Valvular Heart Disease Flashcards
Characteristic symptoms of valvular heart disease?
EXERTIONAL symptoms are characteristic; at rest, valve issues can be asymptomatic:
Breathlessness
Chest pain
Collapse/dizzy spells
Describe cardiac related breathlessness
Usually related to exertion and is often associated with ankle swelling
Patients describe orthopnoea and PND - ask how many pillows they sleep with?
Patients describe sitting up as relieving symptoms - this relieves venous congestion (effect of gravity)
Which type of heart failure are orthopnoea and PND associated with?
Left-sided heart failure (has effects on lungs)
New York Heart Association Functional Classification (NYHA)?
Class I - no limitation (but do have heart disease)
Class II - slight limitation of ordinary activity, on marked exertion
Class III - marked limitation of less than ordinary activity, e.g: on minimal activity
Class IV - severe limitation of minimal activity or symptoms at rest
Signs of right-sided heart failure?
Raised JVP
Ankle/sacral pitting oedema - venous congestion changes hydrostatic pressure in capillaries
Hepatic congestion - liver is vulnerable to circulatory disturbances so right-sided heart failure causes this
Apex beat in mitral stenosis?
Tapping apex
Apex beat in left ventricular dilatation?
There is volume overload and a displaced and diffuse apex
Apex beat in left ventricular hypertrophy?
There is pressure overload and a displaced and heaving apex
Sometimes, the apex is be displaced. Heaves may be felt though
When do parasternal heaves occur?
Thrusting feeling
When there is right ventricular overload due to COR PULMONALE (right-sided heart failure secondary to pulmonary hypertension and lung disease)
What is a cardiac murmur?
Audible turbulence of blood flow
Types of cardiac murmurs?
Innocent and pathological
Important information when describing murmurs?
Systolic or diastolic murmur?
What type of murmur?
Where is it loudest?
Where does it radiate to?
What grade of murmur?
Is the murmur influenced by breathing?
Differentiating between systolic and diastolic murmurs?
Feel carotids:
Systolic murmurs occur after S1 and are in time with the pulse
Diastolic murmurs occur after S2 and will not be in time with the pulse
Types of systolic murmurs?
Pansystolic - heard at a constant volume throughout systole
Ejection systolic - increase in volume towards S2 before dropping off
ADD PICTURE
Types of diastolic murmurs?
Early diastolic - decrease in volume towards S1
Mid-diastolic (rumbling) - variable volume towards S1 (increase, decrease, increase in volume)
Where do murmurs commonly radiate to?
Carotids (aortic stenosis)
Axilla (mitral regurgitation)
Grading system of murmurs?
I - very quiet II - quiet but easy to heart III - loud IV - loud with a thrill V - very loud with a thrill VI - loud and audible without a stethoscope
How does inspiration affects murmurs?
Right-sided murmurs tend to be louder with inspiration
When are systolic clicks heard?
Mitral valve prolapse (two valve flaps do not close evenly)
When is a continuous murmur heard?
Ventricular-septal defect (can occur post-MI)
When is a pericardial rub heard?
Heard throughout the cycle and indicates pericarditis (swelling of pericardial sac)
Features of innocent (functional) murmurs?
Soft (less than 3/6 severity)
Position-dependent (these murmurs tend to be influenced by venous return so position changes are important)
Often early systolic murmurs (diastolic murmurs are never innocent)
No thrills are felt
What is valve stenosis?
Valves which do not open properly, e.g: aortic stenosis (most common valve lesion)
What is valve regurgitation?
Valves which do not close properly
