Valvular Heart Disease Flashcards
Cardiac breathlessness:
- What is it related to?
- What is it often associated with?
- Related to activity
- Often associated with ankle swelling, orthopnoea and paroxysmal dyspnoea
New York heart association functional classification
Class I = no limitation
Class II = slight limitation of ordinary activity
Class III = marked limitation of less than ordinary activity
Class IV = severe limitation of minimal activity or rest
Signs of right sided heart failure
Raised JVP, pitting oedema in ankles and sacrum, hepatic congestion
When is there a tapping apex beat?
Mitral stenosis
Apex beat in left ventricular dilatation
Displaced and diffuse due to volume overload
Apex beat in left ventricular hypertrophy
Heaving and apex beat may be displaced
Parasternal heave:
- When is it felt?
- What is it caused by?
- When the hand is over the left of the sternum
- Due to right ventricular hypertrophy - cor pulmonare/pulmonary hypertension
What is a cardiac murmur?
Audible turbulence of blood flow
Types of systolic murmur
Pansystolic - same volume all the way through
Ejection systolic - gets louder towards the end
Types of diastolic murmur
Early diastolic - starts loud and gets quieter
Mid diastolic - gets quieter then louder
Murmur radiating to carotids
Aortic stenosis
Murmur radiating to axilla
Mitral regurgitation
Grades of murmur
I - very quiet II - quiet but easy to hear III - loud IV - loud with a thrill V - very loud with a thrill VI - so loud that it is audible without a stethoscope
What murmurs are louder with inspiration?
Right sided
What murmurs are always pathological
Diastolic murmurs
Valve stenosis
When valves don’t open properly
Valve regurgitation
When valves don’t close properly
Mixed valve disease
Valves which don’t open or close properly
Symptoms of aortic stenosis
Breathlessness, chest pain, dizziness/syncope
Signs of aortic stenosis
Low volume pulse, forceful displaced apex beat, ejection systolic murmur radiating to carotids
Treatment of aortic stenosis
Conventional valve replacement, trans catheter aortic valve replacement, balloon aortic valvotomy
Causes of mitral regurgitation
Prolapse of leaflets, rheumatic leaflets, myxomatous leaflets, endocarditis affecting leaflets, chordae rupture, papillary muscle rupture, annular dilatation
Symptoms of mitral regurgitation
Breathlessness, peripheral oedema, fatigue
Signs of mitral regurgitation
Displaced apex beat, pan systolic murmur radiating to axilla
Treatment for mitral regurgitation
Medication: diuretics and ACE inhibitors
Surgical: repair if prolapse, replacement if degenerative
Percutaneous: clips in infancy
Mitral stenosis causes
Rheumatic main cause
Symptoms of mitral stenosis
Breathlessness, fatigue, palpitations (AF)
Signs of mitral stenosis
Malar flush, tapping apex beat, mid diastolic murmur localised to apex
Treatment for mitral stenosis
Medication: diuretics and treat AF
Surgery: valve replacement
Balloon valvuloplasty
Causes of aortic regurgitation
Endocarditis affecting leaflets, connective tissue damage in leaflets, rheumatic leaflets, Marfan’s, aortic dissection
Symptoms of aortic regurgitation
Breathlessness
Signs of aortic regurgitation
Collapsing pulse, wide pulse pressure, displaced apex, early diastolic murmur left sternal edge
Treatment for aortic regurgitation
Medication: ACE inhibitors
Surgery: Valve replacement
