Valvular Heart Disease Flashcards
what is chest pain in valvular disease like?
heavy, squeezing and crushing
what is breathlessness in valvular disease usually related to?
increased activity
may come on at rest in very severe cases
what is a common side effect of stenosed vessels?
collapse
what non-invasive investigation can be done for valvular disease?
ECHO
what invasive investigation can be done for valvular disease?
cardiac catheterisation
what classification is used to express how much someones breathlessness due to cardiac disease affects their lives?
the new york heart association functional classification
name three signs of right heart failure
raised JVP
pitting oedema
hepatic congestion
what does a raised JVP suggest?
fluid overload associated with heart failure
what two locations may pitting oedema be found in?
ankles
sacrum
where is the apex beat normally found?
in the 5th ICS, midclavicular line
what happens to the apex beat in mitral stenosis?
it creates a tapping beat
what causes a displaced and diffuse apex beat?
LV dilation due to volume overload
what causes a heaving and displaced apex beat?
LV hypertrophy due to pressure overload
where is the hand placed to feel for a parasternal heave?
left of the sternum
what does the presence of a parasternal heave suggest?
RV overload
may be due to cor pulmonale, pulmonary hypertension or a congenital heart disease
what is a cardiac murmur?
the audible turbulence of blood flow
what causes the first heart sound?
closure of the mitral and tricuspid valves
what does S1 mark?
the start of systole
what are two systolic murmurs?
aortic stenosis
mitral regurgitation
what causes the second heart sound?
the closure of the aortic and pulmonary valves
what does S2 start?
the end of systole
the start of diastole
what are two diastolic murmurs?
aortic regurgitation
mitral stenosis
what two types of systolic murmurs are there?
pansystolic
ejection systolic
what is a pansystolic murmur?
one loud, continuous sound
what is an ejection systolic murmur?
one that gets louder and the quieter again
what two types of diastolic murmurs are there?
early diastolic
mid diastolic
where does the murmur from aortic stenosis radiate to?
carotids
where does the murmur from mitral regurgitation radiate to?
the axilla
what are the grades for murmurs and what does each mean?
1 = very quiet 2 = quiet but easy to hear 3 = loud 4 = loud with a thrill 5 = very loud with a thrill 6 = audible without a stethoscope
which sided murmurs are louder with inspiration?
right sided (mitral)
which sided murmurs are louder with expiration?
left sided (aortic)
who is an innocent murmur common in?
young, thin patients
describe an innocent murmur
soft (less than 3/6)
early systolic
what type of murmur is always pathological?
diastolic
what is stenosis of valves?
when valves do not open properly
what valve regurgitation?
when valves do not close properly
what occurs in mixed valve disease?
valves that do not open or close properly
name three causes of aortic stenosis
degenerative
congenital bicuspid aortic valve
rheumatic fever
what is a bicuspid aortic valve?
when the valve has two cusps instead of three
what causes symptoms in aortic stenosis?
not enough blood getting round the body
name three symptoms of aortic stenosis
breathlessness
chest pain
syncope
describe the murmur associated with aortic stenosis
ejection systolic murmur that can radiate to the carotids
name two signs associated with aortic stenosis
low volume pulse
forceful displaced apex
name three possible treatments for aortic stenosis
valve replacement (most common)
TAVI
balloon aortic valvotomy (BAV)
what is a TAVI?
trans catheter aortic valve replacement
what are the two types of prosthetic valve?
mechanical
bio-prosthetic
which type of prosthetic valve needs to be changed every 10 years?
bio-prosthetic
which type of valve will result in life long warfarin treatment for the patient?
mechanical
what is AVR?
aortic valve replacement
name four causes of mitral regurgitation
problems with valve leaflets
chordae rupture
papillary muscle rupture
annular dilation
what can cause problems with leaflets that can lead to mitral regurgitation?
prolapse
rheumatic fever
endocarditis
what may cause chordae rupture?
ischaemia
degeneration
name three symptoms of mitral regurgitation
breathlessness
peripheral oedema
fatigue
describe the murmur associated with mitral regurgitation
pansystolic murmur that radiates to the axilla
name three things involved in treatment of mitral regurgitation
diuretics + ACEI
surgical repair
surgical replacement
what treatment is done if mitral regurgitation occurs in infancy?
clips
what is the main cause of mitral stenosis?
rheumatic fever
name three symptoms of mitral stenosis
breathlessness
fatigue
palpitations (AF)
name two signs associated with mitral stenosis
malar flush
tapping apex beat
describe the murmur associated with mitral stenosis
mid diastolic rumbling murmur localised to the apex
what three things can be done to treat mitral stenosis
diuretics
valve replacement
balloon valvuloplasty
name a symptom of aortic regurgitation
breathlessness
name three signs of aortic regurgitation
collapsing pulse
wide pulse pressure
displaced apex
describe the murmur associated with aortic regurgitation
early diastolic murmur at the left sternal edge
outline treatment for aortic regurgitation
ACEI
valve replacement
