Valvular Heart Disease Flashcards
In aortic stenosis describe the common triad associated?
SOB on exertion
Syncope
Chest pain
(+palpitations)
What two clinical findings may be found in a patient with AS O/E?
Slow rising pulse
Ejection systolic murmur - radiating to the carotid (A)
(Crescendo-Decrescendo)
Severe AS can be asymptomatic, however patients can deteriorate quick. Which 5 circumstances are an indication to operate?
LV dysfunction Abnormal exercise test Fast progression Severe LV hypertrophy Recurrent ventricular arrhythmias
What is the major cause of AS?
Age related calcification of the heart (increased stiffness)
Describe the symptoms of mitral stenosis?
Exertional SOB
Tachycardia - exaggerates the trans-mitral gradient and therefore = frank pulmonary oedema
Heamoptysis
Systemic emobolisms (increased stroke risk)
Describe the clinical findings O/E of MS?
LATE diastolic murmur Prominent 1st heart sound with low pitched diastolic murmur - better heard on inspiration Mallar flush Tachycardia ?Basal crepitations
What is the major cause of MS and which groups are most affected?
Rheumatic valve disease secondary to rheumatic fever (Group A streptococcus (pyogenes) found in the mouth) causes vegetations on the heart along with inflammation and scarring
3rd world and pregnant young women
On CXR what features are to note of a patient with MS?
Atrial enlargement with cardiomegaly
Patients may complain of swallowing difficulties as the atrium presses on the oesophagus
Describe aortic regurgitation?
EARLY diastolic murmur
Describe the symptoms associated with aortic regurgitation?
Asymptomatic on presentation
SOB on exertion
Palpitations (regular)
Angina = late manifestation
O/E of a patient with aortic regurgitation describe five clinical findings?
De Musset's sign Corrigan's pulse (collapsing) Pistol shot femoral pulse De Quincke's sign Early diastolic murmur - best heard in inspiration
What is De Musset’s sign?
Rhythmic head bobbing with heart beat
What is pistol shot femoral pulses?
Loud cracking sound on auscultation over the femoral area
What is De Quincke’s sign?
Alternating flashing of the finger nails from pink to white
Name five causes for the development of AR?
Infective endocarditis Rheumatic fever Dilated aortic aneurysm (Marfan's) VSD Bicuspid valve prolapse
Name five causes of mitral regurgitation?
Post MI (dilation of LV) Dilated cardiomyopathy (dilation of LV) Rheumatic fever (early presentation) Infective endocarditis Mitral valve prolapse
Name three causes of mitral valve prolapse?
Idiopathic
Marfan’s syndrome (CT disorder)
Ehler’s Danlos syndrome (CT disorder)
What presentation and under what circumstances, would you get with acute mitral regurgitation?
Papillary muscle rupture (or chordae tendoneae) leading to frank pulmonary oedema
Describe the murmur of MR?
Pansystolic = radiates to the axilla
What symptoms and signs would you get with mitral valve prolapse syndrome?
SOB Syncope Atypical chest pain Palpitations MID-systolic click
Name the major causative agents for infective endocarditis?
Staphylococcus aureus
Streptococcus viridens
Name the major causative agents for rheumatic fever?
Streptococcus pyogenes (group A)
