Valvular heart disease Flashcards
What are some common symptoms of valvular heart disease?
Crushing chest pain that radiates to the arm or jaw
Breathlessness on exertion
Ankle swelling
Orthopnoea
Paroxysmal Nocturnal Dyspnoea
Collapse
What is a cardiac murmur?
The audible turbulence of blood flow
What are the 2 main causes of murmurs?
Stenosis (valve too narrow)
Regurgitation (valve leaks)
What causes the first heart sound?
The closure of the Mitral and Tricuspid valves
What causes the second heart sound?
The closure of the aortic and pulmonary valves
When is a systolic murmur heard?
Between S1 and S2
When is a diastolic murmur heard?
After S2 and before the next S1
Which conditions cause a systolic murmur?
Aortic stenosis
Mitral regurgitation
Which conditions cause a diastolic murmur?
Mitral stenosis
Aortic regurgitation
What is heard in patent ductus arteriosus upon auscultation?
A constant murmur
What is meant by a pansystolic murmur?
A murmur of constant volume that stretches across the whole length of systole
What is meant by an ejection systolic murmur?
A murmur that quickly gets loud and then dies down over the course of systole
What are the 2 types of systolic murmurs?
Pansystolic murmur
Ejection systolic murmur
What are the 2 types of diastolic murmurs?
Early diastolic murmur
Mid-diastolic murmur
What is meant by an early diastolic murmur?
A murmur at the start of diastole that starts loud and descendos
What is meany be a mid diastolic murmur?
A murmur that starts midway through diastole and crescendos to the end of diastole
How are murmurs graded?
I - Very quiet
II - Quiet but easy to hear
III - Loud
IV - Loud with a thrill
V - Very loud with a thrill
VI - Audible without a stethoscope
How does inspiration affect right sided murmurs?
Right sided murmurs are louder upon inspiration
What are some common conditions that cause cardiac murmurs?
Innocent murmur
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Mitral stenosis
Continuous murmur
Tricuspid regurgitation
What are the characteristics of an innocent murmur?
Soft (Less than 3/6 grading)
Early diastolic
Only heard in one location
What are the main causes of aortic stenosis?
Degenerative - Age related
Congenital (e.g. bicuspid valve not tricuspid)
Rheumatic
What are some common symptoms of aortic stenosis?
Breathlessness on exertion
Chest pain
Dizziness
What causes chest pain in aortic stenosis?
Blood cannot flow into the coronary arteries as it is forced at high pressures
Also the increased strain on the heart increases oxygen demand
What are the clinical signs of aortic stenosis?
Low volume pulse as less blood is being pumped out
Pressure build up in the left ventricle causes hypertrophy, which displaces the apex
Ejection systolic murmur
Radiation to the carotid arteries
Loudest in aortic area
Where does the murmur of aortic stenosis radiate to?
The carotid arteries
What are the 2 types of valve replacement?
Mechanical
Bio-prosthetic
What are the pros and cons of mechanical valves?
They last a very long time, however, they require lifetime warfarin treatment
What are the pros and cons of bio-prosthetic valves?
They are formed of pig tissue and only last 10 years, however, they do not require warfarin treatment
What are the treatment options for aortic stenosis?
Conventional valve replacement
Trans-catheter Aortic Valve Implantation (TAVI)
Balloon aortic valvotomy
What are the causes of mitral regurgitation?
Leaflet prolapse
Rheumatic
Myxomatous (Floppy) valve
Endocarditis
Chordae rupturing
Papillary muscle rupturing
Annular dilatation
What are some symptoms of mitral regurgitation?
Breathlessness on exertion
Peripheral oedema
Fatigue
What are the clinical signs of mitral regurgitation?
Pansystolic murmur
radiates to the axilla
Loudest in the mitral area
Can lead to cardiomegaly
What are the treatment options for mitral regurgitation?
Diuretics
Heart failure medication
Repair - Prolapse
Replace - Degenerative
Percutaneous clipping of annulus
What are the causes of mitral stenosis?
Most commonly rheumatic (Rheumatic fever)
Very rarely will be congenital
What are the symptoms of mitral stenosis?
Breathlessness
Fatigue
Palpitations (Atrial Fibrillation)
What are the clinical signs of mitral stenosis?
Malar flush - Plum red cheeks
Tapping apex beat
Mid diastolic rumbling murmur
Localised to the apex
Straight left border on CXR due to left atrial hypertrophy
What are the treatment options for mitral stenosis?
Diuretics
Treatment for AF
Valve replacement
Balloon valvuloplasty
What are some causes of aortic regurgitation?
Endocarditis
Connective tissue damage
Rheumatic
Annulus dilatation
Marfan’s syndrome
Aortic dissection
What is the main symptom of aortic regurgitation?
Breathlessness
What are the clinical signs of aortic regurgitation?
Collapsing pulse
Displaced apex due to left ventricular dilatation
Early diastolic murmur at the left sternal edge
Cardiomegaly on CXR
