Valvular heart disease Flashcards
What is the first heart sound
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
wHat is the second heart sound
Dub
Due to closure of the aortic and pulmonary valves (before diastole)
how are murmurs classified
Systolic vs diastolic murmurs
What is valvular stenosis
narrowing of the valve that does not fully open
-With normal blood flow
What is valvular regurgitation/incompetance
Valve does not shut properly
-After normal blood flow
What are the most common valves that have pathologies
Aortic and mitral
What is aortic stenosis
Causes
Narrowing of aortic valve causing obstruction of blood flow across valve
Causes: congenital, rheumatic fever, age-related calcification
Aortic stenosis history
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
Aortic stenosis examination
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)
What investigations to do if suspect aortic stenosis and regurgitation and what would these show
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
Aortic stenosis management
Acute- balloon valvuloplasty
Chronic- aortic valve replacement
Where is aortic stenosis loudest heard
2nd ICS right sternal edge
Aortic regurgitation causes
Hypertension Aortic dissection Weak connective tissue Infection Rheumatic fever
History of aortic regurgitation
SOB Fatigue Palpitations Chest pain Faint
Aortic regurgitation examination
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
Aortic regurgitation management
Acute- Haemodynamic support
Chronic-
- Medical management (lower bp)
- Aortic valve replacement if symptoms worsen
Where is aortic regurgitation loudest
left sternal edge
Causes of mitral stenosis
95% due to rheumatic fever
Congenital, degenerative, autoimmune causes like lupus
History of mitral stenosis
SOB
Fatigue
AF (left atrium dilates and causes AF)
Haemoptysis (back flow into pulmonary circulation which stresses blood vessels)
Examination findings mitral stenosis
Inspection- malar flush (purple red cheeks)
Palpation
Pulse- small volume
Parasternal heave
Auscultation
-Mid diastolic murmur
Loudest for mitral stenosis
5th ics midclavicular line
-Ask pt to lie in left lateral position and breathe out
mitral stenosis investigations
ECG- may show AF
CXR
Echo-determine degree of stenosis
Cardiac catheterisation to asses pressure gradient across valve
Mitral stenosis management
acute- haemodynamic support
Chronic- medical management (diuretics), percutaneous balloon valvotomy
What does mitral stenosis sound like
Low pitched rumbling
Opening snap
Causes of mitral regurgitation
Left ventricular dilatation
Cardiomyopathy
Old-age degenerative infection
Autoimmune
MR history
SOB
Fatigue
Peripheral oedema
Faint/dizzy
MR exam
Palpation
- pulse: possible AF
- Paraseternal heave
Auscultation
Pan0systolic murmur
MR management
Acute- haemodynamic support
Chronic- medical managenet- ACEI, B blocker, mitral valve replacement if symptoms worsen
where does MR radiate
Axilla
