CARDIOVASCULAR Valvular 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

Normal: AS: AS: (click on late aortic stenosis) MR: MR: (click on mitral regurg) Useful(ish) sites:

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 IntensityGrading 1Just audible with stethoscope in a quiet room 2Audible with stethoscope 3Easily audible with a stethoscope 4Loud murmur + palpable thrill 5Very loud murmur heard elsewhere in the body 6Heard without stethoscope

Aortic Stenosis  Sounds like: (click on AS)   Coarse  Ejection systolic murmur  Heard in all areas – sash like distribution  Radiates to carotids  Differentials MR

Mitral Regurgitation  Sounds like: (click on MR)   Harsh – (but softer than AS)  Pan systolic murmur  Heard in apex  Radiates to anterior axilla  Differential AS

Aortic Reguritation  Sounds like:  ar.wav 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:  ms.wav 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 valve B. it is open during ventricular diastole C. it transmits oxygenated blood D. it is opened by the pull of chordae tendineae E. 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 (2 o 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!!!!

Pulmonary Aortic Tricuspid Mitral