Ventricular heart disease Flashcards
Aortic stenosis clinical features
Common Exertional breathlessness Syncope Chest pain Slow rising pulse Ejection systolic murmur radiating to the carotids
Indication for op in asymptomatic AS
Valve area <1cm Consider in: • Abnormal exercise test • Fast progression on follow up • LV dysfuntion • Severe associated LVH • Recurrent otherwise unexplained ventricular arrhythmias
Mitral stenosis clinical features
Now rare due to fall in rheumatic heart disease
Exertion breathlessness (can provoke tachycardia and pulmonary oedema)
Haemoptysis
Systemic embolism
Malar flush
Prominent 1st heart sound and low pitched diastolic murmur radiating to the axilla
Complications: thromboembolism, not automatic progression of lesion, often have sudden deterioration when they develop AF
Percutaneous mitral valvotomy
For MS Mortality very low Severe MR occurs in 2% Improves survival rates Possible reduction in thromboembolic events
Indications for percutaneous mitral valvotomy in asymptomatic patients
Valve area <1.5cm
High risk for thromboembolism
Pulmonary hypertension
Desire for pregnancy
Warfarin in MS
Yes if in AF (aim for 2.5-3.5 INR) In sinus rhythm, give if: • LA >5cm • Presence of echo contrast • Thrombus in LA • Previous thromboembolic event Note: other, newer anticoagulants may be better
Aortic regurgitation clinical features
Fairly common Often asymptomatic at presentation Breathless on exertion Awareness of a normal heart beat Angina is late Bizarre eponymous features: De Musset's sign (head bobbing), Corrigan's pulse (collapsing pulse), Quinke's sign (pulsing nail beds), pistol shot femorals Wide pulse pressure Early diastolic murmur (leaning forward, held expiration, LLSE) Assess via echo
Aortic regurgitation causes
Rheumatic fever Bicuspid valve Dilated aortic root Infective endocarditis Ventricular septal defect
Indications for operation in asymptomatic AR
Left ventricular failure
Left ventricular enlargement
nb. symptoms is often too late!
Mitral regurgitation clinical features
Common Often asymptomatic Pulmonary oedema Heart failure Breathlessness Pansystolic murmur at apex Echo to assess
Mitral regurgitation causes
Secondary to poor LV function and dilatation of the mitral valve ring
Mitral valve prolapse
Rheumatic fever
Endocarditis
Associated with hypertrophic cardiomyopathy
