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Clinical lectures: Yr2 > Aortic and Mitral Valve Diseases > Flashcards

Aortic and Mitral Valve Diseases Flashcards

1
Q

What is aortic valve stenosis?

A

Narrowing of the aortic valve opening, reducing blood flow from left ventricle to aorta

Aortic valve stenosis occurs in approximately 80% of cases.

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2
Q

What happens to systolic pressure in the left ventricle during aortic stenosis?

A

Systolic pressure increases in the left ventricle due to obstruction of the aortic valve

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3
Q

What develops across the left ventricle and aorta due to aortic stenosis?

A

Transvalvular pressure gradient develops (higher pressure in LV, lower pressure in aorta)

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4
Q

What compensatory change occurs in the left ventricle due to pressure overload from aortic stenosis?

A

Compensatory left ventricular hypertrophy

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5
Q

What effect does left ventricular hypertrophy have on the chamber size and stiffness?

A

Reduces left ventricular chamber size and increases stiffness

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6
Q

What happens to Left Ventricular End-Diastolic Pressure (LVEDP) due to increased volume of blood in the left ventricle?

A

LVEDP increases due to impaired ejection and increased afterload

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7
Q

What is a consequence of diastolic dysfunction caused by aortic stenosis?

A

Increased left atrial pressure and left atrium hypertrophy

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8
Q

What condition can result from left atrial hypertrophy due to aortic stenosis?

A

Pulmonary hypertension

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9
Q

What are the symptoms of pulmonary hypertension?

A
  • Pulmonary edema
  • Orthopnea
  • Cough
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10
Q

What is the effect of decreased cardiac output in aortic stenosis?

A

Decreased coronary artery perfusion pressure

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11
Q

What leads to ischaemia in patients with aortic stenosis?

A

Decreased coronary artery perfusion pressure, mostly occurring in diastole

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12
Q

What are some symptoms of ischaemia in aortic stenosis?

A
  • Syncope
  • Wide pulse pressure
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13
Q

What is aortic valve stenosis?

A

Narrowing of the aortic valve opening, reducing blood flow from left ventricle to aorta

Aortic valve stenosis occurs in approximately 80% of cases.

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14
Q

What happens to systolic pressure in the left ventricle during aortic stenosis?

A

Systolic pressure increases in the left ventricle due to obstruction of the aortic valve

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15
Q

What develops across the left ventricle and aorta due to aortic stenosis?

A

Transvalvular pressure gradient develops (higher pressure in LV, lower pressure in aorta)

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16
Q

What compensatory change occurs in the left ventricle due to pressure overload from aortic stenosis?

A

Compensatory left ventricular hypertrophy

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17
Q

What effect does left ventricular hypertrophy have on the chamber size and stiffness?

A

Reduces left ventricular chamber size and increases stiffness

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18
Q

What happens to Left Ventricular End-Diastolic Pressure (LVEDP) due to increased volume of blood in the left ventricle?

A

LVEDP increases due to impaired ejection and increased afterload

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19
Q

What is a consequence of diastolic dysfunction caused by aortic stenosis?

A

Increased left atrial pressure and left atrium hypertrophy

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20
Q

What condition can result from left atrial hypertrophy due to aortic stenosis?

A

Pulmonary hypertension

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21
Q

What are the symptoms of pulmonary hypertension?

A
  • Pulmonary edema
  • Orthopnea
  • Cough
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22
Q

What is the effect of decreased cardiac output in aortic stenosis?

A

Decreased coronary artery perfusion pressure

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23
Q

What leads to ischaemia in patients with aortic stenosis?

A

Decreased coronary artery perfusion pressure, mostly occurring in diastole

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24
Q

What are some symptoms of ischaemia in aortic stenosis?

