Valvular Heart Disease Flashcards
what type of symptoms are characteristic of cardiac/ valvular heart disease
exertional symptoms
- chest pain
- breathlessness/ SOB
- collapse/ dizzy spells
what is a stabbing chest pain more likely to be
pleuritic
describe cardiac chest pain
gripping, squeezing, heavy, crushing
why is ankle swelling common associated with breathlessness
if Ls of heart fails and there is a back pressure in lungs the RS of the heart will failure leading to ankle oedema
what is orthopnoea and why does it happen
breathlessness when lying flat
effect of gravity increases pressure in the lung worsening SOB
what is PND and how does it happen
paroxysmal nocturnal dyspnoea- when patient wakes struggling to breath in the middle of the night
what does the new york heart association of functional classification describe
gradient based on activity 1= no limitation 4= severe limitation
what are the signs of right heart failure
raised JVP, pitting oedema, hepatic congestion (because of back pressure in systemic system)
what are the signs of left heart failure
basal crepitations, pulmonary oedema, SOB
what does the JVP estimate
right arterial pressure
where does pitting oedema occur
ankles and sacrum (in bed ridden patients)
where is the apex beat normally
5th intercostal space/ mid clavicular line
what can cause a tapping apex beat
mitral stenosis
what can cause a displaced and diffuse apex beat
left ventricular dilatation (volume overload)
what is a diffuse apex beat
when the apex beat can be felt equally with four or more fingers or in more than one intercostal space
what can cause left ventricular hypertrophy
hypertension and aortic stenosis
what is felt at the apex beat in left ventricular hypertrophy
heaving and maybe displaced
where do you feel for a parasternal heave
hand left of sternum
what can cause a parasternal heave
right ventricular overload e.g. cor pulmonale/ pulmonary hypertension
what is a cardiac murmur
audible turbulence of blood flow
what is an innocent murmur
increased flow causing turbulence in right ventricular outflow tract
what causes a pathological murmur
structural cardiac abnormalities
where do you auscultate the aortic valve
2nd- 3rd right intercostal space
where do you auscultate the pulmonary valve
2nd-3rd left intercostal space
where do you auscultate the tricuspid valve
left sternal border
where do you auscultate the mitral valve
apex
what creates the first heart sound
mitral and tricuspid valve closing
what does the first sound signify in the heart cycle
start of systole
what creates the second heart sound
aortic and pulmonary valves closing
what does the second sound signify in the heart cycle
start of diastole
what murmur is a diamond shape in a phenocardiogram
mitral stenosis
describe a pansystolic murmur
same volume throughout systole
describe an ejection systolic murmur
crescendo decrescendo-rises slowly then falls quickly- late peaking
what type of murmur coincides with the pulse
systolic murmurs
what are the characteristics of an innocent murmur
soft mid systolic, heard in pulmonary area, localised, no radiation, no other symptoms
what causes the physiological splitting of the 2nd heart sound
inspiration causes a drop in intrathoracic pressure resulting in increased venous return to RHS of the heart. this increased volume prolongs RV ejection time hence the pulmonary component of the second heart sound may be delayed behind the aortic during inspiration
in splitting of 2nd heart sound which is louder
first (aortic) louder than second (pulmonary)
where is the splitting of the 2nd heart sound best heart
pulmonary area- in the second intercostal space at the sternal border
what causes a third heart sound and when is it heard
caused by acceleration and deceleration of blood flow during early passive filling of the ventricle
an low frequency early diastolic sound, occurs immediately after 2nd hs
where is a third heart sound best heard
at the apex with the bell
what does a 3rd heart sound mean
can be physiological or pathological (usually LV systolic dysfunction)
describe the 4th heart sound and when it is heard
low frequency lat diastolic filling sound
occurs shortly before 1st heart sound
