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6. Cardiovascular System > 8. Valvular Heart Disease > Flashcards

8. Valvular Heart Disease Flashcards

1
Q

Name 4 valvular heart diseases.

A
  1. Aortic stenosis.
  2. Mitral regurgitation.
  3. Mitral stenosis.
  4. Aortic regurgitation.
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2
Q

After a valve replacement, a patient starts showing signs of heart failure. What can this be indicative of?

A

Heart failure

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3
Q

After a valve replacement, a patient presents with splinter haemorrhages and Osler’s nodes. What can this be indicative of?

A

Infective Endocarditis (IE).

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4
Q

After a valve replacement, a patient presents with bruising and pale conjunctiva. What can this be indicative of?

A

Over-anticoagulation.

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5
Q

After a valve replacement, a patient presents with jaundice and pale conjunctiva. What can this be indicative of?

A

Haemolysis.

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6
Q

Briefly describe aortic stenosis.

A

A disease where the aortic orifice is restricted and so the LV can’t eject blood properly in systole = pressure overload.

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7
Q

Describe the aetiology of aortic stenosis.

A
  1. Congenital bicuspid valve. and its calcification.
  2. Acquired e.g. age-related degenerative calcification and rheumatic heart disease.
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8
Q

Describe the pathophysiology of aortic stenosis.

A

Aortic orifice is restricted e.g. by calcific deposits and so there is a pressure gradient between the LV and the aorta. LV function is initially maintained due to compensatory hypertrophy. Overtime this becomes exhausted = LV failure.

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9
Q

Give 3 signs of aortic stenosis.

A
  1. Slow rising carotid pulse and decreased pulse amplitude.
  2. Soft or absent heart sounds.
  3. Ejection systolic murmur: <> shape.
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10
Q

Give 3 symptoms of aortic stenosis.

A
  1. Exertional syncope
  2. Angina
  3. Exertional dyspnoea
  4. Orthopnoea
  5. Paroxysmal nocturnal dyspnoea
  6. Palpitations
  7. CCF (congestive cardiac failure)

Onset of symptoms is associated with poor prognosis.

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11
Q

What is the classical triad of symptoms in aortic stenosis?

A

SAD:
Syncope
Angina
Dyspnoea - heart failure

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12
Q

What investigation might you do in someone who you suspect to have aortic stenosis?

A

Echocardiography.

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13
Q

What murmur is heard in aortic stenosis?

A

Ejection systolic murmur

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14
Q

What would you see on a CXR of a patient with aortic stenosis?

A

Normal heart size, prominent ascending aorta, valvular calcification

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15
Q

What would you expect to see on an ECG in aortic stenosis?

A

P mitrale, LVH with strain pattern (depressed ST and T wave inversion in I, AVL, V5 and V6)

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16
Q

Describe the management for someone with aortic stenosis.

A
  1. Ensure good dental hygiene.
  2. Consider IE prophylaxis.
  3. Aortic valve replacement or TAVI.
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17
Q

How would you treat aortic stenosis?

A

Prompt valve replacement

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18
Q

Who should be offered an aortic valve replacement?

A
  1. Symptomatic patients with aortic stenosis.
  2. Any patient with decreasing ejection fraction.
  3. Any patient undergoing CABG with moderate/severe aortic stenosis.
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19
Q

What is mitral regurgitation?

A

Back flow of blood from the LV to the LA during systole - LV volume overload.

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20
Q

Describe the aetiology of mitral regurgitation.

A
  1. Myxomatous degeneration.
  2. Ischaemic mitral regurgitation.
  3. Rheumatic heart disease.
  4. IE.

Prolapsing mitral valve + rheumatic heart disease = most common

Infective endocarditis, annular calcification, LV dilatation, ruptured chordae tendinae, papillary muscle rupture.
connective tissue disorders (Ehlers-Danos, Marfan’s).
cardiomyopathy, congenital.

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21
Q

What is the pathophysiology of mitral regurgitation?

A

LV volume overload! Compensatory mechanisms: LA enlargement and LVH and increased contractility. Progressive LV volume overload -> dilatation and progressive HF.

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22
Q

Give 2 symptoms of mitral regurgitation.

A
  1. Dyspnoea on exertion.
  2. HF
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23
Q

Give 3 signs of mitral regurgitation.

A
  1. Pansystolic murmur (always there).
  2. Soft 1st heart sound.
  3. 3rd heart sound.

In chronic MR the intensity of the murmur correlates with disease severity.

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24
Q

What investigations might you do in someone who you suspect to have mitral regurgitation?

A
  1. ECG.
  2. CXR.
  3. Echocardiogram: estimates LA/LV size and function.
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25
Q

What murmur is heard in mitral regurgitation?

A

Pansystolic murmur

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26
Q

What would you see on CXR in mitral regurgitation?

A

Enlarged LA and LV, mitral valve calcification, pulmonary oedema

27
Q

Describe the management of mitral regurgitation.

A

Rate control for AF e.g. beta blockers.
Anticoagulation for AF.
Diuretics for fluid overload.
IE prophylaxis.
If symptomatic = surgery.

28
Q

How would you treat mitral regurgitation?

A

Asymptomatic = echo every 1-5 yrs.

Anticoagulate with warfarin if - AF, Hx of embolism, prosthetic valve, additional mitral stenosis.

Diuretics.

Surgery - valve replacement or repair.

29
Q

What is mitral stenosis?

A

Thickening and immobility of valve leaflets - leads to obstruction of blood flow from left atrium to left ventricle - prevents proper filling during diastole

30
Q

Describe the management for mitral stenosis.

