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Y4 Cardiology > Valvular heart disease > Flashcards

Valvular heart disease Flashcards

1
Q

What produces the 1st heart sound and what does it signify in terms of the cardiac cycle ?

A
  • Mitral and tricuspid valve closing
  • Start of systole
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2
Q

What produces the 2nd heart sound and what does it signify in terms of the cardiac cycle ?

A
  • Aortic and pulmonary valves closing
  • Start of diastole
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3
Q

Go over the cardiac ascultation positions

A
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4
Q

When describing a murmur what are the 6 things you need to discern ?

A
  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. Is it influenced by respiration?
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5
Q

What murmur radiates to the carotids ?

A

Aortic stenosis

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6
Q

What murmur radiates to the axilla ?

A

Mitral regurgitation

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7
Q

What is meant by a pansystolic murmur ?

A
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8
Q

What is meant by an ejection systolic murmur ?

A
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9
Q

What is meant by an early diastolic murmur ?

A
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10
Q

What is meant by a mid-diastolic murmur ?

A
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11
Q

How are murmurs graded ?

A
  • 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
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12
Q

What does it tell you if a murmur is louder with inspiration ?

A

Right-sided murmurs are louder with inspiration

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13
Q

What is an innocent (functional) heart mumur?

A

They are harmless sounds made by the blood circulating normally through the heart’s chambers and valves or through blood vessels near the heart.

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14
Q

Who are innocent heart murmurs common in ?

A

Infants/children (often have dissapeared by adulthood)

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15
Q

What are the characterisitics suggestive of an innocent murmur ?

A
  • Soft (less than 3/6 severity)
  • Position dependent (vary with posture)
  • Often early systolic
  • localised with no radiation
  • No diastolic component
  • No thrill or added sounds (e.g. clicks)
  • Asymptomatic child
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16
Q

What is a useful mnemonic for remembering the basic murmurs ?

A

MRS ASS

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17
Q

List the ejection systolic murmurs

A

aortic stenosis pulmonary stenosis, hypertrophic obstructive cardiomyopathy atrial septal defect, tetralogy of Fallot ‘Think aortic stenosis and pulmonary stenosis as ejection systolic because during systole the ventricles contract and blood is pumped through these 2 valves so if stenosis there will get a murmur’

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18
Q

List the pansystolic (holosystolic) murmurs

A

mitral/tricuspid regurgitation (high-pitched and ‘blowing’ in character) ventricular septal defect (‘harsh’ in character) ‘Think mitral and tricuspid regur as pansystolic as when the ventricles contract during systole if these valves are not adequate then there will be regurgitation of blood back through them instead of all the blood flowing normally through either the aortic or pulmonary valves’

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19
Q

List the late systolic murmurs

A

mitral valve prolapse coarctation of aorta

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20
Q

List the early diastolic murmurs

A

aortic regurgitation (high-pitched and ‘blowing’ in character) Graham-Steel murmur (pulmonary regurgitation, again high-pitched and ‘blowing’ in character) ‘think aortic and pulmonary regur as end diastolic due to once blood contracted in systole as passed through these valves if there is incompetency then blood flows back through them which is during diastole as systole has already happened ==> think end diastolic murmur’

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21
Q

List the mid-late diastolic murmurs

A

mitral stenosis (‘rumbling’ in character) Austin-Flint murmur (severe aortic regurgitation, again is ‘rumbling’ in character) ‘think mitral stenosis as

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22
Q

What gives a continuous machine like murmur ?

A

patent ductus arteriosus

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23
Q

What are the main symptoms of aortic stenosis ?

A
  • Chest pain
  • Dysponea
  • Syncope/dizziness
24
Q

What are the signs of aortic stenosis ?

A
  • Ejection systolic murmur that can radiate to the carotids
  • Low volume pulse (slow-rising)
  • Forceful displaced apex
  • Left ventricular hypertrophy or failure
25
Q

What are the main causes of aortic stenosis ?

A
  • Degenerative calcification (most common cause in older patients > 65 years)
  • Bicuspid aortic valve (most common cause in younger patients < 65 years)
  • Rheumatic heart disease may also cause it
26
Q

How is aortic stenosis diagnosed ?

A

Doppler echo

27
Q

What is the treatment of asyptomatic aortic stenosis ?

A
  • 1st line = Observation
  • Unless valvular gradient on echo is > 40mmHg + with features such as LVSD then surgery is considered
28
Q

What is the treatment of symptomatic aortic stenosis ?

A

Valve replcaement via either:

  1. Surgical aortic valve replacement (SAVR) - done in the younger patients with less co-morbidities as it has better long-term outcomes
  2. Transcatheter aortic valve replacement (TAVI) - done if patient is older, higher risk with co-morbidities
29
Q

What is the choice of prosthetic heart valve replacement available & why is each chosen ?

