Valve Disorders Flashcards by Martha Innes

What are the general symptoms of valve disorders?

Chest pain
Breathlessness
Collapse/dizziness
Exertional symptoms

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What is the characteristic features of valve disorder symptoms?

Exertional symptoms

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What is the nature of chest pain caused by valve disorders?

Gripping
Squeezing
Heavy
Crushing

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What is the breathlessness of valve disorders associated with?

Activity
Ankle swelling
Orthopnoea (breathlessness when lying down)
PND

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What is the apex beat?

The pulse felt at maximum impulse

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Where is the apex beat felt?

5th intercostal space, mid-clavicular line

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What is tapping apex beat a symptom of?

Mitral stenosis

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When is the apex beat displaced and diffuse?

LV dilation (volume overload)

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When is the apex beat heaving and displaced?

LV hypertrophy (pressure overload)

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What is a cardiac murmur?

Audible turbulence of blood flow

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What are the causes of cardiac murmurs?

Blood flowing through an abnormal narrowing
Blood flowing in the wrong direction though the heart
An abnormal connection between two different parts of the heart

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When is a systolic murmur heard?

Stenosis of either the aortic or pulmonary valve

Regurgitation though the mitral or tricuspid valves

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When is a diastolic murmur heard?

Regurgitation through the aortic or pulmonary valves

Stenosis of mitral or tricuspid valves

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What type of diastolic murmur do regurgitation through the aortic or pulmonary valves cause?

Early diastolic

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What type of diastolic murmur do stenosis of mitral or tricuspid valves cause?

Mid or late diastolic

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What is S1?

Mitral and tricuspid valves closing

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What is S2

Aortic and pulmonary valves closing

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What murmur radiates to the carotids?

Aortic stenosis

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What murmur radiates to the axilla?

Mitral regurgitation

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What are the grades of murmurs?

I. Very quiet
II. Quiet - easy  to hear
III. Loud
IV. Loud with a trill
V. Very loud with a trill
VI. Loud - audible without a stethoscope

What are the manoeuvres that can be done to make murmurs louder, and which murmurs do they affect?

Sitting forward - aortic murmurs

Lying on side - mitral valve murmurs

Which murmurs does inspiration make louder?

Right sided (pulmonary and tricuspid valves)

Which murmurs does expiration make louder?

Left sided (aortic and mitral valves)

What murmurs are likely to be innocent?

Soft (less than 3/6 severity)

Early systole

What is the characteristic feature of aortic stenosis murmurs?

Ejection systolic murmur that radiates to carotids

What are the characteristic symptoms and signs of aortic stenosis?

Heaving apex Ejection systolic murmur that radiates to carotids Loudest on expiration and when sitting forwards Slow rising pulse

What are the causes of aortic stenosis?

Congenital Age Rheumatic

What is the treatment for aortic stenosis?

Conventional valve replacement Trans-catheter aortic valve replacement (TAVI) Balloon aortic valvotomy (BAV)

What is the characteristic feature of mitral stenosis murmurs?

Mid-diastolic rumbling murmur localised to apex

What are the characteristic symptoms and signs of mitral stenosis?

Palpitations Tapping apex beat Mid-diastolic rumbling murmur localised to apex

What are the causes of mitral stenosis?

Mainly rheumatic

What is the treatment for mitral stenosis?

Medication: diuretics and treat AF Surgery: valve replacement Balloon valvuloplasty

What is the characteristic feature of mitral regurgitation murmurs?

Pansystolic murmur heard best at the apex, radiates to axilla

What are the characteristic symptoms and signs of mitral regurgitation?

Displaced apex Pansystolic murmur Radiates to axilla

What are the causes of mitral regurgitation?

``` Degenerative Infective endocarditis Mitral valve prolapse Chordae rupture (degenerative) Connective tissue disease ```

What is the treatment for mitral regurgitation?

Medication: diuretics, ACE inhibitors Surgical: repair (prolapse), replacement (degenerative)

What is the characteristic feature of aortic regurgitation murmurs?

High pitched early diastolic murmur

What are the characteristic symptoms and signs of aortic regurgitation?

Collapsing pulse Displaced apex Early diastolic murmur, left sternal edge

What are the causes of aortic regurgitation?

``` Endocarditis Rheumatic Connective tissue disease Marfan's Aortic dissection ```

What is the treatment for aortic regurgitation?

Medication: ACE inhibitors, diuretics Surgery: symptoms and LV dilation Valve replacement

What is the pathophysiology for aortic stenosis?

Aortic stenosis prevents proper LV emptying, leading to increased pressure and hypertrophy Results in ischaemia of LV myocardium, causing angina, arrhythmias and LV failure

What is the pathophysiology of aortic regurgitation?

Reflux of blood from the aorta to LV causes LV dilation | Diastolic BP decreases and coronary perfusion is decreased

What type of organism causes rheumatic fever?

Group A beta-haemolytic streptococcus

How does rheumatic fever lead to valve dysfunction?

Inflammation leads to fusion the valves over many years

What is the pathophysiology for mitral stenosis?

Harder to pump blood put of the left atrium so pressure increases, causing LA hypertrophy and dilation This causes pulmonary venous and right heart pressure to increase Pulmonary oedema develops Compensatory mechanisms lead to pulmonary hypertension, RV hypertrophy, dilation and failure

What is a common complication of mitral stenosis?

Atrial fibrillation

What is the diagnostic investigation for valve disorders?

Echo

What is the pathophysiology of mitral regurgitation?

Regurgitation into LA causes LA dilation If acute - pressure increases, pulmonary venous pressure rises, causing oedema A proportion of the SV is regurgitated so stroke volume increases, causing LV hypertrophy