A

If in AF rate control e.g. beta blockers/CCB. Anticoagulation if AF. Balloon valvuloplasty or valve replacement. IE prophylaxis.

31
Q

Give 3 causes of mitral stenosis.

A
  1. Rheumatic heart disease.
  2. IE.
  3. Calcification.
32
Q

Describe the pathophysiology of mitral stenosis.

A
  1. LA dilation -> pulmonary congestion.
  2. Increased trans-mitral pressures -> LA enlargement and AF.
  3. Pulmonary venous hypertension causes RHF symptoms.
33
Q

Give 3 signs of mitral stenosis.

A
  1. ‘a’ wave in jugular venous pulsations.
  2. Signs of RHF.
  3. Pink patches on cheeks due to vasoconstriction.
  4. Low pitched diastolic murmur.
  5. Loud opening 1st heart sound snap.
34
Q

Give 3 symptoms of mitral stenosis.

A
  1. Dyspnea (exertional)
  2. Haemoptysis.
  3. RHF symptoms.
35
Q

What investigations might you do in someone who you suspect to have mitral stenosis?

A
  1. ECG.
  2. CXR.
  3. Echocardiogram - gold standard.
36
Q

What diagnostic tests would you perform in mitral stenosis?
What would you see?

A

ECG - AF, bifid P waves.
CXR - LA enlargement, pulmonary oedema, mitral valve calcification.
Echo - diagnostic.

37
Q

What is the heart murmur heard in mitral stenosis?

A

Rumbling mid-diastolic murmur

38
Q

Give 2 complications of mitral stenosis

A

Pulmonary hypertension.
Emboli (dilated LA).
Pressure from large LA on local structures e.g. hoarseness due to compression of L recurrent laryngeal

39
Q

How would mitral stenosis be treated?

A

Diuretics - decrease pre load.
Balloon valvuloplasty / valve replacement.

40
Q

Why might someone with mitral stenosis be breathless? Use Sterling’s law in your explanation.

A

Mitral stenosis means ventricles don’t fill completely -> reduced EDV -> reduced SV -> reduced CO and so breathlessness.

41
Q

Why does mitral stenosis cause AF?

A

There is increased LA pressure. This stretches the myocytes in the atria and irritates pacemaker cells -> AF.

42
Q

Why does mitral stenosis lead to a raised JVP?

A

Pulmonary congestion -> pulmonary hypertension causes a raised JVP.

43
Q

What is aortic regurgitation?

A

A regurgitant aortic valve means blood leaks back into the LV during diastole due to ineffective aortic cusps.

44
Q

What is the aetiology of aortic regurgitation?

A
  1. Bicuspid aortic valve.
  2. Rheumatic.
  3. IE.
45
Q

What are the most common causes of aortic regurgitation?

A

Rheumatic fever and infective endocarditis

46
Q

Give 3 causes of acute aortic regurgitation.

A

Infective endocarditis, acute rheumatic fever, dissection of the aorta, AAA dissection, prosthetic valve failure

47
Q

Give 3 causes of chronic aortic regurgitation

A

Chronic rheumatic heart disease, syphilis, rheumatoid arthritis, severe hypertension, biscupid aortic valve, aortic endocarditis, Marfan’s, osteogenesis imperfecta

48
Q

Describe the pathophysiology of aortic regurgitation.

A

Pressure and volume overload. Compensatory mechanisms - LV dilatation, LVH. Progressive dilation -> HF.

49
Q

Give 3 signs of aortic regurgitation.

A
  1. Wide pulse pressure.
  2. Diastolic blowing murmur.
  3. Systolic ejection murmur.
50
Q

Give 3 symptoms of aortic regurgitation.

A
  1. Dyspnoea on exertion.
  2. Orthopnea.
  3. Palpitations.
  4. Paroxysmal nocturnal dyspnea.
51
Q

What investigations might you do in someone who you suspect to have aortic regurgitation?

A

CXR and echocardiogram.

52
Q

What murmur is heard in aortic regurgitation?

A

Early diastolic murmur.

“at L sternal edge in 4th intercostal space”

53
Q

What would you see on CXR/ECG in aortic regurgitation?

A

CXR - cardiomegaly and dilatation of the ascending aorta, pulmonary oedema.

ECG - LVH.

54
Q

How would you treat aortic regurgitation?

A

Reduce systolic hypertension - ACE inhibitors.

Echo every 6-12/12.

Valve replacement.

55
Q

Describe the management for someone with aortic regurgitation.

A

IE prophylaxis. Vasodilators e.g. ACEi. Regular echo’s to monitor progression. Surgery if symptomatic.

56
Q

Why does medication not work for mitral and aortic stenosis?

A

The problem is mechanical and so medical therapy does not prevent progression.

57
Q

What does a bifid P wave indicate on ECG?

A

Bifid P waves = p mitrale - mitral valve disease

58
Q

In what type of valvular heart disease would you hear a mid-diastolic murmur and a 1st heart sound snap?

A

Mitral stenosis.

59
Q

In what type of valvular heart disease would you hear a pan-systolic murmur?

A

Mitral regurgitation.

60
Q

In what type of valvular heart disease would you hear a ejection systolic murmur?

A

Aortic stenosis.

61
Q

In what type of valvular heart disease would you see a wide pulse pressure and hear an early diastolic blowing murmur and systolic ejection murmur?

A

Aortic regurgitation.

62
Q

What does an abnormal S1 sound indicate? Mitral or aortic?

A

Issue with mitral valve

63
Q

What does an abnormal S2 sound indicate? Mitral or aortic?

A

Issue with aortic valve

6. Cardiovascular System (24 decks)

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