29 - Valvular heart disease Flashcards
Mitral valve prolapse definition
≥2mm systolic prolapse of 1 or both valve leaflets beyond long-axis annular plane during 2DE
Prevalence of mitral valve prolapse
2-3% affecting men and women equally
Pathology of mitral valve prolapse
Myxomatous degeneration
Marfan, Ehlers Danlos
Physiology of mitral valve prolapse
Valve leaflet(s) prolapses back into LA during systole, sometimes producing MR (variable severity - usually trivial)
Symptoms of MVP
Asymptomatic
Signs of MVP
Ejection click/late systolic murmur
Treatment of MVP
Not usually necessary
Causes of aortic stenosis
Calcific disease
Congential bicuspid valve
Rheumatic disease
Symptoms of aortic stenosis
Dyspnoea Angina Syncope LVF Sudden death
What is the cause of dyspnoea in aortic stenosis
increased diastolic pressure in stiff non-compliant LV
What is the cause of angina in aortic stenosis
increased demand of hypertrophied LV
What is the cause of syncope in aortic stenosis
either paroxysmal ventricular arrhythmias or exertional cerebral hypoperfusion
What is the cause of LVF in aortic stenosis
Contractile failure as ventricle dilates
What is the cause of sudden death in aortic stenosis
Ventricular arrhythmias
Signs of aortic stenosis
Slow rising carotid pulse
S4+/- ejection click
Ejection systolic murmur
Indications of surgery in aortic stenosis
Any symptoms of AS
Echocardiogaphic evidence of worsening LV dilation
Causes of aortic regurgitation
Aortic valve leaflet disease - calcific disease, rheumatic disease, endocarditis, congenital bicuspid valve
Aortic root dilating disease - Marfan syndrome, aortic dissection
Symptoms of aortic regurgitation
Often none
Dyspnoea
Angina
Signs of aortic regurgitation
Rapidly rising carotid pulse
Early diastolic murmur
Ejection murmur
What causes Rapidly rising carotid pulse in aortic regurgitation?
vigorous ejection of volume loaded LV
What causes early diastolic murmur in aortic regurgitation?
aortic backflow (left sternal edge
What causes ejection murmur in aortic regurgitation
Turbulent ejection from volume loaded LV
How do you investigate aortic regurgitation
Aortic root angiogram
2D echo doppler
Indications for surgery for Atrial regurgitation
Any symptom of AR
Echocardiogram evidence of worsening LV dilation
Cause of mitral stenosis
Rheumatic fever
Symptoms of mitral stenosis
Dyspnoea, orthopnoea
RV failure
Palpitations
Systemic emboli
What causes dyspnoea in mitral stenosis
Increeased left atrial pressure
What causes RV failure in mitral stenosis
Passive consequence of increased left atrial pressure and reactive pulmonary vasoconstriction
What causes palpitations in mitral stenosis
AFib
- can cause systemic emboli as static blood within dilated fibrillating left atrium predisposes to thrombosis
Signs of mitral stenosis
Pulse - AF
Auscultation - Loud S1, opening snap, mid diastolic rumble, +/- pre-systolic murmur
Volume overload - increased JVP, basal creps, ankle oedema
What are the causes of mitral regurgitation
Mitral valve leaflet disease - prolapse, rheumatic, infective endocarditis
Subvalvular disease -cordal rupture, papillary muscle dysfunction, papillary muscle rupture
Functional MR - LV dilation
Symptoms of mitral regurgitation
Dyspnoea, orthopnoea - increased left atrial pressure
Palpitations- atrial fibrillation
Systemic emboli- static blood within dilated fibrillating left atrium predisposes to thrombosis
Signs of mitral regurgitation
Pulse - SR/AF
Auscultation - Pansystolic murmur - S3
Volume overload - increased JVP, basal creps ,ankle oedema
Investigations for mitral regurgitation
M-mode echo
LV angiogram
Indications for surgery with mitral regurgitation
Symptoms that fail to respond to medical treatment
Worsening CV complications
Pulmonary hypertension
LV dilation
Medical treatment for valvular heart disease
Diuretics for fluid retention
Vasodilators - low output due to regurgiant valves
AF - digoxin, BB, verapamil
Anticoagulants - protect against embolisation
