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!!!!! BRS YR2 !!!!! > Cardio - Valvular Heart Diseases > Flashcards

Cardio - Valvular Heart Diseases Flashcards

1
Q

What are structural heart diseases?

A

defects that affect the valves + chambers of the heart + aorta

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2
Q

What are the 4 most common valvular heart defects?

A

→ aortic stenosis
→ aortic regurgitation
→ mitral stenosis
→ mitral regurgitation

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3
Q

What 3 heart diseases can cause valvular heart defects later on in life?

A

→ rheumatic heart disease
→ degenerative mitral valve disease
→ calcific aortic valve disease

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4
Q

What is rheumatic heart disease?

A

v

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5
Q

What is degenerative heart disease?

A

v

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6
Q

What is calcific aortic valve disease?

A

v

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7
Q

What is aortic stenosis?

A

→ narrowing of exit from left ventricle
→ most common valvular disease in US + Europe
→ more common in > 70 yrs

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8
Q

What is aortic stenosis most commonly preceded by?

A

aortic sclerosis = aortic valve thickening without flow limitation

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9
Q

How does aortic stenosis present on an ECG and on clinical examination?

A

→ early-peaking

→ systolic ejection murmuring

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10
Q

What are some risk factors that can increase the chances of getting aortic stenosis?

A 
→ hypertension
→ LDL levels
→ smoking
→ elevated C-reactive protein
→ congenital bicuspid valves
→ chronic kidney disease
→ radiotherapy
→ older age
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11
Q

What are some causes of aortic stenosis?

A

→ rheumatic heart disease
→ congenital heart disease
→ calcium build-up

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12
Q

How can aortic stenosis result in systolic heart failure?

A

→ Long-standing pressure overload = left ventricular hypertrophy (LVH).
→ Ventricle to maintain a normal wall stress (afterload) despite the pressure overload produced by stenosis
→ As the stenosis worsens, the adaptive mechanism fails and left ventricular wall stress increases
→ Systolic function declines as wall stress increases, with resultant systolic heart failure

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13
Q

What kind of history + presentation does a patient with aortic stenosis have?

A 
→ dyspnoea on exertion + fatigue
→ fatigue
→ ejection systolic murmur
→ rheumatic fever
→ high LDLs
→ CKD
→ age > 65
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14
Q

What investigation do you do if you suspect a patient has aortic stenosis?

A

→ transthoracic ECG
→ ECG chest X-ray
→ cardiac catheterisation
→ cardiac MRI

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15
Q

What is the main surgical way of treating aortic stenosis?

A

AVR (aortic valve replacement)

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16
Q

When is an aortic stenosis patient considered for AVR

A

→ symptomatic AS
→ Asymptomatic patients with severe AS who have an LVEF <50% or who are undergoing other cardiac surgery.
→ asymptomatic patients with very severe AS
→ asymptomatic + severe AS with rapid progression, an abnormal exercise test, or elevated serum B-type natriuretic peptide (BNP) levels

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17
Q

What other treatments for aortic stenosis?

A

→ balloon aortic valvuloplasty
→ antihypertensive
→ ACE inhibitors
→ statins

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18
Q

What are the 2 types of valves that can be used to replace to aortic valve?

A

→ mechanical

→ bioprosthetic

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19
Q

What are the advantages of bioprosthetic valves?

A

→ can do minimally invasive surgery with them

→ can insert valve without a catheter (transcatheter aortic valve implantation device)

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20
Q

What are some valve technologies being developed currently?

A

→ flexible polymeric valve

→ tissue-engineered heart valve

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21
Q

What is aortic regurgitation (AR)?

A

diastolic leakage of blood from aorta into the left ventricle

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22
Q

Why does aortic regurgitation occur?

A

incompetence of valve leaflets because of :
→ intrinsic valve disease
→ dilation of aortic root

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23
Q

What is chronic AR?

A

→ repetitive Ar

→ can culminate into congestive cardiac failure

24
Q

What is acute AR?

A

→ medical emergency

→ presenting w sudden onset of pulmonary oedema + hypotension / cardiogenic shock

25
Q

What are the congenital or acquired disease causes of AR?

A 
→ rheumatic heart disease
→ infective endocarditis
→ aortic valve stenosis
→ congenital heart defects
→ congenital bicuspid valves
26
Q

What are causes of AR related to aortic root dilation?

A 
→ Marfan's Syndrome
→ connective tissue disease
→ collagen vascular disease
→ ankylosing spondylitis
→ trauma
27
Q

How can acute AR cause cardiogenic shock?

A 
→ Increase blood volume in LV during systole
→ LV end diastolic pressure increases
→ increase in pulmonary venous pressure
→ dyspnea and pulmonary oedema
→ heart failure = cardiogenic shock
28
Q

How can chronic AR eventually lead to heart failure?

A

→ gradually increase in LV volume
→ LV enlargement and eccentric hypertrophy
→ at first ejection fraction is normal or slightly increased
→ after some time Ejection fraction falls and LV end systolic volume rises
→ Eventually LV dyspnoea = lower coronary perfusion
→ leads to ischaemia, necrosis and apoptosis

29
Q

How does a patient present with acute AR?

