Cardio: Valvular Heart Disease Flashcards
what are the valves called/
- mitral valve
- tricuspid valve
- aortic valve
- pulmonary valve
where are these valves found?
in the skeleton of the heart, where the valve are found in one plane
which conditions fall under the umbrella term?
- aortic stenosis
- aortic regurgitation
- mitral stenosis
- mitral regurgitation
- pulmonary stenosis/atresia
- tricuspid regurgitation
how can you fix a valve
- valve repair
- valve replacement
what are the main types of valves?
- mechanical
- bioprosthetic
what are the mechanical types of valves?
- ball and cage
- single disc
- bileaflet
what are the bioprosthetic types of valves?
- stented pericardial
- stented porcine
- sutureless (surgical or TAVI)
- stentless valve
- homograft
what happens in aortic stenosis?
- blood is not let out of the ventricle
what is the most common cause of aortic stenosis?
- degenerative disease
- aortic bicuspid valve
- pseudobicuspid
- postinflammatory conditions
what happens in aortic bicupsid valves?
- the leaflet degenerate earlier and thus, are likely to cause problems and are intervened upon earlier
what are aortic pseudobicuspid?
when 2 leaflets of the valve fuse together due to calcification; this is seen as a bicuspid valve on echo
what are the cardinal symptoms of aortic stenosis?
- angina
- syncope
- shortness of breath
- sudden death
what are the signs of aortic stenosis?
- slow rising arterial pulse
- aortic systolic murmur
- LVH with strain on ECG
- gradient across the valve on Echo
- catheterisation
treatment of aortic stenosis
- aortic valve repair
- aortic valve replacement (bioprosthesis, mechanical prosthesis, homograft)
management of a replaced valve
- anticoagulation (warfarin for mechnical, aspirin for bioprosthetic valve)
which mechanical valve is used nowadays and what is the problem with them?
- bileaflet valve
- problem: patient-prosthesis mismatch
what are TAVI?
- transcatheter aortic valve replacement
what is the problem with TAVI
paravalvular leaks
what happens in aortic regurgitation?
- valve leakage
- there is dilatation, which decrease the heart function
what type of symptoms would a patient with aortic regurgitation
ones of heart failure; dyspnoea, orthopnea, fatigue, syncope, ventricular arrhythmias, sudden death
signs of aortic regurgitation
- left ventricular heave
- diastolic murmur
- bounding pulse
- congestive heart failure signs
- ECG: prominent QRS peaked T wave
- CXR: dilated LV
- Echo: increased systolic and diastolic dimensions
- catheterisation: regurgitation evident
treatment of aortic regurgitation
- aortic valve replacement
- TAVI
- etc
what happens in mitral stenosis?
- valve narrowing
- due to back pressure on the lungs, they have pulmonary HTN (can have right-sided HF)
symptoms of mitral stenosis?
- signs of heart failure: dyspnoea, PND, orthopnea, cough, fatigue
- haemoptysis
- atrial fibrillation
what happens in mitral regurgitation?
- mainly asymptomatic
- floppy mitral valve
- repair is beneficial
what is pulmonary atresia?
- the patient does not have a pulmonary valve or pulmonary trunk
- surgery involves creating a pulmonary artery and an outflow tract
evaluation of mitral stenosis
- diastolic murmur
- thrill in apex
- irregularly irregular pulse
- right heart failure (high JVP, hepatomegaly)
- ECG: AF, left atrial enlargement
- CXR: pulmonary oedema
- Echo: valve assessment, area, dimensions
- catheter: right & left heart studies, wedge pressure, LV pressure, gradient 10mmHg, critical stenosis mitral area <1.0cm2
symptoms of mitral regurgitation
- acute: acute heart failure
- chorsal rupture from MI or endocarditis
- chronic: symptomatic
- decompensation with symptoms of heart failure
evaluation of mitral regurgitation
- prominent apical impulse and parasternal lift
- pansystolic murmur
- ECG: LA enlargement and AF
- CXR: very large atrium
- Echo: quantification of MR, assessment of chamber dimensions
- catheterisation: right and left studies: pulmonary wedge pressures, pulmonary pressures, ventriculography and coronary angiography
