when do patient with valvular heart disease characteristically get symptoms?
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?
what 4 murmurs are diastolic?
what is a pansystolic murmur?
equal throughout systole
what are pansystolic murmurs the result of?
regurgitation of blood flow
what are ejection systolic murmurs?
during systole sound gets louder than softer
what are ejection systolic murmurs the result of?
what type of murmurs radiate?
what is an early diastolic murmur?
what is a mid diastolic murmur?
which murmurs are always pathological?
where do aortic systolic murmurs radiate to?
where do pulmonary systolic murmurs radiate to?
where do tricuspid systolic murmurs radiate to?
where do mitral systolic murmurs radiate to?
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
what are the symptoms of aortic stenosis?
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?
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
ischamia or infarction of papillary muscle
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)
what are the symptoms of mitral regurgitation?
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?
what are the treatment options of mitral regurgitation?
percutaneous mitral valve repair
what are the 2 drugs that can be used for mitral regurgitation?
what are the 2 surgery options of mitral regurgitation?
what are the causes of mitral stenosis?
rheumatic heart disease (although past history my be absent)
what are the symptoms of mitral stenosis?
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?
what valvular heart murmur is most likely to give you AF?
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?
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?
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?
connective tissue disease
rheumatic heart disease
what can cause problems with the aortic annulus?
acute aortic dissection
what are the symptoms of aortic regurgitation?
what are the signs of aortic regurgitation?
early diastolic murmur heard maximally in the tricuspid area
what are the treatment options of aortic regurgitation?
what drugs are used in the treatment of aortic regurgitation?
what surgery is used in the treatment of aortic regurgitation?