Valvular Heart disease Flashcards
What is mitral regurgitation?
Mitral valve. Regurgitation= valve doesn’t close fully due to increased stretch of papillary muscles.
Effect= BACKFLOW to pulmonary circulation
What is the main cause of Mitral regurgitation?
LV dilatation.
Some causes of LV dilatation?
- Remodelling post acute MI
- Dilated cardiomyopathy- ischaemic or non.
- Rheumatic fever
- Endocarditis
- Chordae tendineae
- Calcification
Signs + symptoms for M regurgitation?
- Symptoms
- Breathlessness
- Fatigue
- Pulmonary Oedema - Signs
- Displaced apex (axilla)
- Pan systolic murmur
Treatment for M regurgitation?
- Medication- Diuretics + ACE
- Surgical
Repair- prolapse
Replacement- degenerative - Percutaneous- infancy clip (fixes hole in heart).
What is mitral stenosis?
Tight mitral valve, which doesnt fully open.
Causes of mitral stenosis?
- Reumatic fever
- Endocarditis
Signs + Symptoms for mitral stenosis?
- Signs
- Malar flush
- Tapping apex beat
- Mid diastolic rumble. localised to apex. - Symptoms
- Breathlessness
- Fatigue
- Pulmonary oedema
- palpitations
What common heart disease can mitral stenosis be associated with?
Atrial fibrillation
Treatment for Mitral stenosis?
- Medication- diuretics, Treat AF
- Surgery- Valve replacement
- Percutaneous- balloon valvuloplasty (widening valve using balloon)
What is aortic stenosis?
Tight aortic valve, doesn’t fully open.
Main causes for aortic stenosis?
- Congenital- Bicuspid instead of tricuspid
- Age related Calcification
- Rheumatic fever
What are the signs and symptoms of it?
- Signs
- Low volume pulse
- Forceful displaced apex
- Ejection systolic murmur, radiates to carotids. - Symptoms
S-syncope
A-angina
D-dyspnoea
Treatment for aortic stenosis?
- Medical- diuretics + angina treatment
- Surgical- Valve replacement
- Percutaneous- balloon valvuloplasty
What is aortic regurgitation?
Aortic valve doesnt properly close. Backflow of blood into LV
Causes of aortic regurgitation?
- Widening/ aneurysmal change of aortic annulus
- Endocarditis
- Rheumatic fever
Signs and symptoms of aortic regurgitation
- Signs
- Collapsing pulse
- Displaced apex
- Early diastolic murmur, left sternal edge. - Symptoms
- Breathlessness
- Syncope/dizziness
- Fatigue
Treatment for aortic regurgitation?
- Medication- ACE
2. Surgery- Valve replacement.
Most common symptoms related to valvular disease?
- Chest pain
- Dizziness
- SOB.
Exertional symptoms v common.
What are the main clinical signs of Right sided heart failure?
- Raised JVP
- Pitting oedema
- Hepatic congestion
How does one characterise pitting oedema?
Indentation left after applying pressure to skin.
Common areas- ankles, sacrum
What is a cardiac murmur?
Audible turbulence in blood flow.
Checklist to go through when hearing murmurs.
need to memorise this.
- Systolic or diastolic
- Type of murmur.
- Where is it loudest
- Radiating? if yes where to? (either carotid or axilla)
- Grade of murmur.
In relation to heart sounds, when are systolic murmurs heard?
Between 1st and 2nd heart sound.
What are the two types of systolic murmurs?
- Ejection- starts quiet, then big sound, then dies down (sidewards diamond shape)
- Pan systolic- same sound frequency throughout murmur.
What are the two types of diastolic murmurs?
- Early
2. Mid
What are the grades for murmurs?
1- very quiet 2- quiet, easy to hear 3- Loud 4- Loud + thrill 5- V loud + thrill 6- Audible without stethoscope
How does inspiration affect murmurs? (L&R)
Right sided murmurs louder on inspiration
What are the auscultatory sounds for the common murmurs?
- Aortic stenosis- 2nd sound splitting
- Aortic regurgitation- Third sound
- Mitral stenosis- 4th sound
- Mitral regurgitation- pericardial rub
What are the common systolic/ diastolic murmurs?
- Systolic
- Aortic stenosis: ejection systolic
- Mitral regurgitation: pan systolic - Diastolic
- Atrial regurgitation: early diastolic
- Mitral stenosis: mid diastolic
