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Cardiovascular > Valvular Heart Disease | > Flashcards

Valvular Heart Disease | Flashcards

1
Q

4 main types of valvular heart disease:

A
  • Aortic stenosis
  • Aortic regurgitation
  • Mitral stenosis
  • Mitral regurgitation
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2
Q

Cardiovascular clinical exam - 5

A
  • General appearance
  • Arterial pulse - radial + carotid
  • Venous pulse - JVP
  • Palpation - apex + heaves
  • Auscultation - heart sounds and murmurs

GAVPA

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3
Q

What is the main disease valvular diseases can cause and its main signs/symptoms

A

Heart failure

  • Raised JVP
  • Pitting Oedema
  • Hepatic congestion
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4
Q

Apex beat Palpation - 3 causes of change

A

Tapping apex beat - mitral stenosis

Displaced and weak - LV dilatation

Displaced and heaving - LV hypertrophy

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5
Q

Parasternal heave - how and cause

A

Hand left of sternum

RV overload

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6
Q

What is a cardiac murmur

A

Audible turbulence of blood flow
Can be innocent or pathological

Normally caused by valve restricting exit or allowing blood to leak back in

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7
Q

Describing a murmur - 6

A
  • Timing - systole or diastole
  • What type of murmur
  • Where is it the loudest
  • Where does it radiate to
  • What grade of murmur
  • Is it influenced by respiration
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8
Q

What causes the first heart sound and what does it indicate

A

Mitral and tricuspid valves closing
Start of systole

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9
Q

What causes second heart sound and what does it indicate

A

Aortic and pulmonary valves closing
Start of diastole

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10
Q

Types of systolic murmur

A

Pansystolic - consistent sound

Ejection systolic - crechendos

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11
Q

Types of diastolic murmur

A

Early diastolic

Mid diastolic

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12
Q

What are the 4 areas murmurs are listened for

A

Right 2nd intercostal space, sternal edge - aortic valve
Left 2nd intercostal space, sternal edge - pulmonary valve
Left 4th intercostal space, sternal edge - tricuspid valve
Left 5th intercostal space, mid-clavicular line - mitral valve

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13
Q

What two places do you check for radiation and what does it mean if murmur is heard here

A

Carotids - aortic stenosis

Axilla - mitral regurgitation

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14
Q

Grades of murmur

A
  1. Very quiet
  2. Easy to hear
  3. Loud
  4. Loud with thrill
  5. Very loud with thrill
  6. Audible without stethoscope
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15
Q

What effect does respiration have on sound of murmurs

A

Right side murmurs are louder with inspiration

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16
Q

What is an innocent murmur and when is it heard

A

Physiological increased flow

Soft + Early systolic

Affected by position and exercise

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17
Q

What is valve stenosis

A

When valves do not open properly

18
Q

What is valve regurgitation

A

Valves do not close properly

19
Q

What is aortic stenosis

A

Where aortic valve is too small, narrow, or stiff obstructing blood flow from LV to aorta

20
Q

Aortic stenosis - causes

A

Congenital defect - bicuspid not tricuspid - younger patients

Calcifications on aortic valve - older patients

Rheumatic heart disease

21
Q

Aortic stenosis - symptoms

A

No symptoms unless severe

When severe:
- Dyspnoea
- Exercise induced syncope
- Angina

22
Q

Aortic stenosis - signs + auscultation

A

Low volume pulse
Left ventricular hypertrophy + displaced apex

Ejection systolic murmur
Best heard at 2nd right intercostal space, sternal edge

Radiates to carotids

23
Q

Investigations for all valvular diseases

A

Chest X ray
ECG
Echocardiogram

Others if needed: Cardiovascular Magnetic Resonance, Cardiac CT

24
Q

Aortic stenosis - management + benefits

A

Conventional valve replacement preferred (AVR)
- Long term

Patients unable to tolerate operation
Trans-catheter Aortic Valve replacement (TAVI)
- Percutaneous

Or Balloon Aortic valvotomy

25
Q

2 Types of prosthetic valves and differences

A

Mechanical
- Warfarin
- Last lifetime :. Younger patients

Bio-prosthetic
- No warfarin
- Last 10 years :. Older patients

26
Q

What is Aortic Regurgitation

A

Reflux of blood from the aorta through aortic valve into ventricle during diastole

27
Q

Aortic Regurgitaion - causes

A

Valve disease
- Rheumatic fever
- Infective endocarditis
- Connective tissue diseases
- Bicuspid aortic valve

Aortic root disease (affect annulus)
- Aortic dissection
- Marfans
- Hypertension

28
Q

Aortic Regurgitation - symptoms

A

Dyspnoea

Symptoms normally don’t develop until LV failure

Angina

29
Q

Aortic Regurgitation - Signs

A

Collapsing pulse

High pitched early diastolic murmur
Best heard at 4th left intercostal space, sternal edge with patient leaning forward and breath held in expiration

Apex beat is displaced laterally and downwards
Cardiomegaly

30
Q

Aortic Stenosis - management

A

Treat underlying cause if appropriate
ACEi used when severe
Beta blockers in Marfans patients

Valve replacement in symptomatic patients or when LV function is reduced

31
Q

What is Mitral Stenosis

A

Obstruction to the flow through mitral valve during diastole

32
Q

Mitral stenosis - causes

A

Rheumatic fever - main cause
Calcification in older patients

Can be congenital but rare

33
Q

Mitral stenosis - symptoms

A

Dyspnoea
Fatigue
Palpitations - AF
- increased atrial pressure causing it to enlarge which can cause AF

34
Q

Mitral Stenosis - signs

A

Malar flush - plum red discolouration of high cheeks

Mid-diastolic murmur best heard at Apex
Tapping Apex beat

Straight left heart border

35
Q

Mitral Stenosis - management

A

Diuretics
Treat AF

Valve replacement
Balloon valvuloplasty if can’t tolerate

36
Q

What is Mitral Regurgitation

A

When blood leaks back through the mitral valve during systole

37
Q

Mitral regurgitation - causes

A

Primary valve disorder
- Infective endocarditis
- MI causing valve prolapse
- Rheumatic fever
- Valve becomes myxomatosis (floppy)

Chordae rupture - prolapse
Papillary muscle rupture - ischaemic

Can occur secondary to LV dysfunction (HF)
E.g. cardiomyopathy or MI

38
Q

Mitral Regurgitaion - symptoms

A

Dyspnoea
Peripheral oedema
Fatigue

39
Q

Mitral Regurgitation - signs

A

Displaced apex - cardiomegaly

Pan-systolic murmur best heart at Apex
5th left intercostal space, mid-clavicular line

Radiates to axilla

40
Q

Aortic stenosis - management

A

Diuretics
ACEi if HF develops

Open heart surgery and valve repair (for prolapse) or replacement
Percutaneous - MitraClip if can’t tolerate surgery

Cardiovascular (9 decks)

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