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Valvular heart disease Flashcards

1
Q

What is meant by valvular heart disease?

A

This describes any condition affecting the heart valves, preventing either the proper passage of blood through the valves, or allowing blood back through the valves

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2
Q

What is a murmur?

A

An auscultatable sound, caused by the turbulence of blood flow

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3
Q

What are some general signs that may suggest a valvular heart disease?

A

Chest pain
Breathlessness
Collapse

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4
Q

When will a diastolic murmur be heard on auscultation?

A

Between S2 and the following S1

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5
Q

When will a systolic murmur be heart on auscultation?

A

Between S1 and S2

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6
Q

What causes a 3rd heart sound?

A

Passive filling of the ventricle

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7
Q

When can a 3rd heart sound be heard?

A

Just after S2

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8
Q

What causes a 4th heart sound?

A

Active filling of the ventricle against a stiff ventricle

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9
Q

Where are 3rd and 4th heart sounds heard most loudly?

A

Mitral area

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10
Q

What causes physiological splitting of the 2nd heart sound

A

Inspiration decreases intrathoracic pressure
This increases venous return
This increases end diastolic volume on the right
This means the pulmonary valve closes after the aortic valve

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11
Q

What are some pathological causes of a 3rd heart sound?

A

Left ventricular failure (e.g. dilated cardiomyopathy)
Constrictive pericarditis (Pericardial knock)
Mitral regurgitation

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12
Q

What are some pathological causes of 4th heart sound?

A

Aortic stenosis
Hypertrophic Obstructive Cardiomyopathy
Hypertension

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13
Q

What murmurs are systolic?

A

Aortic stenosis
Mitral regurgitation
Pulmonary stenosis
Tricuspid regurgitation

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14
Q

What murmurs are diastolic?

A

Mitral stenosis
Aortic regurgitation
Tricuspid stenosis
Pulmonary regurgitation

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15
Q

What are the 2 main types of systolic murmur?

A

Pansystolic
Ejection systolic

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16
Q

What valvular condition will cause a pansystolic murmur?

A

Mitral regurgitation

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17
Q

What valvular condition will cause an ejection systolic murmur?

A

Aortic stenosis

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18
Q

What are the 2 main types of diastolic murmur?

A

Early diastolic
Mid diastolic

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19
Q

What valvular condition will cause an early diastolic murmur?

A

Aortic regurgitation

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20
Q

What valvular condition will cause a mid diastolic murmur?

A

Mitral stenosis

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21
Q

What is meant by a pansystolic murmur?

A

A murmur that remains at a constant volume throughout systole

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22
Q

What is meant by an ejection systolic murmur?

A

A murmur that gets quickly louder and then becomes quieter in systole

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23
Q

What is meant by an early diastolic murmur?

A

A murmur that starts loud at the beginning of diastole and gets quieter

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24
Q

What is meany by a mid diastolic murmur?

A

A murmur that starts mid way through diastole and gets louder

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25
Q

How are murmurs graded?

A

I - Very quiet
II - Quiet but audible
III - Loud
IV - Loud with a thrill
V - Very loud with a thrill
VI - Audible without stethoscope

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26
Q

What sided murmur is usually louder on inspiration?

A

Right sided

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27
Q

Describe the characteristics of an innocent murmur?

A

Soft (<3/6) for severity
Often early systolic (Not diastolic)

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28
Q

What is aortic stenosis?

A

A condition in which the aortic valve is too small, narrow or stiff, resulting in obstruction of blood flow from left ventricle to the aorta

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29
Q

What are some causes of aortic stenosis?

A

Calcification (Degeneration) in older patients
Congenital (Bicuspid aortic valve)
Post-rheumatic fever
Wiliams syndrome
Hypertrophic obstructive cardiomyopathy

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30
Q

What are some symptoms of aortic stenosis?

A

Think ABCD
Aortic stenosis =>
Breathless
Chest pain
Dizziness

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31
Q

How does aortic stenosis lead to chest pain?

A

Increased pressure through the aortic valve decreases blood flow through the coronary arteries, leading to angina

32
Q

What are some clinical signs of aortic stenosis?

A

Low volume pulse
Narrow pulse pressure
Ejection systolic murmur, radiating to carotids
Slow rising pulse
Soft/absent S2
Presence of S4
Thrill

33
Q

What valvular condition will cause S4?

A

Aortic stenosis

34
Q

What valvular condition will cause a narrow pulse pressure?

A

Aortic stenosis

35
Q

What valvular condition will cause a slow rising, narrow pulse pressure?

A

Aortic stenosis

36
Q

Where can a murmur in aortic stenosis be heard loudest?

A

Aortic region
Carotids

37
Q

What are some treatment options in aortic stenosis?

A

Valve replacement
Trans Catheter Aortic Valve Implantation (TAVI)
Balloon aortic valvotomy

38
Q

What are the 2 types of conventional valve replacement?

A

Mechanical
Bio-prosthetic (Pig)

39
Q

What are the advantages and disadvantages of Mechanical valve replacement?

