valvular heart disease Flashcards
what is the clinical history of valvular heart disease?
- chest pain
- breathlessness
- collapse / dizzy spells
what does cardiac chest pain feel like?
- gripping
- squeezing
- heavy
- crushing
describe cardiac breathlessness?
- related to activity (usually)
- often associated with ankle swelling
- orthopnoea = SOB on lying flat
- paroxysmal nocturnal dyspnoea (PND)
what are the NYHA classifications?
1 = no limitation 2 = slight limitation of ordinary activity 3 = marked limitation of less than ordinary activity 4 = severe limitation of minimal activity or at rest
what are the signs of right sided heart failure?
- raised JVP
- pitting oedema
- hepatic congestion
how do you examine the apex beat?
- normally in 5th interostal mid clavicular line
- tapping apex beat = mitral stenosis
- displaced and diffuse in left ventricular dilation (volume overload)
- heaving and may e displaced in left ventricular hypertrophy (pressure overload)
where is parasternal heave felt and why is it present?
- hand left of sternum
- right ventricular overload = cor pulmonale/pulmonary hypertension
what are the steps used in order to describe a murmur?
- systole / diastole
- what type of murmur
- where is it loudest
- where does it radiate to
- what grade of murmur
- influenced by respiration?
how to work out if it is systolic or diastolic?
- 1st heart sound = mitral and tricuspid valve closing, start of systole
- 2nd heart sound = aortic and pulmonary valves closing, start of diastole
what are the types of systolic murmurs?
- pansystolic
- ejection systolic
what are the types of diastolic murmurs?
- early diastolic
- mid diastolic
what are the grades of murmurs?
I = very quiet II = quiet - easy to hear III = loud IV = loud with a thrill V = very loud with a thrill VI = loud - audible without a stethoscope
which sided murmur is louder on inspiration?
- right-sided
what is an innocent murmur?
- soft (less than 3/6 severity)
- position dependent
- often early systolic (diastolic murmurs always pathological)
what happens in valve stenosis?
- valves do not open properly
what happens in valve regurgitation?
- valves which do not close properly
what happens in mixed valve disease?
- valves which neither open properly nor close properly
what is aortic stenosis?
- degenerative (age related)
- become calcified restricting the opening of the valve
- congenital (eg 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 that can radiate to the carotids
what may an ECG show for aortic stenosis?
- LVH
but this does not diagose it
how do you treat aortic stenosis?
- conventional valve treatment
- trans catheter aortic valve replacement (TAVI)
- balloon aorticvalvotomy (BAV)
what types of prosthetic heart valves can you get?
- mechanical = longevity, warfarin required for prevention of clots within the valve, better for younger patients
- bio-prosthetic (tissue valve) = no warfarin required, last 10 years, better for older patients
what are the differences between aortic valve replacement and transcatheter valve implantation?
AVR = preferred, long term outcomes, no contra-indications, CABG as well TAVI = co-morbidity, previous sternotomy
