tricuspid valves
  • Usually only one sound is heard as both valves close at same time
  • If you hear a second echo it means that one valve is delayed due to a pathology
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2
Q

wHat is the second heart sound

A

Dub

Due to closure of the aortic and pulmonary valves (before diastole)

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3
Q

how are murmurs classified

A

Systolic vs diastolic murmurs

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4
Q

What is valvular stenosis

A

narrowing of the valve that does not fully open

-With normal blood flow

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5
Q

What is valvular regurgitation/incompetance

A

Valve does not shut properly

-After normal blood flow

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6
Q

What are the most common valves that have pathologies

A

Aortic and mitral

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7
Q

What is aortic stenosis

Causes

A

Narrowing of aortic valve causing obstruction of blood flow across valve

Causes: congenital, rheumatic fever, age-related calcification

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8
Q

Aortic stenosis history

A

Angina (coronary arteries are first arteries coming off aorta and so reduction in blood flow causes this)

  • Exertional syncope- People feel faint and may collapse as blood flow to brain limited
  • Arrhythmias (due to remodelling od heart)
  • left ventricular failure
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9
Q

Aortic stenosis examination

A

Palpation

  • Pulse: small volume, slow rising (pulse drags out, small pressure and weak
  • Heaving: (as left ventricle has to push hard to get blood out of stenosed valve)

Auscultation

  • Crescendo-decrescendo ejection systolic murmur
  • May have radiation to carotids (sitting forward and on expiration)
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10
Q

What investigations to do if suspect aortic stenosis and regurgitation and what would these show

A

ECG (left ventricular hypertrophy)
CXR (decide if there’s cardiomegaly of LVH)
Echo- to see how thick the valves are and possible calcification
Cardiac catheterisation- to assess pressure gradient across the valve

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11
Q

Aortic stenosis management

A

Acute- balloon valvuloplasty

Chronic- aortic valve replacement

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12
Q

Where is aortic stenosis loudest heard

A

2nd ICS right sternal edge

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13
Q

Aortic regurgitation causes

A 
Hypertension
Aortic dissection
Weak connective tissue 
Infection
Rheumatic fever
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14
Q

History of aortic regurgitation

A 
SOB
Fatigue 
Palpitations 
Chest pain
Faint
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15
Q

Aortic regurgitation examination

A

palpitation

  • pulse: wide volume, collapsing pulse (feel it trickling down fingers when arm is raised)
  • Displaced apex beat to the left

Auscultation
-Early diastolic murmur at left sternal edge

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16
Q

Aortic regurgitation management

A

Acute- Haemodynamic support

Chronic-

  • Medical management (lower bp)
  • Aortic valve replacement if symptoms worsen
17
Q

Where is aortic regurgitation loudest

A

left sternal edge

18
Q

Causes of mitral stenosis

A

95% due to rheumatic fever

Congenital, degenerative, autoimmune causes like lupus

19
Q

History of mitral stenosis

A

SOB
Fatigue
AF (left atrium dilates and causes AF)
Haemoptysis (back flow into pulmonary circulation which stresses blood vessels)

20
Q

Examination findings mitral stenosis

A

Inspection- malar flush (purple red cheeks)

Palpation
Pulse- small volume
Parasternal heave

Auscultation
-Mid diastolic murmur

21
Q

Loudest for mitral stenosis

A

5th ics midclavicular line

-Ask pt to lie in left lateral position and breathe out

22
Q

mitral stenosis investigations

A

ECG- may show AF
CXR
Echo-determine degree of stenosis
Cardiac catheterisation to asses pressure gradient across valve

23
Q

Mitral stenosis management

A

acute- haemodynamic support

Chronic- medical management (diuretics), percutaneous balloon valvotomy

24
Q

What does mitral stenosis sound like

A

Low pitched rumbling

Opening snap

25
Q

Causes of mitral regurgitation

A

Left ventricular dilatation
Cardiomyopathy
Old-age degenerative infection
Autoimmune

26
Q

MR history

A

SOB
Fatigue
Peripheral oedema
Faint/dizzy

27
Q

MR exam

A

Palpation

  • pulse: possible AF
  • Paraseternal heave

Auscultation
Pan0systolic murmur

28
Q

MR management

A

Acute- haemodynamic support

Chronic- medical managenet- ACEI, B blocker, mitral valve replacement if symptoms worsen

29
Q

where does MR radiate

A

Axilla

FFP SOB (8 decks)

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