CARDIOVASCULAR Valvular Disease
Dec 14, 2015
CARDIOVASCULARValvular Disease
What are we going to do?
How do murmurs present? What causes murmurs? What the **** is this murmur?
QUIZ!
By the end of the session…
You will hopefully be able to: Recognise symptoms and signs of
valvular disease Understand why certain valve defects
result in the murmurs you hear Begin to recognise common murmurs
Symptoms and Signs
SYMPTOMS: Progressive
dyspnoea Orthopnoea PND Syncope Fatigue Palpitations
SIGNS: Slow rising pulse Collapsing pulse Malar flush Raised JVP RV or LV heave Thrills Displaced apex beat Signs of heart failure MURMUR
Types and Pathophysiology
Mitral Stenosis Rheumatic fever
Mitral Regurgitation: Rheumatic fever/ruptured chordae tendinae
due to MI
Aortic Stenosis: Calcification with age/congenital bicuspid
valve Aortic Regurgitation:
Connective tissue disorders e.g. Marfan’s or Ehlers Danlos
Cardiac cycle
In your groups on the poster paper can you draw/write/take complete artistic
license and illustrate the cardiac cycle by pretending you are a solitary RBC on its way home from a busy day oxygenating
tissues
Cardiac Cycle
Aortic Stenosis
Mitral Regurgitation
Aortic Regurgitation
Mitral Stenosis
Auscultation
Auscultation
Normal: http://www.dundee.ac.uk/medther/Cardiology/audio/normal.wav
AS: (click on late aortic stenosis)http://www.med.ucla.edu/wilkes/Systolic.htm
MR: (click on mitral regurg)http://www.med.ucla.edu/wilkes/Systolic.htm
Useful(ish) sites:http://www.med.ucla.edu/wilkes/inex.htmhttp://www.dundee.ac.uk/medther/Cardiology/hsmur.htmlhttp://www.med.umich.edu/lrc/psb/heartsounds/
Presenting Murmurs
Take your time listening to the murmurs Grade Is it diastolic or systolic? Where can you hear it? Where does it radiate to? What are your differentials?
Grading of murmurs
Intensity Grading
1 Just audible with stethoscope in a quiet room
2 Audible with stethoscope
3 Easily audible with a stethoscope
4 Loud murmur + palpable thrill
5 Very loud murmur heard elsewhere in the body
6 Heard without stethoscope
Aortic Stenosis
Sounds like: (click on AS) http
://www.med.ucla.edu/wilkes/Systolic.htm Coarse Ejection systolic murmur Heard in all areas – sash like distribution Radiates to carotids Differentials MR
Mitral Regurgitation
Sounds like: (click on MR) http
://www.med.ucla.edu/wilkes/Systolic.htm Harsh – (but softer than AS) Pan systolic murmur Heard in apex Radiates to anterior axilla Differential AS
Aortic Reguritation
Sounds like: http://www.dundee.ac.uk/medther/Cardiolo
gy/audio/ar.wav
Soft – best heard with patient sat leaning forwards
Early diastolic murmur Heard in aortic area No real radiates Differential is MS
Mitral Stenosis
Sounds like: http://www.dundee.ac.uk/medther/Cardiolo
gy/audio/ms.wav
Soft – low rumbling Mid to late diastolic murmur Heard in axilla (with the bell) No real radiation Differential is MS
QUIZ TIME!!
Quiz
Q1:
Which valves would be open during ventricular systole?
Answer:
Aortic & Pulmonary
Quiz
Q2:
A stethoscope placed over the left second intercostal space just lateral to the sternum would be best positioned to detect sounds associated with which heart valve?
Answer:
Pulmonary
Quiz
Q3:
Which statement is true of the right atrioventricular valve? A. it is also called the mitral valveB. it is open during ventricular diastoleC. it transmits oxygenated bloodD. it is opened by the pull of chordae tendineaeE. it consists of 2 leaflets
Answer:
B - it is open during ventricular diastole
Quiz
Q4:
Give any 3 SYMPTOMS of valvular disease
Answer:
Progressive dyspnoea, Orthopnoea, PND, Syncope, Fatigue, Palpitations….
Quiz
Q5:
Give any 3 SIGNS of valvular disease
Answer:
Slow rising pulse, Malar flush, Raised JVP, RV or LV heave, Displaced apex beat, Signs of heart failure, MURMUR…
Bonus Round!!!
Bonus Round
BONUS Q1:
Mullet wearer Billy Ray Cyrus had a hit in 1992 with which song?
Answer:
Achy Breaky Heart
Bonus Round
BONUS Q2:
1997 film Titantic featured which Celine Dion song?
Answer:
My Heart Will Go On
Bonus Round
BONUS Q3:
In which film did Mel Gibson portray William Wallace with one of the worst Scottish accents ever?
Answer:
Braveheart
Bonus Round
BONUS Q4:
Which English goalkeeper signed for Manchester City in 2006?
Answer:
Joe Hart
Bonus Round
BONUS Q5:
Name an organ
Answer:
Mouth Organ
Quiz
Q6:
Which valvular disease produces an ejection systolic murmur?
Answer:
Aortic Stenosis
Quiz
Q7:
a) What produces the S1 heart sound?b) At what point in the cardiac cycle is this heard?
Answer:
a) Turbulence of blood due to closure of the Mitral and Tricuspid Valves
b) End of Diastole/Start of Systole
Quiz
Q8:
Name some possible causes of Mitral Regurgitation
Answer:
Mitral valve prolapse (2o to MI, chordae tendineae rupture), Rheumatic Fever, Marfan’s…
Quiz
Q9:
What is the most common cause of Mitral Stenosis?
Answer:
Rheumatic Fever
Scarlet Fever
Quiz
Q10:
Which valvular disease produces a pan-systolic murmur?
Answer:
Mitral Regurgitation
THANK YOU!!!!
PulmonaryAortic
Tricuspid
Mitral