15. Valve Disease Flashcards
What are the causes of aortic stenosis?
Degenerative calcification Congenital bicuspid valve Rheumatic fever Radiation Connective tissue disease
What are the risks for aortic stenosis?
End stage renal disease
High cholesterol
Atherosclerosis
Why is LV hypertrophy a consequence of aortic stenosis?
High pressure gradient means LV is at a higher pressure to maintain CO
What can result from aortic stenosis?
Heart failure
Arrhythmias
Syncope
Angina
What are the signs of aortic stenosis?
Ejection systolic murmur at the right upper sternal border, radiating to carotids Low volume slow rising pulse Single S2 S4 Displaced apex beat
What effect does aortic regurgitation have on heart mechanics?
Increases end diastolic volume
What are the causes of aortic regurgitation?
Cusp disease
Aortic root dilation
Aortic dissection
What are the symptoms of aortic regurgitation?
Palpitations
Atypical chest pain
Symptoms of LV HF
What are the signs of aortic regurgitation?
‘Waterhammer’ pulse
Diastolic murmur which is relieved with Valsalva manoeuvre
What is the most common cause of mitral stenosis?
Rheumatic fever (‘fish mouth’ appearance)
What effect does mitral stenosis have on the heart?
LA dilatation, leading to atrial fib and embolus
What are the signs of mitral stenosis?
Malar flush
Increased JVP
Opening snap
Right sided heart failure
What are the causes of mitral regurgitation?
Rheumatic Infective endocarditis Mitral valve prolapse Rupture of papilllary muscle/chordae tendinae LV dilation
What are the signs of mitral regurgitation?
Pansystolic murmur radiating to axilla
Atrial fibrillation
What are the common causes of tricuspid stenosis?
Rheumatic or carcinoid syndrome
What are the common causes of tricuspid regurgitation?
Endocarditis in an IVDU or LV failure
What set of criteria are used to assess rheumatic fever?
Jones criteria
What are the major criteria in the Jones criteria?
Polyarthritis Carditis Sydenham's chorea Erythema marginatum Subcutaneous nodules
What are the minor criteria in the Jones criteria?
Fever
Arthralgia
Elevated CRP or ESR
Prolonged PR
What are the microscopic signs of rheumatic fever?
Aschoff bodies or Anitschokow cells at any level of the heart
What is the difference between acute and subacute endocarditis?
Acute: normal valve and virulent organism
Subacute: Deformed valve and less virulent organism
What are common pathogens in acute endocarditis?
Staph aureus
Enterococcus faecalis
What is the most common pathogen in subacute endocarditis?
Strep viridans
What is the most common pathogen on prosthetic valves?
Staph epidermidis
What is non-infective endocarditis in debilitated patients known as?
Marantic endocarditis
What non-infective endocarditis is associated with lupus?
Libman-Sacks disease
What effect does a left to right shunt have on circulation?
Increase pulmonary blood flow causing pulmonary hypertension
What is shunt reversal known as?
Eisenmenger’s syndrome
What are the symptoms of ASD?
Well tolerated and usually asymptomatic
Can cause paradoxical embolisation
What is paradoxical embolisation?
Thrombus crosses an intracardiac defect into systemic circulation
What are the symptoms of a right to left shunt?
Hypoxaemia and cyanosis
Paradoxical embolism
Polycythaemia
What is the sign of aortic coarctation?
Higher BP in upper limbs than in lower limbs
What investigations can be done into valve disease?
ECHO TOE for mitral valve ECG CXR, MRI Cardiac catheterisation
What weeks of gestation are CV structures formed?
3-8 weeks
