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Cardiology > 2: Valve Defects > Flashcards

2: Valve Defects Flashcards

1
Q

What causes mitral stenosis

A

Rheumatic Disease/Fever

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2
Q

What are 4 causes of mitral regurgitation

A
  • IHD
  • Mitral valve prolapse
  • Degenerative calcification
  • Dilated cardiomyopathy
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3
Q

What are 2 causes of aortic stenosis

A
  • Calcification

- Bicuspid aortic valve

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4
Q

What are 3 causes of aortic regurgitation

A
  • Bicuspid aortic valve
  • Connective tissue disorder
  • Infective endocarditis
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5
Q

What are 2 causes of tricuspid stenosis

A
  • Infective endocarditis in IVDU

- Rheumatic fever

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6
Q

What are 4 causes of tricuspid regurgitation

A
  • IE in IVDU
  • Right-Ventricle dilation
  • Rheumatic fever
  • Connective tissue disorder
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7
Q

What is a cause of pulmonary stenosis

A

Congenital

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8
Q

What are 2 causes of pulmonary regurgitation

A
  • Pulmonary HTN

- Dilated cardiomyopathy

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9
Q

What can cause pulmonary HTN

A

VSD

TOF

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10
Q

What is aortic stenosis

A

narrowing of the aortic valve

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11
Q

What is the commonest valvular heart disease

A

aortic stenosis

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12
Q

In which population is aortic stenosis more common

A

elderly

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13
Q

What is a supra-valvular cause of aortic stenosis

A

william’s syndrome

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14
Q

What are 2 causes of valvular aortic stenosis

A
  • degenerative calcification

- bicuspid aortic valve

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15
Q

What is the commonest cause of valvular aortic stenosis in >65y

A
  • degenerative calcification
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16
Q

What is the commonest cause of valvular aortic stenosis in <65y

A
  • bicuspid aortic valve
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17
Q

What is the most common congenital heart defect

A

bicuspid aortic valve

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18
Q

Is bicuspid aortic valve more common in Male or females

A

male

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19
Q

What is the problem with bicuspid aortic valve

A

predisposes to degenerative calcification. Meaning these individuals have aortic stenosis a lot younger than those with tricuspid valves

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20
Q

What is a sub-valvular cause of aortic stenosis

A

HOCM

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21
Q

what is the triad of symptoms associated with aortic stenosis

A

‘SAD’
Syncope
Angina
Dyspnoea

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22
Q

what murmur is heard in aortic stenosis

A

Ejection Systolic Crescendo-Decrescendo murmur

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23
Q

what pulse is associated with aortic stenosis

A

Pulsus parvus et tardes - slow rising pulse

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24
Q

what is pulses parvus de tardus

A

slow rising pulse

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25
Q

how do heart sounds change in aortic stenosis

A

soft S2

S4

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26
Q

what can be felt in aortic stenosis

A

Thrill

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27
Q

explain pathophysiological consequences of aortic stenosis

A
  • narrowing in aortic valve causes back-up of pressure
  • left ventricle undergoes hypertrophy to compensate
  • initially keeps up with demands but eventually the left ventricle will become stiff resulting in diastolic dysfunction
  • this means left-ventricle ejection depends on the atria which undergoes hypertrophy to maintain EDV
  • hypertrophy increases oxygen demands leading to ischaemia
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28
Q

What investigations are performed in aortic stenosis

A
  1. Trans-thoracic ECHO

2. ECG

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29
Q

What will an ECG show in aortic stenosis

A

Left Ventricular Hypertrophy

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30
Q

What criteria is used to diagnose LVH on ECG

A

Sokolow-Lyon Criteria

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31
Q

What value defines mild aortic stenosis on ECHO

A

1.2-.18

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32
Q

What diameter defines moderate aortic stenosis

A

0.8-1.2

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33
Q

What diameter defines severe aortic stenosis

A

0.6-0.8

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34
Q

What diameter defines critical aortic stenosis

A

<0.6

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35
Q

What are the two management options for aortic stenosis

A

Conservative

Surgical

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36
Q

When is conservative management indicated

A

Asymptomatic

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37
Q

When is surgical management indicated

A
  • Symptomatic

- Asymptomatic with pressure gradient >40mmHg

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38
Q

What are the 3 surgical options for aortic stenosis

A
  • Surgical aortic valve replacement
  • Trans-catheter aortic valve implantation (TAVI)
  • catheter ballon valvuloplasty
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39
Q

