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CR2 > 29 - Valvular heart disease > Flashcards

29 - Valvular heart disease Flashcards

1
Q

Mitral valve prolapse definition

A

≥2mm systolic prolapse of 1 or both valve leaflets beyond long-axis annular plane during 2DE

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2
Q

Prevalence of mitral valve prolapse

A

2-3% affecting men and women equally

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3
Q

Pathology of mitral valve prolapse

A

Myxomatous degeneration

Marfan, Ehlers Danlos

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4
Q

Physiology of mitral valve prolapse

A

Valve leaflet(s) prolapses back into LA during systole, sometimes producing MR (variable severity - usually trivial)

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5
Q

Symptoms of MVP

A

Asymptomatic

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6
Q

Signs of MVP

A

Ejection click/late systolic murmur

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7
Q

Treatment of MVP

A

Not usually necessary

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8
Q

Causes of aortic stenosis

A

Calcific disease
Congential bicuspid valve
Rheumatic disease

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9
Q

Symptoms of aortic stenosis

A 
Dyspnoea
Angina
Syncope
LVF
Sudden death
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10
Q

What is the cause of dyspnoea in aortic stenosis

A

increased diastolic pressure in stiff non-compliant LV

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11
Q

What is the cause of angina in aortic stenosis

A

increased demand of hypertrophied LV

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12
Q

What is the cause of syncope in aortic stenosis

A

either paroxysmal ventricular arrhythmias or exertional cerebral hypoperfusion

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13
Q

What is the cause of LVF in aortic stenosis

A

Contractile failure as ventricle dilates

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14
Q

What is the cause of sudden death in aortic stenosis

A

Ventricular arrhythmias

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15
Q

Signs of aortic stenosis

A

Slow rising carotid pulse
S4+/- ejection click
Ejection systolic murmur

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16
Q

Indications of surgery in aortic stenosis

A

Any symptoms of AS

Echocardiogaphic evidence of worsening LV dilation

17
Q

Causes of aortic regurgitation

A

Aortic valve leaflet disease - calcific disease, rheumatic disease, endocarditis, congenital bicuspid valve
Aortic root dilating disease - Marfan syndrome, aortic dissection

18
Q

Symptoms of aortic regurgitation

A

Often none
Dyspnoea
Angina

19
Q

Signs of aortic regurgitation

A

Rapidly rising carotid pulse
Early diastolic murmur
Ejection murmur

20
Q

What causes Rapidly rising carotid pulse in aortic regurgitation?

A

vigorous ejection of volume loaded LV

21
Q

What causes early diastolic murmur in aortic regurgitation?

A

aortic backflow (left sternal edge

22
Q

What causes ejection murmur in aortic regurgitation

A

Turbulent ejection from volume loaded LV

23
Q

How do you investigate aortic regurgitation

A

Aortic root angiogram

2D echo doppler

24
Q

Indications for surgery for Atrial regurgitation

A

Any symptom of AR

Echocardiogram evidence of worsening LV dilation

25
Q

Cause of mitral stenosis

A

Rheumatic fever

26
Q

Symptoms of mitral stenosis

A

Dyspnoea, orthopnoea
RV failure
Palpitations
Systemic emboli

27
Q

What causes dyspnoea in mitral stenosis

A

Increeased left atrial pressure

28
Q

What causes RV failure in mitral stenosis

A

Passive consequence of increased left atrial pressure and reactive pulmonary vasoconstriction

29
Q

What causes palpitations in mitral stenosis

A

AFib

- can cause systemic emboli as static blood within dilated fibrillating left atrium predisposes to thrombosis

30
Q

Signs of mitral stenosis

A

Pulse - AF
Auscultation - Loud S1, opening snap, mid diastolic rumble, +/- pre-systolic murmur
Volume overload - increased JVP, basal creps, ankle oedema

31
Q

What are the causes of mitral regurgitation

A

Mitral valve leaflet disease - prolapse, rheumatic, infective endocarditis
Subvalvular disease -cordal rupture, papillary muscle dysfunction, papillary muscle rupture
Functional MR - LV dilation

32
Q

Symptoms of mitral regurgitation

A

Dyspnoea, orthopnoea - increased left atrial pressure
Palpitations- atrial fibrillation
Systemic emboli- static blood within dilated fibrillating left atrium predisposes to thrombosis

33
Q

Signs of mitral regurgitation

A

Pulse - SR/AF
Auscultation - Pansystolic murmur - S3
Volume overload - increased JVP, basal creps ,ankle oedema

34
Q

Investigations for mitral regurgitation

A

M-mode echo

LV angiogram

35
Q

Indications for surgery with mitral regurgitation

A

Symptoms that fail to respond to medical treatment
Worsening CV complications
Pulmonary hypertension
LV dilation

36
Q

Medical treatment for valvular heart disease

A

Diuretics for fluid retention
Vasodilators - low output due to regurgiant valves
AF - digoxin, BB, verapamil
Anticoagulants - protect against embolisation

CR2 (34 decks)

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