Valvular heart disease Flashcards
What are the signs of right heart failure?
Raised JVP
Pitting oedema
Hepatic congestion
What happens to the apex beat in mitral stenosis?
Tapping apex beat
What happens to the apex bear in left ventricular dilatation?
Displaced and diffuse
What happens to the apex beat in left ventricular hypertrophy?
Heaving and may be displaced
What does a left parasternal heave indicate?
Right ventricular overload
Cor pulmonale/pulmonary hypertension
What is a cardiac murmur?
Audible turbulence of blood flow
What is the first heart sound?
Mitral and tricuspid valve closing
Start of systole
What is the second heart sound?
Aortic and Pulmonary valve closing
Start of diastole
What are diastolic murmurs always?
Pathological
What are the types of systolic murmur?
Pansystolic
Ejection systolic
What are the types of diastolic murmur?
Early diastolic
Mid diastolic
Which murmur radiates to the carotid?
Aortic stenosis
Which murmur radiates to the axilla?
Mitral regurgitation
Which murmurs are influenced by respiration?
Right sided murmurs are louder with inspiration
What are the gradings of murmur severity?
I. Very quiet II. Quiet- easy to hear III. Loud IV. Loud with a thrill V. Very loud with a thrill
Describe an innocent murmur?
Soft (less than 3/6)
Position dependant
Often early systolic
What are the causes of mitral regurgitation?
Leaflets >prolapse >rheumatic >myxomatous >endocarditis
Chordae rupture (dengenerative) >prolapse, flail leaflet
Papillary muscle rupture
>ischaemia
Annular dilatation
>functional
What are the symptoms of mitral regurgitation?
Breathlessness
Peripheral oedema
Fatigue
What are the signs of mitral regurgitation?
Displaced apex
Pansystolic murmur radiating to the axilla
What are the treatments for mitral regurgitation?
Medication
>diuretics and heart failure (ACE)
Surgical
>repair- prolapse
>replacement- degenerative
Percutaenous
>clips in infancy
What are the causes of aortic stenosis?
Degenerative
Congenital e.g. bicuspid valve
Rheumatic
What are the symptoms of aortic stenosis?
Breathlessness
Chest pain
Dizziness/syncope
What are the signs of aortic stenosis?
Low volume pulse
Forceful displaced apex
ejection systolic murmur radiating to carotids
What are the treatment options of aortic stenosis?
Conventional valve replacement
Trans-catheter aortic valve replacement (TAVI)
Balloon aortic valvotomy
What are the types of valves used in aortic stenosis valve replacement?
Mechanical
- longevity
- warfarin
- younger patients
Bio-prosthetic
- no warfarin
- 10 years
- older patients
What are the benefits of AVR over TAVI?
Long term outcomes, no contra-indications.
TAVI has other co-morbities associated with it
What are the causes of aortic regurgitation?
Leaflets
>endocarditis
>connective tissue disease
>rheumatic
Annulus
>marfans
>aortic dissection
What are the symptoms of aortic regurgitation?
Breathlessness
What are the signs of aortic regurgitation?
Collapsing pulse
Wide pulse pressure
displaced apex
early diastolic murmur left sternal edge
What is the treatment for aortic regurgitation?
Medication
>ACE inhibitors
Surgery
>symptoms and LV dilatation
>Valve replacement
What are the causes of mitral stenosis?
Rheumatic
Rarely congenital
What are the symptoms of mitral stenosis?
Breathlessness
Fatigue
Palpitations AF
What are the signs of mitral stenosis?
Malar flush
Tapping apex beat
Mid diastolic rumbling localised to apex
What are the treatments of mitral stenosis?
Medication
-diuretics and treat AF
Surgery
-valve replacement
Balloon valvuloplasty
What other heart sounds can be present?
continuous murmurs
tricuspid regurgitation
pericardial rub
2nd sound splitting
third sound
fourth sound
systolic clicks
Describe valve stenosis?
Valves which do not open properly
Describe valve regurgitation?
Valves which do not close properly
Describe mixed valve disease?
Valves that neither open or close properly
