38. Valvular Heart Disease Flashcards

1
Q

What is rheumatic heart disease?

What would you use to inspect heart valves?

What are the 6 types of common valve lesions?

A

From rheumatic fever, caused by strep, sore throat, autoimmune inflammatory reaction, affects heart valves -> scar -> valvular stenosis/regurg. particularly MITRAL valve affected. Lss common now b/c of environmental factors, decrease in virulence of group A strep, and surgery (valve replacement)

Echocardiogram + doppler, or 2D echo

AS MR AR MS (only caused by RHD) and mitral valve prolapse, R sided valve lesions

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2
Q

What is mitral valve prolapse?

What would you hear and when?

What is the treatment?

A

As L ventricle contracts and mitral valve shuts in systole, in pts with floppy valves, mitral valve prolapses back into L atrium -> click. (Sometimes producing mitral regurg).

Late systolic murmur (and possibly ejection click)

Usually not needed.

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3
Q

What is aortic steosis?

What are the causes?

What are the symptoms?

What are the signs?

A

Narrowing of aortic valve

Calcific disease, aging, congenital bicuspid valve (born with 2 leaflets instead of 3), rheumatic disease

L vent hypertrophy, increased pressure in pulmonary veins (and fluid leaks into lungs as pressure increases), dyspnoea, angina (hypertrophy). syncope (exertional= e.g. if run, BP decreases eventually b/c C.O can’t rise enough), LVFailure, sudden death (ventricular arythmia)

Slow rising carotid pulse, S4 (due to still vent) +/- ejection click (if valve still quite mobile), ejection systolic murmur at base of heart

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4
Q

How would you investigate aortic stenosis?

What pressure signal would you see?

What are the indications for surgery?

A

Doppler and echocardiogram

Sever pressure gradient across aortic valve, so prominent ‘a’ wave (arrow in pic)

Any AS symptoms, worsening LV dilation, peak systolic pressure gradient >50mmHg, can have TAVI if too sick for heart surgery

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5
Q

What are the 2 diseases (and their causes) that may cause aortic regurgitation?

What are the symptoms of AR?

What are the signs of AR?

A

1) Aortic valve leaflet disease: leaking back through valve, caused by calcific disease, congenital bicuspid valve, rheumatic disease, infective endocarditis

2) Aortic root dilating disease: valve leafets won’t meet in middle, cause by ankylosing spondylitis, Marfan syndrome, aortic dissection

Symptoms: dypnoea (contractile failure as vent dies), angina (O2 demand of hypertrophied LV) (AR usually well tolerated)

Signs: rapidly rising carotid pulse - vigerous ejection of volume loaded LV, early diastolic murmur, ejection murmur (turbulent ejection)

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6
Q

How would you investigate aortic regurgitation?

What are the indications for surgery?

A

Catheter in aorta and inject contrast -> shouldn’t see contrast in L vent. Can use echo dopp too.

Any symptoms of AR, echocardiographic evidence of worsening LV dilation. Can cure with valve replacemment.

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7
Q

What is the sole cause of mitral stenosis?

What are the symptoms?

What are the signs?

A

Rheumatic fever

Symptoms: dyspnoea (increased L atrial pressure b/c vave thickens), R ventricle failure, palpitations (AF), systemic emboli (static blood in dilated fibrillating L atrium predispose to thrombosis). HIGH STROKE RISK

Signs: pulse (AF), ausculatation: loud S1, opening snap, mid-diastolic murmur, increased JVP due to pulm pressure increase, basal creps, ankle oedema

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8
Q

How would you investigate mitral stenosis?

What is the treatment?

A

Echo dop, can use ECG and see biphasic P waves if in sinus rhythm = sign of L atrium enlargement.

Valvuloplasty, or can do with balloon

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9
Q

What are the 3 main causes of mitral regurgitation and the reasons for those causes?

What are the symptoms for MR?

What are the signs for MR?

A

1) Mitral valve leaflet disease: rheumatic disease, mitral valve prolapse, infective endocarditis

2) Subvalvar disease: chordal rupture, papillary muscle dusfunction (usually ischaemic)/rupture

3) Functional MR: (valve leaflets don’t meet in middle) LV dilation

Symptoms: dyspnoea, palpitations (AF), systemic emboli (static blood in dilated fibrillating L atrium predisposes to thrombosis)

Signs: pulse AF, auscultation: pansystolic murmur (from when valve opens to when it closes), S3, volume overload = increased JVP, basal creps, ankle oedema

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10
Q

How would you investigate mitral regurgitation?

What are the indications for surgery?

A

Echo dopp, or catheter and dye.

Symptoms that fail to respond to medical treatment, worsening CDV complications (e.g. pulm hypertension, LV dilation)

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11
Q

What are some medical treatments for valvular heart disease symptoms?

A

1) fluid retention - diuretics
2) low forward output due to aortic/mitral regurg - vasodilators
3) AF - digoxin, beta blockers, verapamil
4) Anticoagulants to protect against systemic embolisation (AF)

ALL PTS WITH MITRAL VALVE DISEASE SHOULD BE ON WARFARIN

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