Valvular heart disease Flashcards
What are the causes of Mitral Stenosis?
Rheumatic fever Calcification due to old age Infective endocarditis SLE RA
How can Mitral Stenosis cause RHF?
Higher LA pressure causes Pulmonary HTN causing RVH and tricuspid regurgitation leading to RHF
What are the signs of Mitral Stenosis?
60-70% have AF
Malar flush
Palpitations - tapping apex beat due to palpable 1st heart sound
Describe the murmur heard in Mitral Stenosis
Mid diastolic murmur
Heard best with the bell of the stethoscope at the apex with the patient lying on their left side
Loud S1
Opening snap (High pitched sound just after S2)
What would you see on CXR in a patient with Mitral Stenosis?
Enlarged LA
Signs of pulmonary oedema (Batwing pulmonary opacities, Peri-bronchial cuffing, Kerley B lines, Pleural effusion, upper lobe diversion of pulmonary vasculature)
What are the causes of Mitral Regurgitation?
Prolapsing mitral valve Rheumatic fever Papillary muscle rupture post MI Cardiomyopathy Connective tissue disease (Marfans, Ehlers Danlos)
What are the signs of Mitral Regurgitation?
Malar flush
Displaced apex beat
Palpable thrill
Describe the murmur heard with Mitral Regurgitation?
A pansystolic murmur heard with the diaphragm radiating to the axilla
No gap between murmur and S2
What would you see on CXR in a patient with Mitral Regurgitation?
Cardiomegaly
What would you see on ECG in a patient with Mitral Regurgitation?
Bifid P waves LV hypertrophy (S wave in V1 + R wave in V5 or V6 >35mm - 3.5 large squares)
What are the 3 abnormalities that cause a Pansystolic murmur?
Tricuspid regurgitation
Ventral septal defect
Mitral regurgitation
What is the triad of symptoms for Aortic Stenosis?
Dyspnoea
Angina
Syncope
What are some of the causes of Aortic Stenosis?
Age related calcification
Rheumatic fever
Bicuspid Aortic valve
What are some of the signs of Aortic Stenosis?
Slow rising pulse
Low volume
Narrow pulse pressure
Forceful apex beat
What would you hear on auscultation?
An ejection systolic murmur heard loudest over the Aortic region radiating to the Carotids (Both sides)
Audible gap between murmur and S2, unless very severe disease
What would you see on CXR?
Post stenotic dilatation of the ascending Aorta
What would you see on ECG?
LV strain pattern - depressed ST segment, T wave inversion in leads oriented towards the LV
Signs of LV hypertrophy
What are the signs of LV hypertrophy on ECG?
Increased R wave amplitude in left sided ECG leads, increased S wave depth in the right sided leads and delayed repolarisation in the lateral leads
What are the causes of Aortic Regurgitation?
Rheumatic fever
Bicuspid valve
Infective endocarditis
Marfan’s syndrome
Why is there LVH in patients Aortic regurgitation?
Regurgitation of the Aortic valve allows blood from the Aorta back into the LV during diastole, therefore the volume needed to be pumped out during systole is larger causing an increased pressure to be needed so LVH occurs
What are the signs of Aortic regurgitation?
Bounding collapsing pulse with a wide pulse pressure Pistol shot femorals Quincke's sign De Musset's sign Displaced apex beat
When can the pulse pressure increase physiologically?
Post exercise due to an increase in SV and decrease in total peripheral resistance
Pregnancy
What can cause an increase in pulse pressure?
Aortic regurgitation
Atherosclerosis
Thyrotoxicosis
Arterovenous fistula
What is Quincke’s sign?
Capillary pulsation in the nail beds seen in Aortic Regurgitation
What is De Musset’s sign?
Head nodding with each heartbeat seen in Aortic Regurgitation
What are Pistol shot femorals?
A sharp bang can be heard on auscultation of the femoral arteries in time with each heartbeat
What would you hear on auscultation in a patient with Aortic regurgitation?
A high pitched early diastolic murmur best heard left sternal edge 4th ICS with the patient leaning forward holding their breath in expiration.
What would the ECG of someone with Aortic regurgitation show?
Signs of LV hypertrophy