A

+ They last much longer than bio-prosthetic
- It requires lifetime warfarin

40
Q

What are the advantages and disadvantages of bio-prosthetic valve replacement?

A

+ Does not require warfarin
- Only last around 10 years

41
Q

What are some investigations that can be carried out in suspected aortic stenosis?

A

Chest X-rays
ECG
Echocardiogram
Cardiac CT (If indicated)

42
Q

What is mitral regurgitation?

A

A condition that causes the flow of blood back through the mitral valve during systole

43
Q

What are some causes of mitral regurgitation?

A

Prolapsed valve
Rheumatic fever
Myxomatous (Floppy) valve
Endocarditis
Chordae or papillary rupture post MI
Annular dilatation due to cardiomyopathy

44
Q

What are some common symptoms of mitral regurgitation?

A

Breathless on exertion
Peripheral oedema
Fatigue

45
Q

What are some clinical signs of mitral regurgitation?

A

Displaced apex
Pansystolic murmur, radiates to axilla
Presence of S3

46
Q

Where can the murmur of mitral regurgitation be heard?

A

Mitral area
Axilla

47
Q

What condition can be caused by mitral regurgitation?

A

Left ventricular hypertrophy (Cardiomegaly on x-ray)

48
Q

What are some surgical treatment options of mitral regurgitation?

A

Valve repair in cases of prolapse
Valve replacement in cases of degeneration
Percutaneous clips in infancy or those unable to tolerate open heart surgery

49
Q

What are some pharmacological treatment options in mitral regurgitation?

A

ACEi or ARBs
Diuretics

50
Q

What are some investigations that can be performed in mitral regurgitation?

A

Chest X-ray (Shows cardiomegaly)
Echocardiogram
Coronary angiography (If indicated)

51
Q

What is meant by mitral stenosis?

A

A condition in which there is obstruction to flow through the mitral valve during systole

52
Q

What is the most common cause of mitral stenosis?

A

It has a mostly rheumatoid aetiology
(rare calcification or congenital)

53
Q

What are some possible symptoms of mitral stenosis?

A

Breathlessness
Fatigue
Palpitations (A Fib)

54
Q

How does mitral stenosis cause atrial fibrillation?

A

Increased pressure in the left atrium can lead to ectopic foci formation as the atria enlarges

55
Q

What are some clinical signs of mitral stenosis

A

Malar flush
Tapping apex beat
Mid diastolic rumbling murmur
Loud S1
Haemoptysis
Opening snap

56
Q

What valvular condition causes malar flush?

A

Mitral stenosis

57
Q

What valvular condition causes a loud S1?

A

Mitral stenosis

58
Q

What valvular condition causes an opening snap?

A

Mitral stenosis

59
Q

How does mitral stenosis cause haemoptysis?

A

Increased pressure in the left atrium causes a build up of pressure in the lungs, leading to oedema and bleeding, causing pink, frothy sputum

60
Q

What are some surgical treatment options in mitral stenosis?

A

Valve replacement
Balloon valvuloplasty

61
Q

What are some pharmacological treatment options in mitral stenosis?

A

Diuretics
Direct oral anti-coagulation

62
Q

What are some investigations that can be performed in mitral stenosis?

A

Chest X-ray (Straight left heart border)
ECG
Echocardiography

63
Q

What is meant by aortic regurgitation?

A

A condition resulting in the reflux of blood from the aorta through the aortic valve and back into the left ventricle, during diastole

64
Q

What are some causes of aortic regurgitation?

A

Endocarditis
Connective tissue disease
Rheumatic fever
Annulus dilatation

65
Q

What are some conditions that can lead to aortic regurgitation?

A

Marfan’s syndrome
Aortic dissection
Spondylarthropathis
Hypertension
Ehler-Danlos syndrome
Syphilis

66
Q

What are some possible symptoms of aortic regurgitation?

A

Angina
Dyspnoea

67
Q

What are some clinical signs of aortic regurgitation?

A

Collapsing pulse
Displaced apex
Early diastolic murmur at left sternal edge
Low diastolic BP
Wide pulse pressure
Quincke’s sign (Pulsing nailbed)
De Musset’s sign (Head bobbing)

68
Q

What manoeuvre can be performed to increase volume of an aortic regurgitation murmur?

A

Patient leaning forward

69
Q

What valvular condition causes a collapsing pulse?

A

Aortic regurgitation

70
Q

What valvular condition causes a wide pulse pressure?

A

Aortic regurgitation

71
Q

What is the pharmacological treatment for acute aortic regurgitation?

A

Vasodilators and inotropes

72
Q

What is the pharmacological treatment for chronic, severe aortic regurgitation and heart failure?

A

ACE inhibitors

73
Q

What is the pharmacological treatment for aortic dilation in Marfan’s patients?

A

ß-Blockers

74
Q

Who is surgical management of aortic regurgitation indicated in?

A

Symptomatic patients
Asymptomatic patients with left ventricular dysfunction

75
Q

What are some investigations that can be carried out in aortic regurgitation?

A

ECG
Chest X-ray
Echocardiogram (Gold standard)

New cardio (28 decks)

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