1b Structural Heart Disease Flashcards
Which side of the heart is the bicuspid (mitral) valve on?
Left side
Which side of the heart is the tricuspid valve on?
The right side
What do structural heart diseases cover?
Number of defects which affect the valves and chambers of the heart
What are some examples of congenital heart diseases?
Atrial Septum defects
Ventricular septem defects
Coarctation of Aorta
Tetralogy of Fallot
Which are the examples of Structural Heart Disease which develops later in life?
Due to valvular dysfunction - Atrial Stenosis / regurgitation or muscular (cardiomyopathies)
Describe the pathology which occurs in Atrial and Ventricular Septum Defects?
Holes between either ventricles or atria - separates left and right
therefore, there is mixing of the blood which is oxygenated and deoxygenated
Left = under higher pressure so when right blood enters into left = results in overload and hypertension leading to right sided heart failure
What are the four problems in Tetralogy of Fallot?
- Over riding aorta
- Right ventricular hypertrophy
- Ventricular septum defects
- Pulmonary Valve Stenosis
What is coarctation of the aorta?
When the wall of the aorta bends in on itself and becomes constricted, reducing stroke volume and cardiac output resulting in breathlessness
What are the four types of valvular defects?
Aortic Stenosis / Regurgitation
Mitral Stenosis / Regurgitation
Can you get pulmonary / tricuspid defects?
Yes but they are significantly more uncommon
What two things indicate aortic stenosis?
Early peaking, systolic ejection murmur - confirmed through echo
What preceeds aortic stenosis?
aortic sclerosis
What is aortic sclerosis?
Aortic valve thickening without flow limitation
What are the risk factors associated with Aortic Stenosis?
Hypertension
High LDL
Smoking
CRP
CKD
Radtiotherapy
What are the causes of Aortic Stenosis?
Rheumatic Heart Disease
Congenital Heart Disease
Calcium Build Up
Why is a murmur present in aortic stenosis?
When there is blood which is force flowing against calcified wall results in a murmur
What happens to the valvular endocardium in aortic stenosis?
The valvular endocardium is damaged as the result of abnormal blood flow across the valve (in the case of a bicuspid valve) or by an unknown trigger.
Why is calcium deposited on the valve?
Endocardial injury initiates an inflammatory process similar to atherosclerosis and ultimately leads to leaflet fibrosis and deposition of calcium on the valve.
What leads to stenosis?
Progressive fibrosis and calcium deposition limit the leaflet mobility and eventually produce stenosis
Why does rheumatic disease lead to AS?
Autoimmune inflammatory reaction = triggered prior to streptococus infection which targets the valvular endothelium, leads to inflammation and eventually calcification
How can AS lead to heart failure?
Long standing pressure overload -> left ventricular hypertrophy as more blood in the left ventricle
Ventricle does try to maintain normal wall stress (afterload) despite the increased pressure caused by the stenosis
Eventually this becomes too much, so systolic function declines as wall stress increases resulting in systolic heart failure
What type of murmur will be present in patient with Aortic Stenosis?
Ejection systolic murmur (≥3/6 is present with a crescendo-decrescendo pattern that peaks in mid-systole and radiates to the carotid)
What symptoms might someone with Aortic Stenosis have?
Exertional dyspnoea
fatigue
Chest Pain
What four investigations should be done for a patient with suspected Aortic Stenosis?
Transthoracic echocardiography
ECG Chest X ray (LVH)
Cardiac catheterisation
Cardiac MRI