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