Cardio: Valvular Heart Disease Flashcards

1
Q

what are the valves called/

A
  • mitral valve
  • tricuspid valve
  • aortic valve
  • pulmonary valve
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2
Q

where are these valves found?

A

in the skeleton of the heart, where the valve are found in one plane

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3
Q

which conditions fall under the umbrella term?

A
  • aortic stenosis
  • aortic regurgitation
  • mitral stenosis
  • mitral regurgitation
  • pulmonary stenosis/atresia
  • tricuspid regurgitation
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4
Q

how can you fix a valve

A
  • valve repair

- valve replacement

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5
Q

what are the main types of valves?

A
  • mechanical

- bioprosthetic

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6
Q

what are the mechanical types of valves?

A
  • ball and cage
  • single disc
  • bileaflet
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7
Q

what are the bioprosthetic types of valves?

A
  • stented pericardial
  • stented porcine
  • sutureless (surgical or TAVI)
  • stentless valve
  • homograft
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8
Q

what happens in aortic stenosis?

A
  • blood is not let out of the ventricle
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9
Q

what is the most common cause of aortic stenosis?

A
  • degenerative disease
  • aortic bicuspid valve
  • pseudobicuspid
  • postinflammatory conditions
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10
Q

what happens in aortic bicupsid valves?

A
  • the leaflet degenerate earlier and thus, are likely to cause problems and are intervened upon earlier
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11
Q

what are aortic pseudobicuspid?

A

when 2 leaflets of the valve fuse together due to calcification; this is seen as a bicuspid valve on echo

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12
Q

what are the cardinal symptoms of aortic stenosis?

A
  • angina
  • syncope
  • shortness of breath
  • sudden death
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13
Q

what are the signs of aortic stenosis?

A
  • slow rising arterial pulse
  • aortic systolic murmur
  • LVH with strain on ECG
  • gradient across the valve on Echo
  • catheterisation
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14
Q

treatment of aortic stenosis

A
  • aortic valve repair

- aortic valve replacement (bioprosthesis, mechanical prosthesis, homograft)

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15
Q

management of a replaced valve

A
  • anticoagulation (warfarin for mechnical, aspirin for bioprosthetic valve)
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16
Q

which mechanical valve is used nowadays and what is the problem with them?

A
  • bileaflet valve

- problem: patient-prosthesis mismatch

17
Q

what are TAVI?

A
  • transcatheter aortic valve replacement
18
Q

what is the problem with TAVI

A

paravalvular leaks

19
Q

what happens in aortic regurgitation?

A
  • valve leakage

- there is dilatation, which decrease the heart function

20
Q

what type of symptoms would a patient with aortic regurgitation

A

ones of heart failure; dyspnoea, orthopnea, fatigue, syncope, ventricular arrhythmias, sudden death

21
Q

signs of aortic regurgitation

A
  • 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
22
Q

treatment of aortic regurgitation

A
  • aortic valve replacement
  • TAVI
  • etc
23
Q

what happens in mitral stenosis?

A
  • valve narrowing

- due to back pressure on the lungs, they have pulmonary HTN (can have right-sided HF)

24
Q

symptoms of mitral stenosis?

A
  • signs of heart failure: dyspnoea, PND, orthopnea, cough, fatigue
  • haemoptysis
  • atrial fibrillation
25
what happens in mitral regurgitation?
- mainly asymptomatic - floppy mitral valve - repair is beneficial
26
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
27
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
28
symptoms of mitral regurgitation
- acute: acute heart failure - chorsal rupture from MI or endocarditis - chronic: symptomatic - decompensation with symptoms of heart failure
29
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