Cardio-valvular disease Flashcards
What is valvular heart disease (VHD)?
A condition affecting the function of one or more of the heart valves (mitral, tricuspid, aortic, pulmonary) due to stenosis or regurgitation
What are the two primary types of valvular dysfunction?
Stenosis: Narrowing of the valve, obstructing blood flow.
Regurgitation (insufficiency): Incomplete closure of the valve, causing backflow
How does valve stenosis affect the heart?
Increases pressure overload → leads to hypertrophy and eventually heart failure
How does valve regurgitation affect the heart?
Increases volume overload → leads to dilatation and eventually heart failure
What is the most common cause of mitral stenosis?
Rheumatic heart disease
What are the pathophysiological effects of mitral stenosis?
Increased left atrial pressure → left atrial enlargement → atrial fibrillation.
Pulmonary hypertension → right heart failure.
Reduced cardiac output → fatigue
What are the key clinical features of mitral stenosis?
Dyspnea, hemoptysis, fatigue, atrial fibrillation, right heart failure signs
How is mitral regurgitation classified?
Primary vs. Secondary
Acute vs. Chronic
What are common causes of primary and secondary MR?
Primary MR: Mitral valve prolapse, leaflet perforation, rheumatic disease.
Secondary MR: Ischemic cardiomyopathy, non-ischemic cardiomyopathy, atrial MR
What are the symptoms of mitral regurgitation?
Fatigue, dyspnea, atrial fibrillation, right heart failure signs
What is the most common cause of aortic stenosis in the elderly?
Senile calcific degeneration
What is the classical triad of symptoms in severe aortic stenosis?
Syncope, angina, dyspnea (SAD)
What is the natural history of aortic stenosis?
Once symptoms appear, rapid progression occurs, necessitating urgent valve intervention
What are common causes of aortic regurgitation in young vs. elderly patients?
Young: Bicuspid aortic valve, Marfan syndrome, ankylosing spondylitis.
Elderly: Degenerative, atherosclerotic aortic dilation, syphilis
What is the most common acute cause of severe aortic regurgitation?
Aortic dissection
What is the pathophysiology of aortic regurgitation?
Volume overload → LV dilatation → LV hypertrophy → LV systolic dysfunction
What are key diagnostic investigations for valvular heart disease?
Echocardiography (gold standard).
ECG (assesses atrial fibrillation, LVH).
CXR (assesses cardiomegaly, pulmonary congestion).
Blood tests (BNP, troponins, coagulation studies).
What are the key auscultation findings in valvular heart disease?
MS: Mid-diastolic murmur at apex (best heard in left lateral position).
MR: Pansystolic murmur radiating to axilla.
AS: Ejection systolic murmur radiating to carotids.
AR: Early diastolic murmur, best heard sitting forward
What is the general medical management for valvular heart disease?
Treat heart failure if present (diuretics, beta-blockers, ACE inhibitors).
Manage atrial fibrillation (rate/rhythm control, anticoagulation).
Treat infective endocarditis if present (antibiotics, valve surgery if needed)
What are the indications for surgical intervention in valvular disease?
Severe symptomatic AS or AR.
Severe MS with symptoms or pulmonary hypertension.
Severe MR with LV dysfunction or symptoms
What are the types of valve replacement procedures?
Mechanical valves (require lifelong anticoagulation, last longer).
Bioprosthetic valves (no anticoagulation needed, lasts 10-15 years)
What are the Duke’s criteria for diagnosing infective endocarditis?
Definite IE: 2 major OR 1 major + 3 minor OR 5 minor criteria
What are the major criteria for infective endocarditis?
Positive blood cultures, echocardiographic evidence of endocardial involvement
What are the minor criteria for infective endocarditis?
- Predisposition to IE:
*Previous IE, IVDU, Prosthetic valve, Cyanotic heart disease etc - Fever > 38 degrees
- Vascular phenomenon – Janeway lesions, conjunctival haemorrage, embolic infarcts
- Immunologic phenomenon – Osler nodes, Roth spots, glomerulonephritis
- Microbiologic findings – positive blood culture that does not meet major criteria
