Valvular Heart Disease Flashcards
What causes aortic stenosis?
Congenital bicuspid vale
Age-related
Rheumatic heart disease
What are symptoms of aortic stenosis?
Often initially asymptomatic
Breathlessness, chest pain, dizziness/syncope on exertion
What are signs of aortic stenosis?
Slow rising pulse with narrow pulse pressure
Displaced apex beat
Ejection systolic murmur heart in the aortic area radiating to carotids and apex
What are investigations for aortic stenosis?
ECG - LVH
How is aortic stenosis treated?
Valve replacement surgery
TAVI
Balloon aortic valvotomy
What is a TAVI?
Trans-catheter aortic valve replacement
What causes mitral regurgitation?
Leaflets (rheumatoid, myxomatous degeneration, endocarditis)
Chordal rupture
Pipillary muscle ischaemia/infarction
Left ventricle enlargement
What are symptoms of mitral regurgitation?
Breathlessness
Ankle swelling
What are signs of mitral regurgitation?
Displaced and volume overload apex beat; soft S1
Pansystolic murmur maximal at the apex beat and radiating to axilla
What would be seen on CXR for mitral regurgitation?
Cardiomegaly
How do you treat mitral regurgitation?
Diuretics and ACEI
Surgery
Percutaneous mitral valve reapir, percutaneous clips in infancy
What causes mitral stenosis?
Mainly rheumatic
Rarely congenital
What are symptoms of mitral stenosis?
Dyspnoea
Fatigue
Palpitations (AF)
What are signs of mitral stenosis?
Malar flush
Tapping apex beat
Mid-diastolic murmur localised to apex
What are investigations for mitral stenosis?
AF on ECG
CXR - straight heart border
How can you treat mitral stenosis?
Diuretics and treat AF
Valve replacement
Balloon valvuloplasty
Outline a balloon valvuloplasty?
Blow balloon in calcified mitral valve
Palliative to reduce morbidity and hold-off surgery
What causes aortic regurgitation?
Leaflets (infective endocarditis, rheumatic disease)
Annulus (Marfan’s, acute aortic dissection)
What are symptoms of aortic regurgitation?
Breathlessness
Chest pain
Dizziness
What are signs of aortic regurgitation?
high volume collapsing pulse
Displaced apex
Early diastolic murmur at lower left sternal edge
Wide pulse pressure
How is aortic regurgitation treated?
ACEI/ARB, diuretic
Valve replacement
Parasternal heave is a sign of?
Left ventricular overload
Low volume pulse = ?
Aortic stenosis
Collapsing pulse = ?
Aortic regurgitation
Tapping Apex beat = ?
Mitral stenosis
What type of murmur does aortic stenosis have?
Ejection systolic murmur
What type of murmur does mitral regurgitation have?
Pansystolic murmur
What kind of murmur does aortic regurgitation have?
Diastolic
Diastolic murmurs are _____ pathological
always
Right sided murmurs are found with?
Inspiration
Valve stenosis =
Valves that don’t open properly
Valve regurgitation =
Valves that don’t close properly
