Flashcards in Valvular Disease Deck (36)
When do symptoms typically start to occur in patients with aortic stenosis? Before this point, what is the only sign?
When the valve area is < 1.5cm2 / Murmur
Name 3 potential causes of aortic stenosis?
Age, bicuspid aortic valve, rheumatic fever
When does degenerative aortic stenosis typically present?
The 6th or 7th decade of life
When should surgery be considered for aortic stenosis?
When symptoms start to occur
Describe the progression of symptoms typically seen in aortic stenosis?
Dyspnoea + fatigue, anginal symptoms, presyncope or syncope, heart failure symptoms
Describe the typical murmur heard in aortic stenosis? Where is this murmur loudest? Where does it radiate to?
Ejection systolic murmur, loudest at the aortic area (on expiration), radiating to the carotids
What is the most common major valve problem? What is it closely followed by?
Aortic stenosis, followed by mitral regurgitation
What are the long-term consequences of untreated, left-sided valvular disease?
Left ventricular hypertrophy and/or pulmonary hypertension
What is the most common cause of valvular dysfunction?
Age related generation
Symptoms which occur when, are characteristic of valvular heart disease?
What is the only definitive treatment for a poorly functioning heart?
Surgical replacement or repair
Describe the pulse associated with aortic stenosis?
Slow rising, low volume pulse
A soft S2 is associated with what valvular abnormality?
A narrow pulse pressure is associated with what valvular abnormality?
What investigation is the gold standard for confirming and grading aortic stenosis?
In addition to an ECHO, what other investigations may be performed in someone with aortic stenosis?
ECG and coronary angiography
What is the definitive treatment option for aortic stenosis?
What type of prosthetic valve is typically used in younger patients?
What type of prosthetic valve is typically used in older patients?
What anticoagulation is required with mechanical aortic valves?
Lifelong anticoagulation with warfarin
What anticoagulation is required with biological aortic valves?
Warfarin for 3 months after surgery
Which type of prosthetic valve is more likely to give off a 'click' and is therefore easier to identify?
What is the most common cause of aortic stenosis in patients aged < 65?
Bicuspid aortic valve
What procedure is a less invasive approach to aortic stenosis treatment, that is currently targeted to high-risk or inoperable patients?
Trans-catheter aortic valve implantation (TAVI)
A wide pulse pressure is seen in which valvular abnormality? What clinical features may this cause?
Aortic regurgitation / head bobbing and nail pulsing
A collapsing pulse is associated with which valvular abnormality?
A bounding pulse is associated with which valvular abnormality?
Describe the typical murmur that occurs with aortic regurgitation? When is this best heard?
Early diastolic murmur, loudest at the left sternal edge with the patient leaning forwards on expiration
What is the investigation of choice for diagnosing aortic regurgitation?