When are transcutaneous aortic valve implantation performed

A

if too high a surgical risk

40
Q

When is catheter balloon valvuloplasty performed

A

Children - no aortic calcification

41
Q

What can aortic stenosis cause

A
  • Left-sided HF
  • Infective endocarditis
  • Sudden death
42
Q

What is aortic regurgitation

A
  • incomplete closing of the valve leaflets, resulting in the regurgitation of blood from the aorta to the left ventricle
43
Q

How can the aetiology of aortic regurgitation be divided

A
  • Acute

- Chronic

44
Q

What are 3 causes of acute aortic regurgitation

A
  • Infective endocarditis
  • Aortic dissection
  • Trauma
45
Q

What are 4 causes of chronic aortic regurgitation

A
  • Congenital bicuspid aorta
  • Rheumatic fever
  • Syphillis
  • Connective tissue disorder
46
Q

What is the most common cause of chronic aortic regurgitation in developed countries

A

Congenital bicuspid aorta

47
Q

What is the most common cause of chronic aortic regurgitation in developing countries

A

Rheumatic Fever

48
Q

What are 3 symptoms of acute aortic regurgitation

A
  • Dyspnoea
  • Cardiac decompensation due to HF
  • Pulmonary oedema
49
Q

How may chronic aortic regurgitation present

A
  • May be asymptomatic for years
  • Present with left-sided HF
  • Palpitations
50
Q

What murmur is heard in aortic regurgitation

A

Early diastolic murmur

51
Q

What type of pulse is present in aortic regurgitation

A
  • Wide pulse pressure = waterhammer pulse

- Collapsing pulse

52
Q

What is a water hammer pulse

A

Also referred to as corigan’s sign it is caused by a wide pulse pressure. The pulse will be forcefully present and suddenly disappear

53
Q

What is another term for water hammer pulse of collapsing pulse when seen at the carotids

A

Corrigan’s sign

54
Q

What are 3 signs of aortic regurgitation

A

Quinicke’s sign
De Musset’s sign of regurgitation
Corrigan’s sign

55
Q

What murmur is heard in severe aortic regurgitation

A

Austin Flint Murmur = mid-diastolic murmur

56
Q

Why does aortic regurgitation cause a wide pulse-pressure

A

In AR there is regurgitation of blood from the aorta into the left ventricle. This means already ejected blood (systolic BP) refluxes back, reducing diastolic blood pressure in the aorta giving a raised systolic and decreased diastolic BP

57
Q

Explain pathophysiology of acute AR

A

The left ventricle cannot sufficiently dilate to accommodate blood increasing end diastolic pressure which is transmitted back to the pulmonary circulation to cause pulmonary oedema and breathlessness. Also will decrease cardiac output causing cariogenic shock

58
Q

Explain pathophysiology of chronic AR

A

Initially there is a compensatory increase in SV. Over time increase in EDV will cause LV dilation and heart failure.

59
Q

What is first-line investigation for AR

A

Transthoracic ECHO

60
Q

What is the treatment of aortic regurgitation

A

Aortic valve replacement

61
Q

What will aortic regurgitation eventually lead to

A

Heart Failure

62
Q

What is mitral stenosis

A

abnormality of the mitral valve that obstructs flow from the left atrium to the left ventricle

63
Q

What causes mitral stenosis

A

rheumatic fever

64
Q

How will mitral stenosis present clinically

A
  • Asymptomatic at first. May present up to 10y following rheumatic heart disease
  • Dyspnoea
  • Haemoptysis
  • AF
65
Q

What murmur is present in mitral stenosis

A

mid-diastolic murmur

66
Q

How do heart sounds vary in mitral stenosis

A

loud S1 (opening snap)

67
Q

What sign will be present in mitral stenosis and why

A

malar flush. Due to reduced cardiac output there is an accumulation of CO2 in tissues which has a vasodilatory effect

68
Q

Why may AF occur in mitral stenosis

A

reduced flow from left atrium to ventricle increases EDV in the left atrium. This results in dilation of the left atrium. Dilation of the left atrium predisposes to AF.