A

→ Cardiogenic shock
→ Tachycardia
→ Cyanosis - change of body tissue colour to blue-purple due to lack of oxygen
→ Pulmonary edema
→ Austin flint murmur - low pitch rumbling heart murmur best heard in the cardiac apex

30
Q

How does a patient present with chronic AR?

A

→ wide pulse pressure
→ corrigan (wate hammer pulse)
→ pistol shot pulse (Traube sign)

31
Q

What investigations do you carry out if you suspect a patient has AR?

A

→ transthoracic ECG
→ chest x-ray
→ cardiac catheterisation
→ cardiac MRI / CT scan

32
Q

How is acute AR managed / treated?

A

→ lonotropes / vasodilators

→ valve replacement / repair

33
Q

How is chronic asymptomatic AR managed / treated?

A

if LV function is normal, can be managed with drugs or reassurance

34
Q

How is chronic symptomatic AR managed / treated?

A

first line = valve replacement + adjunct vasodilator therapy

35
Q

How can AR be prevented?

A

treat any disease causes (e.g. rheumatic fever or infective endocarditis) before it can progress to AR

36
Q

What is mitral stenosis?

A

obstruction to left ventricular inflow at level of mitral valve due to structural abnormality of mitral valve

37
Q

What is the main cause of mitral valve stenosis?

A

rheumatic fever in developing countries

38
Q

What are some other causes of mitral stenosis?

A 
→ Carcinoid syndrome
→ Use of ergot/serotonergic drugs
→ SLE
→ Mitral annular calcification due to aging
→ Amyloidosis
→ Rheumatoid arthritis
→ Whipple disease
→ Congenital deformity of the valve
39
Q

What can progression of mitral stenosis lead to?

A

→ pulmonary hypertension

→ right heart failure

40
Q

What is the pathophysiology of mitral stenosis?

A

→ severe mitral stenosis
causes increase in left atrial pressure
→ transduction of fluid into lung interstitium
→ causes dyspnoea at rest + exertion
→ pulmonary hypertension may also develop
→ restricted filling of left ventricle limits cardiac output
→ can cause hemoptysis is bronchial vein ruptures

41
Q

How does a patient with mitral stenosis present?

A 
→ history of rheumatic fever
→ dyspnoea
→ orthopnoea
→ diastolic murmur
→ loud P2
→ neck vein distention
→ hemoptysis
42
Q

What investigations do you perform on a patient you suspect has mitral stenosis?

A 
→ ECG
→ transthoracic ECG
→ chest x-ray
→ cardiac catheterisation
→ cardiac MRI / CT scan
43
Q

How do you manage progressive but asymptomatic mitral stenosis?

A

no therapy required

44
Q

How do you manage severe asymptomatic mitral stenosis?

A

no therapy generally required adjuvant balloon valvotomy

45
Q

How do you manage severe symptomatic mitral stenosis?

A

→ diuretic
→ balloon valvotomy
→ valve replacement + repair
→ adjunct beta-blockers

46
Q

What is mitral regurgitation?

A

leakage of blood from left ventricle into the left atrium

47
Q

What are the causes of acute mitral regurgitation?

A 
→ Mitral valve prolapse
→ Rheumatic heart disease
→ Infective endocarditis
→ Following valvular surgery
→ Prosthetic mitral valve dysfunction
48
Q

What are the causes of chronic mitral regurgitation?

A 
→ Rheumatic heart disease
→ SLE
→ Scleroderma
→ Hypertrophic cardiomyopathy
→ Drug related
49
Q

How does chronic MR progress?

A

→ progression leads to eccentric hypertrophy
→ leading to elongation of myocardial fibres and increased left end diastolic volume
→ Increase in preload & a decrease in afterload
→ increase in end- diastolic volume + decrease in end-systolic volume

50
Q

What is the history + presentation of chronic MR?

A 
→ dyspnoea
→ fatigue
→ diminished S1
→ orthopnoea
→ atrial fibrillation
→ high-pitched murmur
→ chest pain
51
Q

What are some investigations for MR?

A 
→ ECG
→ transthoracic ECG
→ chest x-ray
→ cardiac catheterisation
→ cardiac MRI / CT scan
52
Q

How is acute MR managed?

A

→ emergency surgery
→ adjunct preoperative diuretics
→ adjunct intra-aortic balloon counter-pulsation

53
Q

How is chronic asymptomatic MR managed?

A

→ ACE inhibitors
→ beta blockers
→ surgery later if necessary

54
Q

When is chronic asymptomatic MR treated with surgery?

A

left ventricular ejection fraction less than 60%

55
Q

How is chronic symptomatic MR managed?

A

→ first-line = surgery + medical treatment

→ intra-aorthic balloon counter-pulsation

56
Q

When is chronic asymptomatic MR treated with intra-aorthic balloon counter-pulsation?

A

left ventricular ejection fraction is less than 30%

!!!!! BRS YR2 !!!!! (72 decks)

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