Cardio: Valvular heart disease Flashcards
Left sided murmurs
How does mitral stenosis progress? [3]
Pressure builds up in the Left Atrium [1] which backs up through the pulmonary circ causing pulmonary hypertension [1]
As a result the Right heart dilates with Tricuspid and pulmonary regurgitation. [1]
Left sided murmurs
What can cause mitral stenosis? [7]
- Mainly Rheumatic Heart Disease fibrosing the valve.
- Congenital Mitral Stenosis
- Autoimmune: SLE or rheumatoid arthritis, amyloid
- Mitral Valve Prolapse
- Infect. Endocarditis
- Degenerative Disease (annular calcification)
- Ventricle enlargement stretching the valve
Left sided murmurs
What are the symptoms of mitral stenosis? [5]
- Dyspnoea & Pulmonary Oedema (secondary to pulmonary HTN)
- Chest Pain
- Haemoptysis/pink frothy sputum due to pulmonary pressures, vascular congestion
- Systemic embolisation due to enlargement of LA & LAA (left atrial appendage)
- Hoarseness (enlarged heart compresses L Recurrent Laryngeal Nerve)
Left sided murmurs
What are the clinical signs of mitral stenosis? [6]
Tachycardia, Low volume pulse
A Diastolic Thrill & Tapping Apex Beat
A RV Heave due to dilatation
Mid-late diastolic murmur on expiration.
Loud S1, opening snap
Mitral Facies
Left sided murmurs
How do we investigate suspected Mitral Stenosis? [4]
An ECG, CXR - LA enlargement
Echocardiogram - Thickening/Scarring of mitral leaflets
CMR
Left sided murmurs
How can we treat mitral stenosis? [3]
- Atrial fibrillation > warfarin
- Asymptomatic - monitoring regular ECHO
- Symptomatic - percutaneous mitral balloon valvotomy, mitral valve surgery
Left sided murmurs
What would appear on an MS ECG? [2]
Tall P wave indicating LA enlargement
Prominent R wave showing RVH
Left sided murmurs
How do we treat Mitral Regurgitation? Acute [2] vs Chronic MR [2]
Acute MR: Use Na nitroprusside OR Dobatumine to lower preload/afterload
Chronic MR: Diuretics can reduce symptoms but will still need surgery ie MV repair/Replacement
Left sided murmurs
Rheumatic Heart Disease What is it triggered by? [3]
Describe histology seen in RHF
Rheumatic fever
- GABHS infection - streptococcus pyogenes
- Cross-reactive Immunological reaction to recent strep pyogenes infection - antigen presentation to T cells - molecular mimicry
- 2-6w ago
- the cell wall of Streptococcus pyogenes includes M protein, a virulence factor that is highly antigenic. It is thought that the antibodies against M protein cross-react with myosin and the smooth muscle of arteries
- Aschoff bodies describes the granulomatous nodules found in rheumatic heart fever
Rheumatic Heart Disease Sequelae [5]
- Valvular stenosis + regurgitate *mitral stenosis
- LA dilation due to pressure overload > AF
- Large mural thrombi form
- Chronic venous congestion > LHF
- RV hypertrophy
RHD DX What criteria is used?
Jones criteria
RHD DX
List minor [3] and major [5] criteria
Major Criteria:
- Carditis
- Migratory polyarthritis
- Subcutaneous nodules
- Erythema marginatum skin rash
- Sydenham chorea/ St vitus dance
Jones Criteria Minor Criteria:
- Fever
- Arthralgias
- ECG changes
Left sided murmurs
Mitral valve prolapse associations
congenital heart disease: PDA, ASD
cardiomyopathy
Turner’s syndrome
Marfan’s syndrome, Fragile X
osteogenesis imperfecta
pseudoxanthoma elasticum
Wolff-Parkinson White syndrome
long-QT syndrome
Ehlers-Danlos Syndrome
polycystic kidney disease
Left sided murmurs
Characteristic murmur for mitral valve prolapse
mid-systolic click (occurs later if patient squatting)
late systolic murmur (longer if patient standing)
Left sided murmurs
Complications of MVP [3]
mitral regurgitation, arrhythmias (including long QT), emboli, sudden death
Left sided murmurs
How is MVP diagnosed
what other investigations are needed
Defined by imaging
Ant or post mitral valv leaflets cross valve plane by >2mm into left atrium during ventricular systole
Stress ECHO