valvular heart disease CCL

Question 1

boil valve disturbance down to its basics.

define thrills and heaves

Answer 1

Stenosis- faliure to open properly- impede flow out

regurgitation- faliure to close properly- reverse flow.

Thrill- palpable murmur
Heave- palpable ventricular contraction.

Question 2

aortic valve disease overview

Answer 2

stenosis- ejection murmur.
common with age, most common defect.

if calcification spreads down L side can cause LBBB, LAD.

classified as severe when valve area less than 1cm2

age related calcification, congen bicucpid valve calcification or rheumatic fever valve disease most common.

Question 3

aortic stenosis S+S. Ix, Mx

Answer 3

angina, exertional syncope, Congestive heart faliure, ejection systolic murmur

Ix: ECG, Echo

Rx: mild/ asymtomatic- observation only.
severe with symptoms- need Rx: valve replacement (+lifelong antocoag) TAVI for high risk patients.
the later you do surgery, the better (valve reduces lifespan)

Question 4

Aortic regurg overview.(aetiology,S+S,Rx.)

Answer 4

aetiology: degenerative, congenital, HTN, collagen disorders (marfans), aortic dessication, infective endocarditis, rheumatic fever.

S+S- SOB, Orthopnea,PND, widened pulse pressure, Nail pulsing(Quickes), visible carotid pulse (corrign) collapsing pulse, head bob with pulse, mullers pulse (pulse in uvula).

Rx: vasodilators e.g ACEi, CCB (dec afterload) monitoring, replacement

Question 5

mitral regurg overview

Answer 5

2nd most common valve defect. pan systolic (Shhhhhh dub, Shhhhhh dub)
backflow of blood from LV to LA.

Aetiology: mot common is valve prolapse- (papillary rupture, enlargement valve leaflet)
Congenital, LV dilation stretches valve ring- cant close properly. Infective endocarditis- abcess at annulus.

S+S: any cardio + split s2 or quiet s1.

Ix: Echo, ECG- broad P wave

Rx: in acute emergency surg. asymptomatic- ACEi + B block. (dec afterload)
symptomatic: surg

Question 6

mitral stenosis overview

Answer 6

common complication is AF.

Cause: rheumatic fever (grp A strep) IE less common.

S+S: cardio + malar flush, low rumbling mod diastolic murmur.

Rx: diuretics, B block, CCB.
baloon valvotomy- open it more.
surgery if less than 1.5cm2

Question 7

tricuspid valve regurg overview-cause, signs, mx

Answer 7

Cause: right heart faliure,infecriv endocarditis. (IVDU)

pan systolic murmor, raised jvp, parasternal heave, audible on inspiration.

mx: annuloplasty ring. replacement or rx heart faliure symptoms.