Valves & Murmurs Flashcards
(44 cards)
What type of murmur does aortic stenosis produce and where do you listen to it?
- Ejection systolic
- 2nd intercostal space, right sternal edge/border
Where does aortic stenosis murmur radiate to?
Carotid radiation
What type of murmur does mitral regurgitation/insufficiency produce and where do you listen to it?
- Pansystolic (holosystolic)
- 5th intercostal space, mid clavicular line i.e. apex (PMI)
Where does mitral regurgitation murmur radiate to?
Axilla radiation
What type of murmur does aortic regurgitation produce and where do you listen to it?
- Early diastolic
- 2nd intercostal space, right sternal edge/border
What type of murmur does mitral stenosis produce and where do you listen to it?
- Mid-diastolic
- 5th intercostal space, mid clavicular line i.e. apex (PMI)
What two murmurs have a descrescendo?
Aortic regurgitation and mitral stenosis
How do you accentuate a right heart murmur?
Inspiration
How do you accentuate a left heart murmur?
Expiration
How do you diagnose valve disease
Echocardiogram (Echo) (+ doppler)
What other investigation might you do to diagnose mitral regurgitation?
Cardiac catheterisation
What two investigations might you do in someone with suspected valve disease?
ECG, CXR
What age group of patients typically get aortic stenosis?
Elderly (>60)
What are the 4 causes of aortic stenosis?
1) Senile calcification
2) Rheumatic fever
3) Bicuspid valve (congenital)
4) William’s syndrome (congenital)
What are the symptoms and signs of aortic stenosis?
1) Angina
2) Exertional dyspnoea (heart failure)
3) Syncope
4) Symptoms of LVF - HF, stroke, arrhythmias
5) Slow rising pulse
6) Paradoxically split S2
7) Narrow pulse pressure
How do you treat aortic stenosis and aortic regurgitation?
Valve replacement
How do you treat aortic stenosis if the pt is unfit for surgery?
TAVI/valvuloplasty
When would you use a biological valve?
Older patients (lower chance of clots and rejection)
When would you use a mechanical valve?
Younger patients (<50) (lasts longer)
What is the most common cause of mitral regurgitation?
Mitral valve prolapse
What cardiac condition is mitral regurgitation associated with?
AF
What are other causes of mitral regurgitation?
1) LV dilation - AR, AS, HTN
2) Senile annular calcification
3) Papillary muscle dysfunction/rupture (POST-MI)
4) Rheumatic fever
5) Infective endocarditis
6) Connective tissue disease i.e. Marfan’s/Ehler-Danlos
What are the symptoms of mitral regurgitation
1) Dyspnoea
2) Fatigue
3) Palpitations (AF)
What should you do first in management of valve disease?
Monitor and treat cardiovascular risk factors e.g. BP
