Vavular Heart Disease Flashcards
Common symptoms of Valve disease?
chest pain - gripping, squeezing, heavy
breathlessness
collapse/dizzy spell
What is cardiac breathlessness associated with?
activity and ankle swelling
orthopnoea
Paroxysmal Nocturnal Dysnopnoes (PND)
What is Class I NYHA?
no limitation
What is NYHA Class 2?
slight limitation of ordinary activity
What is Class 3 NYHA/
Marked limitation of less than ordinary activity
What is class IV NYHA?
Severe limitation of minimal activity or at rest
Signs of Right sided Heart Failure
raised JVP
Pitting Oedema
Hepatic Congestion
Describe the apex beat in mitral stenosis?
tapping
If the apex beat is displaced and diffuse in Left ventricular dilatation, what is happening?
volume overload
Heaving and apex beat is displaced in LVH, what is happening?
pressure overload
What is a parsternal Heave indicative of?
Hand left of sternum
Right ventricular overload
cor pulmonale/pulmonary hypertension
What is a cardiac murmur?
audible turbulence of blood flow
How is a murmur described?
Systole or diastole? What type of murmur? Where is it loudest? Where does it radiate to? What grade of murmur? (Influenced by respiration?)
Which murmurs can you hear in systole?
aortic stenosis
mitral regurgitation
Which murmurs can you hear in diastole?
aortic regurgitation
mitral stenosis
describe a pansystolic murmur?
a continuous sound that continues throughout systole
How are the murmurs volume graded?
I-VI
quiet-loud
What side of the heart murmers are louder with inspiration?
right-sided murmurs
Where are innocent murmurs normally heard?
often soft early systolic sound
d: valve stenosis
Valves which do not open properly
d: valve regurgitation
Valves which do not close properly
d; mixed valve disease
Valves which neither open properly nor close properly
Causes of Aortic Stenosis
degenerative
congenital eg bicuspid valve
rheumatic
How does a congenital defect of biscuspid valve cause aortic stenosis?
more turbulent blood flow cos 2 cusps instead of 3
clinical findings of aortic stenosis?
Low volume pulse
Forceful displaced apex
Ejection systolic murmur that can radiate to the carotids
what disease to patients have commonly who have aortic stenosis?
Left ventricular hypertrophy
What does an ECG of aortic stenosis look like?
LVH
Treatment of Aortic Stenosis
Conventional valve replacement
Trans catheter aortic valve replacement (TAVI)
Balloon Aortic valvotomy (BAV)
Why are bio-prosthetic valves given?
no warfarin
Causes of Mitral Reguritation
Leaflets; -Prolapse -Rheumatic -Myxomatous (floppy) -Endocarditis Chordae rupture: (degenerative) -Prolapse/flail leaflet Papillary muscles rupture: -Ischaemic Annular dilatation: -Functional
symptoms mitral regurgitation
Breathlessness
Peripheral oedema
Fatigue
Clinical findings of mitral regurgitation
Displaced apex
Pansystolic murmur
Axilla
What does mitral regurgitation on CXR/
cardiomeagly
Treatment of Mitral regurgitation
Medication
-Diuretics and heart failure (ACE inhibitors)
Surgical
- Repair – prolapse
- Replacement - degenerative
Percutaneous
Clips in infancy – encouraging results
Causes Mitral Stenosis
Essentially rheumatic main cause
Congenital rare
Symptoms Mitral Stenosis
Breathlessness
Fatigue
Palpitations (AF)
Clinical Findings for mitral stenosis
Malar flush
Tapping apex beat
Mid diastolic rumbling diastolic murmur localised to apex
What would an ECG show for mitral stenosis?
atrial fibrillation
What would a CXR show for mitral stenosis?
straight left heart border
Treatment for mitral stenosis
Medication -Diuretics and treat AF Surgery -Valve replacement Balloon Valvuloplasty
causes for aortic regurgitation
Leaflets:
- Endocarditis
- Connective tissue diseases
- Rheumatic
Annulus:
- Marfans
- Aortic dissection
Symptoms Aortic regurgitation
breathlessness
clinical findings of aortic regurgitation
Collapsing pulse
Wide pulse pressure
Displaced apex
Early diastolic murmur left sternal edge
What does CXR show for aortic regurgitation?
cardiomegaly
Treatment for aortic regurgitation
Medication
-ACE inhibitors
Surgery
- Symptoms and LV dilatation
- Valve replacement
