Valvular Heart Disease Flashcards
Clinical History of Valvular heart disease
Cardiac chest pain, breathlessness, collapse, dizzy spells Exertional symptoms
What particular type of breathlessness is related to valvular heart disease
Orthopnea- breathless lying down Paroxysmal Nocturnal dyspnoea- waking up SOB
What is a useful question to ask about when gauging the level of SOB
How many pillows do you use? More pillows the worse orthopnea
Right sided heart failure
raised JVP, pitting oedema, hepatic congestion
Parasternal Heave
left of sternum placed vertically right ventricular overload
Causes of parasternal heave
Cor pulmonale, pulmonary hypertension
Six questions for assessing an murmur
Systole or Diastole What type? Where is it located? Where does it radiate too? What grade is it? Is it influenced by inspiration?
How does the grading for murmurs work?
Grade 1- very quiet Grade 6- audible without a stethoscope Grade 4+ - murmur accompanied by a thrill
Which murmur is affected by respiration?
Right sided murmurs are louder on inspiration
Left sided murmurs are louder on expiration
What causes a constant murmur?
A patent ductus arteriosus
Describe an innocent murmur?
Soft less than a 3 Very localised with no radiation
Symptoms of Aortic stenosis
Breathless
Increased fatigue
Chest pain
Dizziness
Signs of aortic stenosis
Low volume pulse
Forceful displaced apex
High pressure gradient between ventricle and aorta
My show large ST complex due to hypertrophy V1-V6
Murmur of aortic stenosis
Ejection systolic murmur
Rdaiates to the carotids
Treatment for aortic stenosis
Valve replacement
Trans catheter aortic valve replacment
baloon aortic valvotomy
Benefits of mechanical valve replacement in aortic stenosis
Infinite lifespan
Often in younger patients
Benefits of bio prosthetic valve replacement in aortic stenosis
No warfirin required
Better for older patients
Causes of mitral regurgitation
Prolapse, Rheumatic, Myxomatous (floppy), endocarditis
Name a degenerative cause of mitral regurgitation
Chordae rupture
Name an ischaemic cause of mitral regurgitation
Papilliary muscle rupture
Symptoms of mitral regurgitation
Breathlessness
Peripheral oedema
Fatigue
Signs of mitral regurgitation
Displaced apex
Pansystolic murmur
What medication would you give for mitral regurgitaion
Diuretics and ARB and ACE inhibitors
Surgical options for mitral regurgitation
Prolapse- Repair
Degeneration- Replacement
Infancy- percutaneous clip attatchment
Mitral Stenosis
Main cause is essentially rheumatic
Congenital is rare
Symptoms of mitral stenosis
Atrial fibrillation- atria dilates as pressure builds up as increased volume stored in atria
SOB
Fatigue
Symptoms of mitral stenosis
Mallar flush- plum red cheeks due to CO2 retention
Tapping apex beat
Murmur associated with mitral stenosis
Mid diastolic rumbling murmur localised to the apex beat
Medication for mitral stenosis
Treat the atrial fibrilation - anticoagulants, Beta blockers Ca2+ channel blockers
Diuretics
Aortic regurgitation causes
Endocarditi,connective tissue diseases, rheumatic, marfans, aortic dissection
Signs or aortic regurgitation
Collapsing pulse
Wide pulse pressure
Displaced Apex
Murmur associated with aortic regurgitation
Early diastolic murmur
Located at left sternal edge
Treatment for Prosthetic valve infection
Gentamicin+ Vancomycin IV
Add rifiampacin 3-5 days later
Often valve replacement
Treatment for native valve endocarditis
Amoxycillin + gentamicin IV
Usually Viridans Streptococci
Treatmant for drug user endocarditis
Flucloxacillin IV
Subacute Presentation of infective endocarditis
Clubbing
Splinter haemorrhage
New Murmur
Fever
Fatigue
Roth spots