what causes the 4th heart sound
atrial contraction causing rapid flow into a stiff/ less compliant ventricle
when conditions can cause a 4th heart sound
myocardial ischaemia, hypertension, aortic stenosis
where are 4th heart sounds best heard
at the apex with the bell of the stethoscope
can diastolic murmurs be physiological
no always pathological
what murmur radiates to the neck (carotids)
aortic stenosis
what murmur radiates to the axilla
mitral regurgitation
describe mitral stenosis murmur
mid diastolic, rumbling, crescendo decrescendo
what are the two types of diastolic murmur
early and mid
what does the grading of murmurs describe
loudness
I-very quite
VI- audible without a stethoscope
what is a IV murmur
loud with a thrill
what is a V murmur
very loud with a thrill
how are right sided murmurs different from left sided murmurs
right sided murmurs are louder with inspiration
what causes valve stenosis
valves that do not open properly
what causes valve regurgitation
valves which do not close properly
what is mixed valve disease
when the valves neither open or close properly
what can cause aortic stenosis
degenerative (age related, most important),
congenital (presents earlier- bicuspid aortic valve),
rheumatic
what are the symptoms of aortic stenosis
breathlessness, chest pain (mimicking angina), dizziness/ syncope (CO insufficient)
what are the clinical signs of aortic stenosis
low volume pulse, forceful displaced apex, ejection systolic murmur that radiates to the carotids
how is aortic stenosis shown on an ECG
tall r waves- LVH signs
how is aortic stenosis treated
valve replacement: open heart surgery (preferred), trans catheter
balloon aortic valvotomy
medication will NOT help
what types of prosthetic heart valves are there
mechanical (lasts longer but needs warfarin
bio-prosthetic (no warfarin)
what can cause mitral regurgitation
leaflets
- prolapse
- rheumatic
- myxomatous (floppy)
- endocarditis
chordae rupture (degenerative) -prolapse/ fail leaflet
papillary muscle rupture
-ischaemic
annular dilatation
-functional
what are the symptoms of mitral regurgitation
breathlessness (back pressure in lungs), peripheral oedema, fatigue (heart failure, lack of tissue perfusion)
what are the clinical signs of mitral regurgitation
displaced apex, pansystolic murmur (radiating to the axilla)
where is mitral regurgitation best heard
mitral area
how is mitral regurgitation treated
medications- diuretics and ACE inhibitors (for heart failure)
surgical- repair (prolapse), replacement (degenerative)
percutaneous clips in infancy
what causes mitral stenosis
rheumatic (main cause), congenital (main cause)
what are the symptoms of mitral stenosis
breathlessness (back pressure in the lungs), fatigue, palpitations (AF)
what are the clinical signs of mitral stenosis
malar flush, tapping apex beat, mid diastolic rumbling murmur localised to apex
how is mitral stenosis best heard
with bell of stethoscope with patient in left lateral position
how does mitral stenosis cause AF
The pressure buildup of mitral valve stenosis results in enlargement of your heart’s upper left chamber which leads to AF
what can be seen on a CXR of a patient with mitral regurgitation
cardiomegaly
what can be seen on a CXR of a patient with mitral stenosis
straight left heart border
how is mitral stenosis treated
medications- diuretics and treatment for AF
surgery- valve replacement
balloon valvuloplasty
briefly describe the process of balloon valvuloplasty in mitral stenosis
balloon passed through the mitral valve and the blown up
what can cause aortic regurgitation
leaflets;
- endocarditis
- connective tissue disease
- rheumatic
annulus (dilation of the proximal aorta)
- marfans
- aortic dissection
what are the symptoms of aortic regurgitation
breathlessness (congestion of the lungs)
what are the clinical signs of aortic regurgitation
collapsing pulse, wide pulse pressure (large end diastolic volume), displaced apex, early diastolic murmur at left sternal edge
what can be seen on a CXR of a patient with aortic regurgitation
cardiomegaly
how is mitral regurgitation treated
medication- ace inhibitors
surgery- valve replacement, treat symptoms and LV dilatation
