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Cardiovascular

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

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Cardiovascular

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  1. Cardiovascular Valvular Disease

  2. What are we going to do? • How do murmurs present? • What causes murmurs? • What the **** is this murmur? • QUIZ!

  3. 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

  4. 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

  5. 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

  6. 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

  7. Cardiac Cycle

  8. Aortic Stenosis

  9. Mitral Regurgitation

  10. Aortic Regurgitation

  11. Mitral Stenosis

  12. Auscultation

  13. Auscultation Normal: http://www.dundee.ac.uk/medther/Cardiology/audio/normal.wav AS: (click on lateaorticstenosis) http://www.med.ucla.edu/wilkes/Systolic.htm MR: (click on mitralregurg) http://www.med.ucla.edu/wilkes/Systolic.htm Useful(ish) sites: http://www.med.ucla.edu/wilkes/inex.htm http://www.dundee.ac.uk/medther/Cardiology/hsmur.html http://www.med.umich.edu/lrc/psb/heartsounds/

  14. 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?

  15. Grading of murmurs

  16. 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

  17. 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

  18. Aortic Reguritation • Sounds like: • http://www.dundee.ac.uk/medther/Cardiology/audio/ar.wav • Soft – best heard with patient sat leaning forwards • Early diastolic murmur • Heard in aortic area • No real radiates • Differential is MS

  19. Mitral Stenosis • Sounds like: • http://www.dundee.ac.uk/medther/Cardiology/audio/ms.wav • Soft – low rumbling • Mid to late diastolic murmur • Heard in axilla (with the bell) • No real radiation • Differential is MS

  20. QUIZ TIME!!

  21. Quiz Q1: Which valves would be open during ventricular systole? Answer: Aortic & Pulmonary

  22. 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

  23. Quiz Q3: Which statement is true of the right atrioventricular valve? • it is also called the mitral valve • it is open during ventricular diastole • it transmits oxygenated blood • it is opened by the pull of chordae tendineae • it consists of 2 leaflets Answer: B - it is open during ventricular diastole

  24. Quiz Q4: Give any 3 SYMPTOMS of valvular disease Answer: Progressive dyspnoea, Orthopnoea, PND, Syncope, Fatigue, Palpitations….

  25. 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…

  26. Bonus Round!!!

  27. Bonus Round BONUS Q1: Mullet wearer Billy Ray Cyrus had a hit in 1992 with which song? Answer: Achy Breaky Heart

  28. Bonus Round BONUS Q2: 1997 film Titantic featured which Celine Dion song? Answer: My Heart Will Go On

  29. Bonus Round BONUS Q3: In which film did Mel Gibson portray William Wallace with one of the worst Scottish accents ever? Answer: Braveheart

  30. Bonus Round BONUS Q4: Which English goalkeeper signed for Manchester City in 2006? Answer: Joe Hart

  31. Bonus Round BONUS Q5: Name an organ Answer: Mouth Organ

  32. Quiz Q6: Which valvular disease produces an ejection systolic murmur? Answer: Aortic Stenosis

  33. Quiz Q7: a) What produces the S1 heart sound? b) At what point in the cardiac cycle is this heard? Answer: • Turbulence of blood due to closure of the Mitral and Tricuspid Valves • End of Diastole/Start of Systole

  34. Quiz Q8: Name some possible causes of Mitral Regurgitation Answer: Mitral valve prolapse (2o to MI, chordae tendineae rupture), Rheumatic Fever, Marfan’s…

  35. Quiz Q9: What is the most common cause of Mitral Stenosis? Answer: Rheumatic Fever Scarlet Fever

  36. Quiz Q10: Which valvular disease produces a pan-systolic murmur? Answer: Mitral Regurgitation

  37. THANK YOU!!!!

  38. Aortic Pulmonary Mitral Tricuspid

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