69
Q

What is palpable in mitral stenosis

A

LV heave

70
Q

What eponymous name is given to the murmur in mitral stenosis

A

Graham-Steel murmur = a high pitched early diastolic murmur

71
Q

Explain the pathophysiology of mitral valve stenosis

A

There is obstruction of flow from left atrium to ventricle. This decreases blood in the left ventricle and hence cardiac output. Initially the left atrium compensates by dilating. Eventually it will decompensated resulting in blood flowing back towards the lungs and increasing pulmonary capillary pressure resulting in pulmonary oedema.

72
Q

What investigations are ordered for mitral stenosis

A
  1. ECG
  2. CXR
  3. ECHO
73
Q

What may be seen on ECG

A

P mitrale

AF

74
Q

What may be seen on CXR

A

Signs of pulmonary oedema (A-E)

75
Q

What is the management of mitral valve stenosis

A
  • Balloon valvuloplasty
  • Mitral valve replacement
  • Open commissurotomy
76
Q

What are 3 complications of mitral stenosis

A
  • AF- can lead to thrombotic event
  • Left-sided HF
  • Enlarged left atrium may compress oesophagus or recurrent laryngeal (rare)
77
Q

What is mitral regurgitation

A

Reflux of blood from the left ventricle into the left atrium

78
Q

What is the second most common type of valve disease

A

Mitral regurgitation

79
Q

How can aetiology of mitral valve disease be divided

A

Primary

Secondary

80
Q

What is primary mitral valve regurgitation

A

No underlying heart disease

81
Q

What can cause primary mitral valve regurgitation

A

Rheumatic Fever
Infective endocarditis
Mitral valve prolapse

82
Q

What is secondary mitral valve regurgitation

A

MR due to underlying cardiac disease

83
Q

What can cause secondary mitral valve regurgitation

A
  • MI involving papillary muscles
  • Dilated cardiomyopathy
  • Left-sided HF
84
Q

What is a major risk factor for mitral valve regurgitation

A

Connective tissue disorders

85
Q

How do patients with mitral valve regurgitation typically present

A

Asymptomatic.

If symptoms - caused by left ventriclar failure

86
Q

What are symptoms of mitral valve regurgitation

A
  • Left sided HF
  • Pulmonary Oedema
  • Palpitations
87
Q

What murmur is heard in mitral regurgitation

A

pan systolic murmur

88
Q

How do heart sounds vary in MR

A

Quiet S1

Split S2

89
Q

Explain the pathophysiology of MR

A

Reflux of blood from the left ventricle to the left atrium. This decreases cardiac output. To try and maintain CO, the left ventricle undergoes hypertrophy but this increases oxygen demand

90
Q

What may be seen on ECG in MR

A

P mitrale

91
Q

What investigation is ordered for MR

A

Transthoracic ECHO

92
Q

How is acute MR managed pharmacologically

A

Need to try and stabilise the patient by giving nitrates, diuretics (offload fluid) and anti-HTN

93
Q

If pharmacological management is insufficient how should acute MR be managed

A

intra-aortic balloon pump

94
Q

When is conservative management chosen in chronic MR

A

if ejection fraction is normal (>60%) and patient is asymptomatic

95
Q

When is valve replacement indicated in MR

A
  1. Symptomatic

2. Or, asymptomatic and decreased ejection fraction <60%

96
Q

What are the complications of MR

A
  • AF
  • HF
  • Endocarditis

Cardiology (13 decks)

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