Valvular Heart Disease Flashcards
What is mitral regurgitation?
Backflow though the mitral valve during systole
What are causes of mitral regurgitation?
Functional - LV dilatation Annular calcifcation Rheumatic fever Infective endocarditis Ruptured cord tendinae Papillary muscle dysfunction/rupture (post MI) CT disorders Cardiomyopathy Congenital
What are symptoms of mitral regurgitation
Dyspnoea, fatigue, palpitations, symptoms of cause (fever etc)
What are signs of mitral regurgitation?
Pansystolic murmur at apex
Radiates to axilla
AF
Displaced hyperdynamic apex due to dilated LV
How do you manage mitral regurgitation?
Control rate if AF fast
Anticoagulate if AF, history of embolism, prosthetic heart valve, mitral stenosis.
Diuretics
Surgery
What is mitral prolapse? Symptoms and signs?
Inversion of mitral valve
Mid-systolic click or late systolic murmur
What is mitral stenosis? Causes?
Narrowing of the mitral valve Rheumatic fever Congenital Prothetic valve Tumour
What are signs of mitral stenosis?
Mid diastolic murmur (rumbling) heard best in expiration with patient on left side (ROLL) Opening snap Malar flush on cheeks due to reduced CO Low volume pulse AF Tapping, non-displaced apex beat RV heave
How do patients with mitral stenosis present?
Pulmonary hypertension causes dyspneaa, haemoptysis, chronic bronchitis, pressure from large left atrium on local structures:
Hoarseness (RLN)
Dysphagia (oesophagus)
Bronchial obstruction
Fatigue, palpitations, chest pain, systemic emboli, IE
How is mitral stenosis managed?
Rate control if in AF Anticoagulate with warfarin Diuretics to reduce preload and pulmonary congestion Balloon valvuloplasty Valve replacement
What is aortic stenosis? Causes?
Narrowing of aortic valve Degenerative calcification Bicuspid aortic valve William's syndrome (supravalvular aortic stenosis Rheumatic heart disease
How does AS present?
Chest pain
Exertional Dyspnoea
Syncope
What are signs of AS?
Ejection systolic murmur at left steal edge, aortic area and radiates to carotids
Slow rising pulse with narrow pulse pressure - parvus et tardus carotid upstroke - diminished and delayed
Soft absent S2
S4
LV heave
Aortic thrill
Non-displaced apex beat
What are Ddx for AS?
Hypertrophic obstructive cardiomyopathy
Aortic sclerosis - senile degeneration of valve (no carotid radiation and normal pulse)
How is AS managed?
If symptomatic Valve replacement
TAVI transcatheter aortic valve implantation if not fit for surgery with critical aortic stenosis
What is aortic regurgitation?causes?
Backflow through aortic valve
Valve disease: rheumatic fever, IE, CT disease - SLE, bicuspid aortic valve
Aortic root disease: aortic dissection, spondyloarthropathies, hypertension, syphilis, Marfan’s/ED
Symptoms of AR?
Exertional dyspnoea
Orthopnoea - breathlessness lying flat so use lots of pillow
Paroxysmal nocturnal dyspnoea - night breathlessness
Signs of AR?
Early diastolic murmur (high pitched, heard best in expiration with patient sat forward)
Collapsing (water hammer) pulse
Wide pulse pressure
dIsplaced apex beat
Corrigan’s signs - carotid pulsation
de Musset’s sign - head nodding with each heart beat
Quincke’s sign - capillary pulsation in nail beds
Severe - Austin flint murmur - mid diastolic
Management of AR?
Reduce systolic hypertension - ACEi
Echo every 6-12 months
Severe AR with enlarged ascending aorta, increased symptoms, enlarging LB or refractory IE –> surgery valve replacement
What is the diagnostic test for all valvular heart disease?
Echocardiography
What does a continuous machine-like murmur indicate?
Patent ductus arteriosus
What does an ejection systolic murmur indicate?
Aortic stenosis
Radiates to carotids
slow rising pulse - narrow pulse pressure
What does a holosystolic/pansystolic murmur indicate?
Mitral regurgitation
radiates to axilla
What does a late systolic murmur indicate?
Mitral valve prolapse
+ mid-systolic click
What does an early diastolic murmur indicate?
Aortic regurgitation
Best heard on expiration with patient sat forward
Collapsing pulse - wide pulse pressure
What does a mid-late diastolic murmur indicate?
Mitral stenosis
On expiration, Patient roll on left hand side
