Valvular Heart Disease Flashcards
What types if symptoms are characteristic of valvular heart disease?
Exertional symptoms
What is a tapping apex characteristic of?
Mitral stenosis
What could a displaced heaving apex be characteristic of?
- Left ventricular dilation (volume overload)
- LVH (pressure overload)
What does a parasternal heave indicate?
- Right Ventricular overload
- Cor pulmonale/pulmonary hypertension
What is a cardiac murmur?
Audible turbulence of blood flow
What are the six points when describing murmurs?
- Systole or diastole?
- What type?
- Where is it loudest?
- Where does it radiate to?
- What grade?
- Influenced by respiration?
What are the sound patterns of:
- Aortic stenosis
- Mitral regurgitation
- Aortic regurgitation
- Mitral stenosis
- Patent ductus arteriosus
What is the difference between ejection systolic and pan systolic?
What are the two types of diastolic murmur?
What type of murmur radiates to the carotids?
Aortic stenosis
What type of murmur radiates to the axilla?
Mitral regurgitation
What are the 6 murmur grades?
- I - Very Quiet
- II - Quiet - easy to hear
- III - Loud
- IV - Loud with thrill
- V - Very loud with thrill
- VI - Loud - audible without stethoscope
What type of murmurs are louder with inspiration?
Right sided
What is an innocent murmur?
- Soft (less than 3/6 severity)
- Position dependant
- Often early systolic (diastolic always pathological)
What is mixed valve disease?
- Both stenosis (valve not opening properly) and regurgitation (valve not opening or shutting properly)
What are the three main categories of cause of aortic stenosis?
- Degenerative (age related)
- Congenital (e.g. bicuspid valve)
- Rheumatic
What are the symptoms and signs of aortic stenosis?
- Breathlessness
- Chest Pain
- Presyncope/Syncope
- Low volume pulse
- Forceful displaced apex
- Ejection systolic murmur that can radiate to the carotids
What are the treatment options for aortic stenosis?
- Conventional valve replacement
- TAVI - trans catheter aortic valve replacement
- BAV - balloon aortic valvotomy
What are the two types of prosthetic valves, who gets them and why?
- Mechanical
- Longevity
- Warfarin
- Younger patients
- Bio-prosthetic
- No warfarin
- 10 years
- Older patients
Is AVR or TAVI preferred? Why and when would the less preferred be used?
- AVR
- Preferred as better long term outcomes
- No contraindications and can perform CABG also
- TAVI
- Co-morbidity
- Preferred if previous sternotomy
What are four causes of leaflet dysfunction in mitral regurgitation?
- Prolapse
- Rheumatic
- Myxamatous (floppy)
- Endocarditis
What can cause chordae rupture, papillary muscle rupture and annular dilation leading to mitral regurgitation?
- Chordae rupture - prolapse/flail leaflet
- Papillary muscle rupture - ischaemic
- Annular dilatation - functional/congenital
What are the symptoms and signs of mitral regurgitation?
- Breathlessness
- Peripheral oedema
- Fatigue
- Displaced apex
- Pansystolic murmur (radiating to the axilla)
What is the treatment of mitral regurgitation?
- Medication
- Diuretics and HF (ACEI)
- Surgical
- Repair - prolapse
- Replacement - degenerative
- Percutaneous
- Clips in infancy
What is the main (and rare) cause of mitral stenosis?
- Main - rheumatic
- Rare - congenital
What are the symptoms and signs of mitral stenosis?
- Breathlessness
- Fatigue
- Palpitations (AF)
- Malar flush
- Tapping apex
- Mid diastolic rumbling diastolic murmur localised to apex
What is the treatment of mitral stenosis?
- Medication
- Diuretics and treat AF
- Surgery
- Valve replacement
- Balloon valvuloplasty
What can damage leaflets and annulus leading to aortic regurgitation?
- Leaflets
- Endocarditis
- Connective tissue disease
- Rheumatic
- Annulus
- Marfans
- Aortic Dissection
What are the symptoms and signs of aortic regurgitation?
- Breathlessness
- Collapsing pulse
- Wide pulse pressure
- Displaced apex
- Early diastolic murmur left sternal edge
What is the treatment for aortic regurgitation?
- Medication
- ACEIs
- Surgery
- Valve replacement
