valvular heart disease

Question 1

what is the clinical history of valvular heart disease?

Answer 1

• chest pain
• breathlessness
• collapse / dizzy spells

Question 2

what does cardiac chest pain feel like?

Answer 2

• gripping
• squeezing
• heavy
• crushing

Question 3

describe cardiac breathlessness?

Answer 3

• related to activity (usually)
• often associated with ankle swelling
• orthopnoea = SOB on lying flat
• paroxysmal nocturnal dyspnoea (PND)

Question 4

what are the NYHA classifications?

Answer 4

1 = no limitation
2 = slight limitation of ordinary activity
3 = marked limitation of less than ordinary activity
4 = severe limitation of minimal activity or at rest

Question 5

what are the signs of right sided heart failure?

Answer 5

• raised JVP
• pitting oedema
• hepatic congestion

Question 6

how do you examine the apex beat?

Answer 6

• normally in 5th interostal mid clavicular line
• tapping apex beat = mitral stenosis
• displaced and diffuse in left ventricular dilation (volume overload)
• heaving and may e displaced in left ventricular hypertrophy (pressure overload)

Question 7

where is parasternal heave felt and why is it present?

Answer 7

• hand left of sternum

- right ventricular overload = cor pulmonale/pulmonary hypertension

Question 8

what are the steps used in order to describe a murmur?

Answer 8

1. systole / diastole
2. what type of murmur
3. where is it loudest
4. where does it radiate to
5. what grade of murmur
6. influenced by respiration?

Question 9

how to work out if it is systolic or diastolic?

Answer 9

• 1st heart sound = mitral and tricuspid valve closing, start of systole
• 2nd heart sound = aortic and pulmonary valves closing, start of diastole

Question 10

what are the types of systolic murmurs?

Answer 10

• pansystolic

- ejection systolic

Question 11

what are the types of diastolic murmurs?

Answer 11

• early diastolic

- mid diastolic

Question 12

what are the grades of murmurs?

Answer 12

I = very quiet
II = quiet - easy to hear
III = loud
IV = loud with a thrill
V = very loud with a thrill
VI = loud - audible without a stethoscope

Question 13

which sided murmur is louder on inspiration?

Answer 13

• right-sided

Question 14

what is an innocent murmur?

Answer 14

• soft (less than 3/6 severity)
• position dependent
• often early systolic (diastolic murmurs always pathological)

Question 15

what happens in valve stenosis?

Answer 15

• valves do not open properly

Question 16

what happens in valve regurgitation?

Answer 16

• valves which do not close properly

Question 17

what happens in mixed valve disease?

Answer 17

• valves which neither open properly nor close properly

Question 18

what is aortic stenosis?

Answer 18

• degenerative (age related)
• become calcified restricting the opening of the valve
• congenital (eg bicuspid valve)
• rheumatic

Question 19

what are the symptoms of aortic stenosis?

Answer 19

• breathlessness
• chest pain
• dizziness / syncope

Question 20

what are the signs of aortic stenosis?

Answer 20

• low volume pulse
• forceful displaced apex
• ejection systolic murmur that can radiate to the carotids

Question 21

what may an ECG show for aortic stenosis?

Answer 21

• LVH

but this does not diagose it

Question 22

how do you treat aortic stenosis?

Answer 22

• conventional valve treatment
• trans catheter aortic valve replacement (TAVI)
• balloon aorticvalvotomy (BAV)

Question 23

what types of prosthetic heart valves can you get?

Answer 23

• mechanical = longevity, warfarin required for prevention of clots within the valve, better for younger patients
• bio-prosthetic (tissue valve) = no warfarin required, last 10 years, better for older patients

Question 24

what are the differences between aortic valve replacement and transcatheter valve implantation?

Answer 24

AVR = preferred, long term outcomes, no contra-indications, CABG as well
TAVI = co-morbidity, previous sternotomy

Question 25

what are the causes of mitral regurgitation?

Answer 25

• leaflets = prolapse, rheumatic, myxomayous (floppy), endocarditis
• chrodae rupture (degenerative) = prolapse/flail leaflet
• papillary muscles rupture = ischaemic
• annular dilation = functional

Question 26

what are the symptoms of mitral regurgitation?

Answer 26

• breathlessness
• peripheral oedema
• fatigue

Question 27

what are the signs of mitral regurgitation?

Answer 27

• displaced apex

- pan systolic murmur (axilla)

Question 28

what is the treatment of mitral regurgitation?

Answer 28

• medication = diuretics and heart failure (ACE inhibitors)
• surgical = repair (prolapse) and replacement (degenerative)
• percutaneous = clips in infancy (encourgaing results)

Question 29

what causes mitral stenosis?

Answer 29

• rheumatic

- congenital rare

Question 30

what are the symptoms of mitral stenosis?

Answer 30

• breathlessness
• fatigue
• palpitations (AF)

Question 31

what are the signs of mitral stenosis?

Answer 31

• malar flush
• tapping apex beat
• mid diastolic rumbling diastolic murmur localised to apex

Question 32

what is the treatment of mitral stenosis?

Answer 32

• mediaction = diuretics and treat AF
• surgery = valve replacemnet
• balloon valvuloplasty

Question 33

what are the causes of aortic regurgitation?

Answer 33

• leaflets = endocarditis, connective tissue diseases, rheumatic
• annulus = marfans, aortic dissection

Question 34

what are the symptoms of aortic regurg?

Answer 34

• SOB

Question 35

what are the signs of aortic regurg?

Answer 35

• collapsing pulse
• wide pulse pressure
• displaced apex
• early diastolic murmus left sternal edge

Question 36

what is the aortic regurg treatment?

Answer 36

• meidiaction - aCE

- surgeyr = LV dilation, valve replacment