A
  1. Mechanical (metal) - used in younger patients as they last longer. Long-term warfarin is needed however
  2. Bio-prosthetic (e.g. pig or cadaveric) - last less time (10years) ==> used in older patinets. Doesnt require warfarin use
30
Q

When are balloon aortic valvuloplasties (BAV) used to treat patients with aortic stenosis ?

A

In patients with critical AS who are not fit for valve replacement

31
Q

What are the risk factors for the development of mitral regurigtation ?

A
  • Female sex
  • Lower body mass
  • Age
  • Renal dysfunction
  • Prior myocardial infarction
  • Prior mitral stenosis or valve prolapse
  • Collagen disorders e.g. Marfan’s Syndrome and Ehlers-Danlos syndrome
32
Q

What are the main causes of MR?

A
  • Following coronary artery disease or post-MI (if papillary muscles or chordae tendinae are ruptured)
  • Mitral valve prolapse
  • Infective endocarditis
  • Rheumatic fever
  • Congenital
33
Q

What are the consequences of MR ?

A

Can eventually develop into heart failure

34
Q

What are the characteristic features of MR ?

A
  • Fatigue
  • Dysponea
  • Peripheral oedema

i.e. more of heart failure

35
Q

What are the clinical signs of MR?

A
  • Pansystolic ‘blowing’ murmur radiating to the axilla
  • Displaced apex beat
36
Q

On CXR what may be seen in someone with MR ?

A

Cardiomegaly

37
Q

What is used to defintivley diagnose & grade the severity of MR ?

A

Echo

38
Q

What is the treatment of MR ?

A

If in HF then treat the heart failure with ACEi + Beta-blocker + spironolactone (i.e. normal HF treatment)

  • Surgical repair if caused by prolapse
  • Surgical replacement (mechanical or bi-prosthetic) if caused by degenerative changes
39
Q

What is the primary cause of mitral stenosis ?

A
  • Rheumatic fever!​
  • Congenital is rare
40
Q

What are the symptoms of MS ?

A
  • Dysponea
  • Fatigue
  • Palpitations (AF)
41
Q

What are the clinical signs of MS ?

A
  • Malar flush (on cheeks)
  • AF common
  • Tapping apex beat
  • Mid-diastolic ‘rumbling’ murmur localised to the apex (heard best during expiration i.e. right vs left sided murmurs)
42
Q

What may be seen on CXR in someone with MS ?

A

Left atrial enlargement

43
Q

What is used to definitivley diagnose MS?

A

Echo

44
Q

What is the treatment of MS?

A

If in AF then treat the AF + diuretics

2nd line = if failure to control symptoms then either valve replacement or BAV done

45
Q

How do mitral valve prolapses occur ?

A

Occur alone or in association with:

  • Congenital HD - ASD, PDA
  • Cardiomyopathy
  • Turner’s syndrome
  • Marfan’s syndrome, Fragile X
  • osteogenesis imperfecta
  • pseudoxanthoma elasticum
  • Wolff-Parkinson White syndrome
  • long-QT syndrome
  • Ehlers-Danlos Syndrome
  • polycystic kidney disease
46
Q

What are the clinical symptoms of mitral valve prolapse ?

A

Often asymptomatic but if symptomatic mainly:

  • Atypical chest pain & palpitations +/- some aptients have anxiety, panic attacks or syncope
47
Q

What are the signs of mitral valve prolapse ?

A

Mid-systolic click &/or late systolic murmur

48
Q

What complications of mitral valve prolapse may develop?

A
  • MR
  • Cerebral emboli
  • Arrhythmias
  • SCD
49
Q

How is mitral valve prolapse diagnosed ?

A

Echo

50
Q

What is the treatment of mitral valve prolapse ?

A
  • Beta-blocker for palpitations & chest pain
  • If severe MR develops then surgery needed
51
Q

What are the causes of aortic regurgitiation ?

A
  • Acute = Infective endocarditis, aortic dissection, chest trauma
  • Chronic = congenital, connective tissue disorders (marfans, ehler danlos), rheumatic fever, RA, SLE
52
Q

What are the symptoms of AR?

A
  • Dysponea
  • Orthoponea
  • Paroxysmal nocturnal dysponea

i.e. breathlessness is the main one

53
Q

What are the signs of AR?

A
  • Early diastolic murmur at the left sternal edge
  • Collapsing pulse
  • Wide pulse pressure
  • Displaced apex beat
54
Q

What may be seen on CXR in AR?

A

Cardiomegaly

55
Q

What is used to diagnose & assess the severity of AR?

A
  • Echo to diagnose
  • Cardiac catheterisation to assess severity
56
Q

How is AR treated ?

A
  • 1st line = ACEi to decrease HTN
  • 2nd line = if increasing symptoms & enlarging heart on Echo/CXR (LV dilatation) then do valve replacement

Y4 Cardiology (27 decks)

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