Valvular Heart Disease Flashcards
Causes of Rheumatic fever
Rheumatic Fever: Streptococcal pyogenes infection leads to ASO antibodies that cross react with valve tissue causing damage.
Causes of Mitral Stenosis
Senile Ageing - most common
Rheumatic fever
Prosthetic valves
Malignancy
How does mitral stenosis present?
Dyspnoea Fatigue Palpitation Chest pain Haemoptysis
Signs: Malar flush (reduced CO)
low volume pulse
AF
Loud S1/opening snap, mid diastolic murmur(low rumbling, heard best on expiration)
Investigations into MS
CXR - mitral valve calcification, left atrial enlargement.
ECG - p-mitrale, AF, RVH
Echo
Causes Mitral Regurgitation
LV dilatation, annular calficiation, Rheumatic fever, IE, MI-ruptured papillary muscle, Ruptured chordae tendonae
Signs and Symptoms of MR
Symptoms: Dyspnoea, Fatigue, palpitations, IE.
Signs: AF, Displaced hyperdynamic apex beat (LVH), RV heave(RVH) split S2, Pansystolic murmur (radiating the to axilla).
Investigations into MR
ECG - p-mitrale, AF, LVH
CXR - cardiomegaly, mitral calcification, pulmonary oedema
Echo
Causes of Aortic Stenosis
Senile calcification, Congenital disease - bicuspid valve, Rheumatic Fever, IE
Presentation of AS, signs and symptoms.
Symptoms: Elderly patients, chest pain/angina, syncope, SOBOE, Heart Failure, palpitations,
Signs: Slow rising pulse, delayed carotid pulse, LV heave,
Ejection systolic murmur(crecendo-decrescendo) loudest in aortic area, Radiates to carotids, Ejection clicks,
Tests for AS
ECG - p-mitral, LVH, LBBB/complete AV block, Evidence of MI,
CXR - Cardiomegaly, Calcified Aortic valve, post stenotic dilation of aorta
Echo - narrowing of the aortic opening, doppler shows increased jet velocity
Causes of AR
Acute: IE, Ascending Aortic dissection, Trauma
Chronic: Congential/Marfans/Ehler Danlos, RF, Rheumatoid Arthritis, SLE, Hypertension
Signs and Symptoms of AR
SOBOE, Orthopnoea, PND, Palpitations, Syncope, CCF, Angina
Signs: Collapsing pulse, Diastolic murmur, Hyperdynamic apex beats
What is corrigans sign?
Carotid pulsation at rest
What is de Mussets sign
Head nodding with heart beat
What is Quincke’s sign
Capillary pulsation below nail bed
What is Duroziez’s sign
compressing femoral pulse there is proximal femoral bruit
What is Traube’s sign
Pistol shot femoral pulses on auscultation
Tests for AR
ECG - LVH, p mitrale
CXR- Cardiomegaly, dilated ascending aorta (dilated annulus causes regurgitation) Pulmonary oedema
What are the benefits of Echocardiography in valvular disease.
Able to assess ventricular function.
Can visualise valve compromise and assess degree of disease (Area of stenosis)
Able to use doppler to assess flow across valves in diastole and systole.
Management of Mitral valve disease
Control AF, diuretics, balloon valvuloplasty, open surgery to replace valve.