A
  • Syncope
  • Wide pulse pressure
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25
What is aortic regurgitation/insufficiency?
Leaking of the aortic valve that causes blood to flow in the reverse direction during ventricular diastole, from the aorta back into the left ventricle.
26
What is the pathophysiology of aortic regurgitation?
1. Volume overload in left ventricle during diastole due to regurgitation of blood from aorta and blood ejected from left atrium. 2. Increased preload causes compensatory left ventricular hypertrophy.
27
What happens to Left Ventricular End-Diastolic Volume (LVEDV) in aortic regurgitation?
Increased volume of blood in left ventricle causes increased LVEDV.
28
What is the consequence of left ventricular hypertrophy in aortic regurgitation?
LV hypertrophy eventually causes reduced left ventricular chamber size and more stiffness, leading to diastolic dysfunction.
29
What does diastolic dysfunction cause in aortic regurgitation?
Diastolic dysfunction causes left atrial pressure increase and left atrium hypertrophy, which leads to pulmonary hypertension.
30
What are the symptoms of pulmonary hypertension in aortic regurgitation?
Pulmonary edema, orthopnea, cough.
31
What is the effect of decreased cardiac output in aortic regurgitation?
Decreased cardiac output causes decreased coronary artery perfusion pressure, leading to ischaemia.
32
What are the symptoms of ischaemia in aortic regurgitation?
Syncope, wide pulse pressure.
33
What is the difference between acute and chronic mitral regurgitation?
Acute mitral regurgitation: Hypertrophy doesn't occur as left atrium compliance is usually normal. Chronic mitral regurgitation: Hypertrophy of the left ventricle and dilation of the left atrium.
34
What are the causes of aortic regurgitation?
CREAM: C: Congenital heart defects (e.g., bicuspid aortic valve) R: Rheumatic damage (e.g., Rheumatic fever, SLE, RA, Takayasu arteritis, Crohn's, AxSpa) E: Endocarditis A: Aortic dissection or aortic root dilation M: Marfan's syndrome.
35
What is mitral valve stenosis?
Narrowing of the mitral valve opening, reducing blood flow from left atrium to left ventricle.
36
What happens to left atrial pressure in mitral stenosis?
Left atrial pressure increases due to obstruction of blood ejection into the left ventricle.
37
What is the effect on left ventricle due to mitral stenosis?
Decreased left ventricular end-diastolic pressure (LVEDP) and decreased left ventricular end-diastolic volume (LVEDV).
38
What compensatory mechanism occurs in mitral stenosis?
Compensatory left atrial hypertrophy occurs.
39
What is the consequence of increased left atrial pressure?
It is transmitted retrograde into pulmonary circulation, causing pulmonary congestion and hypertension.
40
What is mitral regurgitation?
Leaking of the mitral valve that causes blood to flow in reverse direction, from the left ventricle back into the left atrium and pulmonary veins.
41
What are primary causes of mitral regurgitation?
Mitral valve prolapse, congenital heart defects, genetic diseases (e.g., Marfan syndrome), rheumatic damage, and infective endocarditis.
42
What are secondary causes of mitral regurgitation?
Dilated left ventricle due to cardiomyopathy, hypertension, and ischaemic heart disease.
43
What type of hypertrophy is caused by volume overload?
Eccentric hypertrophy.
44
What type of hypertrophy is caused by pressure overload?
Concentric hypertrophy.
45
What occurs during ventricular systole in mitral regurgitation?
Mitral valve leaflets bulge back into the left atrium, causing backflow of blood from the left ventricle into the left atrium, as well as forward flow into the aorta.
46
What happens to left atrial pressure in mitral regurgitation?
Left atrial pressure increases.
47
What changes occur in left ventricular filling pressure during mitral regurgitation?
Left ventricular filling pressure (LVEDP) and LVEDV increase to match the pressure in the left atrium.
48
What characterizes acute mitral regurgitation?
Hypertrophy doesn't occur as left atrial compliance is usually normal.
49
What are the effects of chronic mitral regurgitation?
Hypertrophy of the left ventricle and dilation of the left atrium.
50
What causes heart valve stenosis?
1. Direct damage to valve leaflets. 2. Damage to the valve ring (the annulus). 3. Damage to supporting structures (papillary muscles, chordae tendineae).
51
What are congenital causes of heart valve stenosis?
Congenital heart defects with abnormal valves that wear faster than normal, e.g., children born with a bicuspid aortic valve instead of a tricuspid valve.
52
What are inflammatory causes of heart valve stenosis?
Endocarditis and rheumatic fever.
53
What is rheumatic fever?
An inflammatory condition affecting the heart, brain, skin, and joints, resulting from untreated Group A strep or scarlet fever infections.
54
What is the pathogenesis of rheumatic fever?
1. Child/young adult has a Group A streptococcal infection or scarlet fever, inadequately treated by a short course of penicillin. 2. 3 weeks later: Acute cardiac inflammation. 3. Recurrent episodes cause chronic cardiac inflammation, unresponsive to long courses of penicillin and aspirin. 4. Chronic rheumatic heart disease causes valvular damage, needing surgical intervention.
55
What is endocarditis?
Inflammation of the endocardium, usually involving the heart valves.
56
What is a degenerative cause of valve disease?
Age-related thickening and calcification of a normal (or bicuspid) valve, more common over age 50.
57
What are nonspecific symptoms of heart valve disease?
Fatigue, shortness of breath (SOB) worse on exertion or orthopnea, swollen legs, and peripheral edema.
58
What are associations with mitral valve disease?
History of stroke, palpitation, atrial fibrillation.
59
What are associations with aortic valve disease?
Angina, dizziness, sudden death.
60
What is the first-line radiological investigation for heart valve disease?
Echocardiography.
61
What does echocardiography assess in heart valve disease?
Severity of stenosis or regurgitation, ventricular size, atrial size, estimated pulmonary artery pressure.
62
What are other investigations for heart valve disease?
Exercise ECG, Exercise ECHO, Low dose dobutamine stress ECHO, Cardiac MRI, Multi slice CT scan.
63
What is the management for heart valve stenosis?
Surgery including valvotomy, mitral valve repair, aortic valve replacement, and TAVI.
64
What are the benefits of TAVI?
Safe, suitable for elderly patients with contraindications for other surgical options, durability up to 5 years, long-term anticoagulants not needed.
65
What are the types of valve replacements?
Mechanical valve and tissue valve (homograft and heterograft).
66
What is the main benefit of a mechanical valve?
Durable and lasts a long time.
67
What is the main disadvantage of a mechanical valve?
Patient needs to take anticoagulants.
68
What is the main benefit of a tissue valve?
Patient only needs to take anticoagulants if they have atrial fibrillation.
69
What is the main disadvantage of a tissue valve?
Lasts less than 15 years, even less in younger patients.
70
What is the management for significant enlargement of the ascending aorta?
Immediate referral for surgery.
71
What is the management for severe regurgitation without significant enlargement of the ascending aorta?
Considered for surgery or follow-up appointments only.

Clinical lectures: Yr2 (56 decks)

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