Valvular heart disease (mitral stenosis, regurg, prolapse. // Aortic stenosis, regurg) Flashcards
What are the causes of mitral stenosis?
- Rheumatic fever
- congenital
- endocardial fibroelastosis
- prosthetic valve
- malignant carcinoid
How does mitral stenosis present?
The normal mitral valve orifice is 4-6cm2, when this becomes less than 2cm2 symptoms:
- SOB
- fatigue
- palpitations
- chest pain
- systemic emboli
- haemoptysis
- chronic bronchitis like picture (daily productive cough)
What are the examination signs of mitral stenosis?
- malar flush (due to decreased cardiac output)
- low volume pulse
- AFib
Ascultation:
- loud S1
- opening snap
- rumbling mid diastolic murmur (heard best in expiration with patient on left side)
- graham steell murmur may occur
What is the classical murmur heard in mitral stenosis?
-rumbling mid diastolic murmur (heard best in expiration with patient on left side)
What is the cause of a rumbling mid diastolic murmur>?
mitral stenosis
What murmur is best heard in expiration with the patient rolled onto their left side
mitral stenosis - rumbling mid diastolic murmur
What tests are done for mitral stenosis?
1) ECG
- AFib
- P-mitrale if sinus rhythm
- Right ventricular hypertrophy
2) CXR
- left atrial enlargement
- pulmonary oedema
- miitral valve calcification
3) Echocardiography is diagnostic
P-mitrale is seen (if sinus rhythm) on an ECG - what is it and what valve disease does it signify?
- P-mitrale is a bifid P wave, it shows left atrial enlargement.
(seen in mitral stenosis / regurg, aortic stenosis)
What is seen on the CXR of mitral stenosis?
- left atrial enlargement
- pulmonary oedema
- mitral valve calcification
What are the indications for cardiac catheterisation?
- previous valvotomy
- other valve disease
- angina
- severe pulmonary hypertension
- calcified mitral valve
How is mitral stenosis managed?
- Afib - control rate
- Anticoagulate with warfarin
- Diuretics to decrease pre load / pulmonary congestion
- balloon valvuloplasty
- mitral valve replacement
When abx is used as prophylaxis for rheumatic fever?
oral penicillin
What are the complications of mitral stenosis?
- Emboli
- pulmonary hypertension
- pressure from left atrium on local structures (e.g. recurrent laryngeal nerve - hoarseness, dysphagia, bronchial obstruction)
- infective endocarditis
How can hoarse voice be related to mitral stenosis?
- Left atrium enlargement from mitral stenosis can put pressure on the recurrent laryngeal nerve —-> hoarsness.
What are the causes of mitral regurgitation?
- LV dilatation
- mitral annular calcification
- rheumatic fever
- infective endocarditis
- mitral valve prolapse
- ruptured chordae tendinae
- papillary muscle dysfunction/rupture
- connective tissue (Ehlers-Danlos / Marfan’s)
- cardiomyopathy
What are the symptoms of mitral regurgitation?
- SOB
- fatigue
- palpitations
- infective endocarditis
What are the signs of mitral regurg?
- Afib
- displace apex
- RV heave
- soft S1
PANSYSTOLIC MURMUR at apex radiating to axilla
What murmur identifies mitral regurg?
Pansystolic murmur at the apex radiating to axilla
” pansystolic murmur at the apex radiating to axilla” is classical of what valvular disease?
- Mitral regurgitation has a pansystolic murmur at the apex radiating to the axilla
What tests are done for mitral regurg?
1) ECG
- AF
- P-mitrale (sign of increased LA size)
- left ventricle hypertrophy
2) CXR:
- enlarged LA / LV
- mitral valve calcification
- pulmonary oedema
3) Echo
4) Cardiac catheterization to confirm mitral regurg and exclude other valve / artery disease.
What is the treatment for mitral regurg?
-control AF
- anticoagulate (if AF / emboli history)
- prosthetic valve
- diuretics
-
mitral valve prolapse is the most common valve abnormality, it can occur on its own or with other conditions. What conditions are these?
- Patent ductus arteriosus
- turner’s syndrome
- marfan’s
What are the symptoms of mitral valve prolapse?
- asymptomatic OR
- atypical chest pain
- palpitations
What are the signs of mitral valve prolapse?
Mid systolic click and/or late systolic murmur
what valve condition has a Mid systolic click and/or late systolic murmur ?
mitral valve prolapse has mid-systolic click and/or late systolic murmur.
What are the complications of mitral valve prolapse?
- mitral regurg
- emboli
- arrhythmias
- sudden death
What drug can help palpitations and chest pain in mitral valve prolapse>
beta blockers
What is the cause of aortic stenosis?
- calcification due to age
congenital:
- bicuspid valve
- williams syndrome
-rheumatic heart disease
An elderly person presents with chest pain, exertional SOB, or syncope - which valve condition comes to mind first?
- Aortic Stenosis
What are the symptoms / presentation of Aortic stenosis?
Over 60 with the classic triad of:
- angina
- syncope
- heart failure
- SOB
- dizziness
- faints
- systemic emboli (infective endocarditis)
- sudden death
A slow rising pulse with narrowed pulse pressure is a sign of what valve disease?
Aortic stenosis has a slow rising pulse with narrowed pulse pressure
What are the signs of aortic stenosis?
- slow rising pulse with narrowed pulse pressure
- heaving
- non displaced apex beat
- LV heave
- aortic thrill
- ejection systolic murmur (heard at base, left sternal edge and aortic area - radiates to carotids)
- ejection click
What murmur is heard with aortic stenosis?
Ejection sysolic murmur
heard at the base, left sternal edge and aortic edge - radiates to carotids
what valve condition has an ejection click?
Aortic stenosis (ejection click)
Mitral stenosis (mid systolic click)
What tests are done for aortic stenosis?
1) ECG
- P-mitrale
- LVH
2) CXR
- LVH
- calcified aortic valve
- dilation of ascending aorta
3) ECHO is diagnostic
4) cardiac catheter
What is the management of aortic stenosis?
surgery (valve replacement)
What are the causes of aortic regurg?
- infective endocarditis
- marfans
- ehler’s - danlos
- SLE
- rheumatic fever
What are the symptoms of aortic regurg?
- Exertional SOB
- Orthopnoea
- paroxysmal nocturnal dysnopnoea
- palpitations
- angina
- syncope
- CCF
Collapsing water hammer pulse is a sign of what valve disease?
aortic regurgitation
What is a high pitched early diastolic murmur a sign of?
aortic regurgitation
what are the classical signs of aortic regurgitation?
- collapsing water hammer pulse
- high pitched early diastolic murmur
