Ventricular heart disease Flashcards Preview

CIDR/FoCP > Ventricular heart disease > Flashcards

Flashcards in Ventricular heart disease Deck (11):
1

Aortic stenosis clinical features

Common
Exertional breathlessness
Syncope
Chest pain
Slow rising pulse
Ejection systolic murmur radiating to the carotids

2

Indication for op in asymptomatic AS

Valve area <1cm
Consider in:
• Abnormal exercise test
• Fast progression on follow up
• LV dysfuntion
• Severe associated LVH
• Recurrent otherwise unexplained ventricular arrhythmias

3

Mitral stenosis clinical features

Now rare due to fall in rheumatic heart disease
Exertion breathlessness (can provoke tachycardia and pulmonary oedema)
Haemoptysis
Systemic embolism
Malar flush
Prominent 1st heart sound and low pitched diastolic murmur radiating to the axilla
Complications: thromboembolism, not automatic progression of lesion, often have sudden deterioration when they develop AF

4

Percutaneous mitral valvotomy

For MS
Mortality very low
Severe MR occurs in 2%
Improves survival rates
Possible reduction in thromboembolic events

5

Indications for percutaneous mitral valvotomy in asymptomatic patients

Valve area <1.5cm
High risk for thromboembolism
Pulmonary hypertension
Desire for pregnancy

6

Warfarin in MS

Yes if in AF (aim for 2.5-3.5 INR)
In sinus rhythm, give if:
• LA >5cm
• Presence of echo contrast
• Thrombus in LA
• Previous thromboembolic event
Note: other, newer anticoagulants may be better

7

Aortic regurgitation clinical features

Fairly common
Often asymptomatic at presentation
Breathless on exertion
Awareness of a normal heart beat
Angina is late
Bizarre eponymous features: De Musset's sign (head bobbing), Corrigan's pulse (collapsing pulse), Quinke's sign (pulsing nail beds), pistol shot femorals
Wide pulse pressure
Early diastolic murmur (leaning forward, held expiration, LLSE)
Assess via echo

8

Aortic regurgitation causes

Rheumatic fever
Bicuspid valve
Dilated aortic root
Infective endocarditis
Ventricular septal defect

9

Indications for operation in asymptomatic AR

Left ventricular failure
Left ventricular enlargement
nb. symptoms is often too late!

10

Mitral regurgitation clinical features

Common
Often asymptomatic
Pulmonary oedema
Heart failure
Breathlessness
Pansystolic murmur at apex
Echo to assess

11

Mitral regurgitation causes

Secondary to poor LV function and dilatation of the mitral valve ring
Mitral valve prolapse
Rheumatic fever
Endocarditis
Associated with hypertrophic cardiomyopathy