Valvular Heart Disease- Diastolic murmurs

Question 1

Aortic Regurgitation

pathophysiology?

Answer 1

regurgitation leads to an increase in LV end diastolic pressure –> LV dilatation & hypertrophy

Question 2

Aortic Regurgitation

causes?

Answer 2

Acute:

• aortic dissection
• perforation
  
  • secondary to infection
• cusp rupture

Chronic:

• congenital: bicuspid aortic valve
• rheumatic heart disease
• connective tissue disease
• autoimmune
• syphilis

Question 3

Aortic Regurgitation

symptoms?

Answer 3

• SOB
• angina
• HF

Question 4

Aortic Regurgitation

signs?

Answer 4

• pulse
  
  • collapsing pulse (corrigan’s/waterhammer pulse)
    
    • forceful & then suddenly collapses
  • wide pulse pressure
  • visible carotid pulsations -corrigan’s sign
• heart
  
  • displaced apex
  • diastolic thrill
• murmur
  
  • early diastolic, soft murmur
  • heard best at LLSE, patient sitting forward & holding breath on expiration
  • in severe AR–> austin flint murmur
    
    • early diastolic rumbling murmur at apex

Question 5

Aortic Regurgitation

other signs?

Answer 5

• Traube’s sign
  
  • pistol shot heard over femoral artery
• De Musset’s sign
  
  • head nodding in time w heart beat
• Quincke’s sign
  
  • pulse felt in nail

Question 6

Aortic Regurgitation

Ix?

Answer 6

• Echo–> confirms diagnosis
• ECG
  
  • LVH
• CXR
  
  • LV enlargement
• Cardiac catheterisation

Question 7

Aortic Regurgitation

Rx?

Answer 7

• conservative
  
  • aimed at risk factors
• medical
  
  • aimed at symptoms
• surgical
  
  • valve replacement

Question 8

Aortic Regurgitation

Complications?

Answer 8

• HF
• Arrhythmia
• IE

Question 9

Mitral Stenosis

pathophysiology?

Answer 9

• narrow mitral valve orifice
• difficult to push blood through to LV
• larger volume of blood left over in LA
• blood backtracks to lungs
• PHT–> RVH–> RHF

Question 10

Mitral Stenosis

causes?

Answer 10

3C’s

• calcification
• carcinoid syndrome
• congenital (rare)
• rheumatic fever
• SLE

Question 11

Mitral Stenosis

symptoms?

Answer 11

manifest when orifice < 2cm²

• SOB, fatigue
• orthopnoea, PND
• Haemoptysis
• RHF
• palpitations if AF

Question 12

why is AF so common in mitral stenosis?

Answer 12

because of dilatation of LA–> takes longer for electrical impulse to reach bundle of His

Question 13

Mitral Stenosis

signs?

Answer 13

• malar flush
  
  • due to retention of co2 causing vasodilation
• tapping, undisplaced apex beat
• signs of PHT: pul oedema
• signs of RHF: increased JVP w prominent a waves
• signs of RVH: left parasternal heave

Question 14

Mitral Stenosis

murmur?

Answer 14

• mid diastolic low pitched “rumbling” murmur
  
  • gets louder w valsalva or anything that increases venous return
• heard w patient lying on left side in end expiration; radiates to axilla
• loud s1
• opening snap

Question 15

Mitral Stenosis

complications?

Answer 15

• ortner’s syndrome –> hoarseness
• HF
• AF
• dysphagia
• bronchial obstruction

Question 16

Mitral Stenosis

Ix?

Answer 16

• Echo
• ECG
  
  • AF
  • P mitrale
  • RVH
• CXR
  
  • pul oedema
  • prominent pul arteries
• Cardiac catheterisation

Question 17

Mitral Stenosis

Rx

Answer 17

• conservative
  
  • manage risk factors
• medical
  
  • aimed at symptoms
• surgical
  
  • valve repair preferred - percutaneous balloon valvotomy