- chest pain - breathlessness - collapse/ dizzy spells

- Mitral and tricuspid valve closing - Start of systole

- Aortic and pulmonary valves closing - Start of diastole

valvular heart disease Flashcards by Anna Halliday

clinical history

chest pain
breathlessness
collapse/ dizzy spells

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Cardiac Breathlessness

Related to activity (usually)
Often associated with ankle swelling
Orthopnoea
Paroxysmal Nocturnal Dyspnoea (PND)

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Class I -

No limitation

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class II -

Slight limitation of ordinary activity

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Class III -

Marked limitation of less than ordinary activity

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Class IV -

Severe limitation of minimal activity or at res

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Signs of Right Heart Failure

Raised JVP

Pitting oedema

Hepatic congestion

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What is a cardiac murmur?

Audible turbulence of blood flow
Innocent and pathological

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1st Heart sound

Mitral and tricuspid valve closing
Start of systole

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2nd Heart sound

Aortic and pulmonary valves closing
Start of diastole

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Where does it radiate to?

Carotids (aortic stenosis)
Axilla (mitral regurgitation)

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Grading of Murmurs

I. Very quiet
II. Quiet - easy to hear
III. Loud
IV. Loud with a thrill
V. Very loud with a thrill
VI. Loud - audible without a stethoscope

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Innocent (functional) Murmur

Soft (less than 3/6 severity)
Position dependent
Often early systolic (diastolic murmurs always pathological)

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VALVE STENOSIS

Valves which do not open properly

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VALVE REGURGITATION

Valves which do not close properly

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MIXED VALVE DISEASE

Valves which neither open properly nor close properly

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types of Aortic Stenosis

Degenerative (age related)
Congenital
E.g bicuspid valve
Rheumatic

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Aortic Stenosis symptoms

Breathlessness

Chest pain

Dizziness/syncop

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aortic stenosis signs

Low volume pulse

Forceful displaced apex

Ejection systolic murmur that can radiate to the carotids

aortic stenosis Treatment

Conventional valve replacement

Trans catheter aortic valve replacement (TAVI)

Balloon Aortic valvotomy (BAV)

mechanical heart valve

Longevity

Warfarin

Younger patients

bio-prothetic heart valve

No warfarin

10 years

Older patients

what is better AVR or TAVI

AVR due to long term outcomes

Mitral Regurgitation - causes

Leaflets
Chordae rupture (degenerative)
Papillary muscles rupture
Annular dilatation

Mitral Regurgitation symptoms

Breathlessness Peripheral oedema Fatigue

Mitral Regurgitation signs

Displaced apex Pansystolic murmur - Axilla

murmur syncronised w corotid pulse =

systole

murmur NOT syncronised w corotid pulse =

diastole

mitral regurgitation investigations

- CXR - ECG - Echocardiogram - to confirm diagnosis and assess severity - Others if indicated: CMR, coronary angiography

mitral regurgitation treatment medications

Diuretics and heart failure (ACE inhibitors)

mitral regurgitation treatment surgery

Repair – prolapse Replacement - degenerative - open heart surgery and valve repair or replacement - MitraClip if can’t tolerate open heart surgery

main cause of mitral stenosis

- Due to Rheumatic fever - Congenital (rare) - Calcification related to age

mitral stenosis symptoms

- Dyspnoea (breathlessness) - Fatigue - Palpitations (AF) - Mitral stenosis causes the pressure in the left atria to remain elevated, so the atria enlarges → can cause AF

mitral stenosis signs

- Mid-diastolic murmur best heard at the apex - Malar flush - Tapping apex beat - due to pressure overload - Presents with Atrial Fibrillation (palpilations)

mitral stenosis investigations

- auscultations - CXR - ECG - Echocardiogram

mitral stenosis Medical therapy

- Diuretics - Treat AF

mitral stenosis Surgery

- Valve replacement - Balloon valvuloplasty if can’t tolerate valve replacement

causes of aortic regurgitation

valve disease aortic route disease

what is aortic regurgitation

Reflux of blood from the aorta through the aortic valve into the left ventricle during diastole (diastolic murmur)

aortic regurgitation symptoms

- Significant symptoms occur late, do not develop until LV failure develops - Angina - Dyspnoea

aortic regurgitation signs

- High-pitched early diastolic murmur best heard at the left sternal edge in the fourth intercostal space with the patient leaning forwards and the breath held in expiration - Collapsing pulse - Apex beat is displaced laterally and downwards and is forceful in quality

aortic regurgitation investigations

- ECG - CXR - Echocardiogram

aortic regurgitation Medical therapy

- Treat underlying cause if appropriate - Patients with acute aortic regurgitation may need treatment with vasodilators and inotropes - ACE inhibitors are useful in individuals with chronic severe AR and heart failure - Beta-blockers may slow aortic dilation in Marfan’s patients

aortic regurgitation surgery

- indicated in symptomatic patients, and in asymptomatic patients when LV function begins to deteriorate - Surgical management involves valve replacement

what is aortic stenosis

Aortic valve is too small, narrow, or stiff, resulting in the obstruction of blood flow from the left ventricle to the aorta during systole

what is mitral regurgitation

Occurs when blood leaks back through the mitral valve during systole

what is mitral stenosis

Occurs when there is obstruction to flow through the mitral valve during diastole