when do patient with valvular heart disease characteristically get symptoms?
on exertion
how do you describe a murmur?
systole or diastole? what type of murmur? where is it loudest? where does it radiate to? what grade of murmur? is it influenced by respiration?
what 4 murmurs are systolic?
mitral regurgitaiton
tricuspic regurgitation
aortic stenosis
pulmonary stenosis
what 4 murmurs are diastolic?
mitral stenosis
tricuspid stenosis
aortic regurgitaion
pulmonary regurgitation
what is a pansystolic murmur?
equal throughout systole
what are pansystolic murmurs the result of?
regurgitation of blood flow
mitral/tricuspid regurgitation
what are ejection systolic murmurs?
during systole sound gets louder than softer
what are ejection systolic murmurs the result of?
stenosis
aortic/pulmonary stenosis
what type of murmurs radiate?
systolic murmurs
what is an early diastolic murmur?
aortic/pulmonary regurgitation
what is a mid diastolic murmur?
mitral/tricuspid stenosis
which murmurs are always pathological?
diastolic murmurs
where do aortic systolic murmurs radiate to?
aortic stenosis
neck
where do pulmonary systolic murmurs radiate to?
pulmonary stenosis
left shoulder
where do tricuspid systolic murmurs radiate to?
tricuspid regurgitation
dont radiate
where do mitral systolic murmurs radiate to?
mitral regurgitation
under left axilla
describe murmur grading?
- very quiet
2/3. loud without thrill
4/5. loud with thrill - loud- audible without stethoscope
which sided murmurs will vary with inspiration?
right sided murmurs will be louder on inspiration than expiration
(eg tricuspid and pulmonary murmurs will vary with inspiration)
what are the 3 characteristics of an innocent murmur?
- everything else is normal
- occurs in early systole
- usually located in pulmonary area but no where else
what is valve stenosis?
valves dont open properly
what is valve regurgitation?
valves don’t stay closed properly
what is mixed valve disease?
valves neither open properly or close properly
what are the 3 main causes of aortic stenosis?
congenital bicuspid aortic valve
age-related calcification
rheumatic
what are the symptoms of aortic stenosis?
breathlessness
chest pain
dizziness/syncope on exertion
what are the signs of aortic stenosis?
- low volume pulse
- forceful apex- LV heave
- ejection systolic murmur which is maximal in aortic area and radiates to the carotids
what are the 3 treatment options for aortic stenosis?
- surgery: valve replacement
- balloon aortic valvotomy
- transcatheter aortic valve implantation
what are the 2 types prosthetic heart valves?
mechanical
bioprosthetic
what are the advantages and disadvantages of mechanical heart valves compared to bioprosthetic?
mechanical have long term durability but need anticoagulants
biporsthetic dont need anticoagulants but aren;t as durable
what are 4 problems can cause mitral regurgitation?
problems with mitral valve leaflets
chordal rupture
ischamia or infarction of papillary muscle
annular dilation
why does annular dilation cause regurgitation?
because valves no longer meet in the middle so are leaky
what 3 things can cause problems with mitral valve leaflets and so cause mitral regurgitation?
- rheumatic heart disease
- myxomatous degeneration (floppy mitral valve syndrome)
- endocarditis
what are the symptoms of mitral regurgitation?
breathlessness
ankle swelling
fatigue
what are the signs of mitral regurgitation?
- displaced apex beat
- pansystolic murmur which is maximally heard at the apex and radiated to the axilla
what is a sign of mitral regurgitation on a cxr?
cardiomegaly
what are the treatment options of mitral regurgitation?
drugs
surgery
percutaneous mitral valve repair
what are the 2 drugs that can be used for mitral regurgitation?
diuretics
ACE inhibitors
what are the 2 surgery options of mitral regurgitation?
valve repair
valve replacement
what are the causes of mitral stenosis?
rheumatic heart disease (although past history my be absent)
congenital
what are the symptoms of mitral stenosis?
breathlessnes
tiredness
palpitations
what are the signs of mitral stenosis?
- malar flush
- tapping apex beat
- mid diastolic murmur localised to apex
- right heart failure in later stages
what valvular heart murmur is most likely to give you palpitations?
mitral stenosis
what valvular heart murmur is most likely to give you AF?
mitral stenosis
what are the signs of mitral stenosis on a CXT?
straight left heart border
because left atrium enlarges
what are the 3 treatment options for mitral stenosis?
drugs
surgery
mitral balloon valvuloplasty
what drugs are given in the treatment of mitral stenosis?
diuretics (for oedema) betablockers, digoxin, warfarin (for AF)
what type of surgery is used in mitral stenosis?
valve replacement
when is mitral balloon valvuloplasty suitable for the treatment of mitral stenosis?
if there is a pliable competent valve
what are the causes of aortic regurgitation?
defect with the aortic leaflets
defects with the annulus
what can cause problems with the aortic leaflets?
infective endocarditis
connective tissue disease
rheumatic heart disease
what can cause problems with the aortic annulus?
marfans syndrome
acute aortic dissection
what are the symptoms of aortic regurgitation?
breathlessness
chest pain
dizziness
what are the signs of aortic regurgitation?
collapsing pulse
displaced apex
early diastolic murmur heard maximally in the tricuspid area
what are the treatment options of aortic regurgitation?
drugs
surgery
what drugs are used in the treatment of aortic regurgitation?
ACEI
ARB
diuretics
what surgery is used in the treatment of aortic regurgitation?
valve replacement
