Valvular Regurgitation & Stenosis Flashcards
What is the main cause of mitral stenosis?
Rheumatic fever
What are the symptoms of mitral stenosis?
Dyspnoea, Fatigue, Palpitations, Chest pain, Haemoptysis
What are the features of mitral stenosis on auscultation? Best heard where?
- Mid-late diastolic murmur (Best heard on expiration)
- Loud S1, opening snap
- Low volume pule
- Best heard with bell at apex with patient rolled to left side holding breath after expiration
What physical signs can be seen in mitral stenosis?
- Malar flush
* AF may develop causing an irregular irregular pulse
How is the diagnosis of mitral stenosis made?
- CXR show left atrial enlargement
* Echo shows left atrial enlargement and thick+calcified mitral valve
What is the treatment of mitral stenosis?
- No treatment if asymptomatic
- Diuretics for pulmonary oedema
- Mitral valvuloplasty if severe (dilate valve with balloon)
What is mitral valve stenosis?
Narrowing of the Mitral valve opening the blocks (obstructs) blood flow from left atrium to left ventricle
What are the causes of aortic stenosis?
- Calcification due to age may worse by HTN, diabetes, hyperlipiproteinaemia and uraemia
- Bicuspid aortic valve (<65years)
- William’s syndrome (supravalvular aortic stenosis)
- Post-rheumatic disease
What are the symptoms of aortic stenosis?
- Angina
- Syncope
- Heart failure
- Chest pain
- Dyspnoea
What are the features of aortic stenosis on auscultation? Best heard where?
- Ejection systolic murmur
- Best hear over aortic area (Right sternal upper edge) which radiates to the carotids
- Slow rising pulse
- Soft/absent S2
- S4 sometimes
What are the features of severe aortic stenosis?
- slow rising pulse
- narrow pulse pressure
- Soft/absent S2
- LV heave
- Aortic thrill
- S4
If the patient is asymptomatic and has aortic stenosis what is the management?
Observe -watch and wait
If the patient is symptomatic and has aortic stenosis what is the management?
Valve replacement
What is mitral regurgitation?
Occurs when blood leaks back through the mitral valve on systole
What are the causes of mitral regurgitation?
- Following coronary artery disease post MI
- Infective endocarditis
- Rheumatic fever
- Congenital
What are the symptoms of mitral regurgitations?
- Most asymptomatic
- Dyspnoea
- Fatigue
- Palpitations
What is heard on auscultation in mitral regurgitation? Heard best?
- Pansystolic murmur (described as blowing)
- Heard best at the apex and radiating to the axilla
- S1 may be quiet
- S2 may be widely split in severe MR
How is mitral regurgitation diagnosed? What confirms the diagnosis in these investigations?
- ECG = broad P wave
- CXR = Left atrial and ventricle dilation + cardiomegaly
- Echo = mitral reverse flow and LV and atrial dilatation
What is the treatment for mitral regurgitation?
- Acute = nitrates, diuretics, positive inotropes, intra aortic balloon pumps
- Treat Heart failure: ACEi, beta blockers and spironolactone
- Treat HTN
- Treat AF
- Valve repair over replacement
What is aortic regurgitation?
Occurs when blood leaks back through the aortic valve during diastole
What are the causes of aortic regurgitation? (Consider due to valve disease and due to aortic root disease)
Due to valve disease:
- Rheumatic fever
- Infective endocarditis
- Connective tissue disease e.g. RA/SLE
- Bicuspid aortic valve
Due to aortic root disease:
- Aortic dissection
- HTN
- Synphilis
- Marfans, Ehler-Danlos syndrome
- Ankylosing spondylitis
What are the symptoms of aortic regurgitation?
- Dyspnoea
- Fatigue
- Angina
- Syncope
- Palpitations
- Cyanosis
What can be heard on auscultation in aortic regurgitation? Best heard?
- Early diastolic murmur
- Best heard. at lower left sternal edfe with patient leaning forward and holding breath after expiration
- intensity increased by handgrip manoeuvre
What signs are there of aortic regurgitation?
- Early diastolic murmur
- Collapsing pulse
- De mussets sign (head bobbing)
- Bounding water hammer pulse
- Apex beat displaced to left
