Valvular Heart disease Flashcards
when are symptoms of valvular heart disease shown?
on exertion
= exertional symptoms
what are symptoms of valvular heart disease?
1) chest pain
- gripping
- squeeing
- heavy
- crushing
2) breathlessness
3) collapse
4) dizzy spells
= exertional symptoms
what 4 things is cardiac breathlessness associated with?
1) related to activity
2) associated with ankle swelling
3) orthopnoea (SOB when lying flat)
4) paroxysmal Nocturnal dyspnoea (PND) = waking from sleep unable to breathe
what is used for functional classification?
Class I = no limitation
Class II = slight limitation on ordinary activity
Class III = mark limitation of less than ordinary activity
Class IV = severe limitation of minimal activity
what are 3 signs of right heart failure?
1) raised JVP
2) pitting oedema
- ankles or sacrum
3) hepatic congestion
what would the apex beat be in mitral stenosis?
= tapping apex
when would the apex beat be displaced and diffused?
= In left ventricular dilation (volume overload)
when would the apex beat be heaving and displaced?
= in left ventricular hypertrophy (pressure overload)
where would you find a parasternal heave?
= hand of left sternum
what would a parasternal heave show?
= right ventricular overload
- cor pulmonale/pulmonary hypertension
what is a cardiac murmur?
= audible turbulence of blood flow
- can be innocent & pathological
what 6 questions should you cover when describing cardiac murmurs?
1) systole or diastole?
2) what type of murmur?
3) where is it loudest?
4) where does it radiate to?
5) what grade of murmur?
6) (influenced by respiration)?
how would you know if the murmur is in systole or diastole?
1st heart sound
= start of systole
= mitral & tricuspid closing
2nd heart sound
= start of diastole
= aortic & pulmonary closing
when is aortic stenosis heard?
systole
when is mitral regurgitation usually heard?
systole
when is aortic regurgitation usually heard?
diastole
when is mitral stenosis usually heart?
diastole
what are the 2 types of systolic and diastolic murmur?
Systolic
1) pan systolic
2) ejection systolic
Diastolic
1) early diastolic
2) mid diastolic
what 2 areas might the murmurs radiate to?
1) carotids (aortic stenosis)
2) axilla (mitral regurgitation)
describe the grading of murmurs?
1) very quiet
2) quiet
3) Loud
4) loud with a thrill
5) very loud with a thrill
6) loud = audible without a stethoscope
when are right sided murmurs louder?
louder with inspriation
what could aortic stenosis cause to heart sounds?
2nd sound splitting
what sound could also be heard in aortic regurgitation?
= 3rd sound
what is an innocent (functional) murmur?
= soft (less than 3/6severity)
= position dependent
- often early systolic
what are diastolic murmurs always?
always pathological
what are 3 types of valvular heart disease?
1) valve stenosis
2) valve regurgitation
3) mixed valve disease
what is valve stenosis?
= valves which don’t open properly
what is valve regurgitation?
= valves which don’t close properly
what is mixed valve disease?
= valves which neither open properly nor close properly
what would you find in the history and physical examination in a patient with valvular disease?
History
= restriction & functional capacity
Physical examination
= murmurs & signs of heart failure
what investigations should be done if you suspect valvular heart disease?
1) non-invasive
= echo
2) invasve
= catheter cauterisation
what are 3 characteristics of AORTIC STENOSIS?
= degenerative (age related)
= congenital (e.g. bicuspid valve)
= rheumatic
what are symptoms of AORTIC STENOSIS?
1) breathlessness
2) chest pain
3) dizziness/syncope
ON EXERTION
what are signs of AORTIC STENOSIS?
1) low volume pulse
2) forceful displaced apex
3) ejection systolic murmur that can radiate to carotids
what 3 things can you do to treat AORTIC STENOSIS?
1) conventional valve replacement
2) trans-catheter aortic valve replacement (TAVI)
or
trans-catheter aortic valve insertion (TAVI)
3) balloon aortic valvotomy (BAV)
what are the 2 types of prothetic heart valves used in AORTIC STENOSIS?
1) mechanical
- lasts longer
- younger patients
- warfarin (patient will need anti-coagulants)
2) bio-prosthetic (tissue valves)
- 10 years lifespan
- older patients
- no warfarin
compare aortic valve replacement (AVR) to trans-catheter aortic calc insertion (TAVI) used in AORTIC STENOSIS?
AVR
- preferred
- long term
- no contra-indications
- CABG as well
TAVI
- co-morbidity
- previous sternotomy
what are 4 causes of MITRAL REGURGITATION?
1) leaflets
2) chord rupture (degenerative)
3) papillary muscles rupture
4) annular dilatation
what are the causes of leaflets in MITRAL REGURGITATION?
- prolapse
- rheumatic
- myxomatous
- endocarditis
what is the cause of chord rupture in MITRAL REGURGITATION?
- prolapse/flail leaflets
what is the cause of papillary muscles rupture in MITRAL REGURGITATION?
= ischaemic
what is the cause of annular dilatation in MITRAL REGURGITATION?
= functional
what are the symptoms of MITRAL REGURGITATION?
- breathlessness
- peripheral oedema
- fatigue
what are the signs of MITRAL REGURGITATION?
- displaced apex
- pan systolic murmur
= axilla
what are the 3 options to treat MITRAL REGURGITATION?
1) Medication
- diuretics & heart failure (ACE inhibitors)
2) surgical
- repair = prolapse
- replace = degenerative
3) per-cutaneous
- clips in infancy
what is the main cause of MITRAL STENOSIS?
= rheumatic is main cause
- congenital is rare
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 diastolic murmur localised to apex
how could you treat mitral stenosis?
1) medication
= diuretics & treat AF
2) surgery
= valve replacement
3) balloon valvuloplasty
= widens the mitral valve so that blood flows more easily through the heart
what are the causes of AORTIC REGURGITATION?
1) leaflets
2) annulus
what causes leaflets in AORTIC REGURGITATION?
- endocarditis
- connective tissue diseases
- rheumatic
what causes annulus in AORTIC REGURGITATION?
- marfans
- aortic dissection
what are then 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
how would you treat AORTIC REGURGITATION?
1) medication
= ACE inhibitors
2) surgery
= symptoms and LV dilatation
= valve replacement
