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MD2 Surgery and Anaesthesia > Heart Valve Disease > Flashcards

Heart Valve Disease Flashcards

1
Q

If untreated, what does severe valve disease lead to?

A

Heart failure

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2
Q

What is rheumatic fever?

A

Type II hypersensitivity reaction to Streptococcus pyogenes

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3
Q

What infections does S pyogenes initially produce in the body?

A

Pharyngitis

Scarlet fever

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4
Q

When does rheumatic fever occur after S pyogenes infection?

A

2-3 weeks post-infection

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5
Q

In whom is rheumatic fever most common?

A

6-15 year-olds

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6
Q

What are the clinical features of rheumatic fever?

A 
Fever
Arthritis
- Migratory polyarthritis
- Large joints
Rash - erythema marginatum
Subcutaneous nodules over
- Bones
- Tendons
Murmur
Sydenham's chorea
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7
Q

How is rheumatic fever diagnosed?

A

On basis of clinical criteria: Jones criteria

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8
Q

What is the management for rheumamtic fever?

A

Abx
NSAIDs
Long-term Abx prophylaxis, as may recur

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9
Q

What is echocardiography?

A

High frequency US looking at

  • Chamber size and function = EF
  • Wall thickness
  • Cardiac structure
  • Valve morphology
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10
Q

What does transoesophageal echocardiography (TOE) show?

A

Valve details, especially mitral
Atrial thrombus
Endocarditis

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11
Q

What is the left ventricle’s response to regurgitation?

A 
Compensation
- Increased SV
- Increased EF
- Increased end diastolic volume
If severe regurgitation > eventual irreversible deterioration in LV
- High increase in end diastolic volume
- Increased end systolic volume
- Decreased ejection fraction
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12
Q

What chamber is affected in aortic regurgitation?

A

Left ventricle

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13
Q

What is the load on the heart in aortic regurgitation?

A

Volume

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14
Q

What is the effect of aortic regurgitation to the structure of the left ventricle?

A

Eccentric hypertrophy (enlargement)

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15
Q

When do symptoms occur in aortic regurgitation?

A

Coincide with irreversible LV changes

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16
Q

What chamber is affected in mitral regurgitation?

A

LV

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17
Q

What is the load on the heart in mitral regurgitation?

A

Volume

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18
Q

What is the effect of mitral regurgitation to the structure of the left ventricle?

A

Eccentric hypertrophy (enlargement)

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19
Q

When do symptoms occur in mitral regurgitation?

A

Coincide with irreversible LV changes

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20
Q

What are other effects of mitral regurgitation?

A

Pulmonary HTN

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21
Q

What is the chamber affected in aortic stenosis?

A

LV

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22
Q

What is the load on the heart in aortic stenosis?

A

Pressure

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23
Q

What is the effect of aortic stenosis on the structure of the left ventricle?

A

Concentric hypertrophy

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24
Q

What is the next step in treatment when symptoms occur in aortic stenosis?

A

Trigger for surgery

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25
Q

Is left ventricular hypertrophy due to aortic stenosis affected after surgery?

A

Yes, it regresses

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26
Q

What chamber is affected in mitral stenosis?

A

LA

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27
Q

What is the load on the heart in mitral stenosis?

A

Pressure

28
Q

What is the effect of mitral stenosis on the structure of the heart?

A

LA enlargement

29
Q

What is the next step in treatment when symptoms occur in mitral stenosis?

A

Surgery

30
Q

What are the other effects of mitral stenosis?

A

Pulmonary HTN

31
Q

What are the options for valve replacement?

A 
Mechanical
- Last forever
- Need anticoagulants
Bioprosthetic
- Shorter lifespan
- Don't need anticoagulants
- Pig valve
- Calf pericardium
- Human valve
32
Q

Can valves be repaired surgically?

A

Yes, especially if mitral valve prolapse

33
Q

For what valve disease is valvuloplasty indicated?

A

Stenosis

34
Q

What is the commonest valve lesion needing surgery?

A

Aortic stenosis

35
Q

What are the causes of aortic stenosis?

A 
Calcific
- Commonest cause
- Increases with age
Congenital
- Stenosed at birth
- Bicuspid aortic valve may become stenotic later in life
Rheumatic fever
- Rare
36
Q

What are the symptoms of aortic stenosis?

A

SOB on exertion
Chest pain on exertion
Syncope

37
Q

When do symptoms of aortic stenosis appear?

A

When stenosis severe

38
Q

What are the signs of aortic stenosis?

A 
Carotid pulse
- Slow upstroke = plateau pulse
- Indicative of reduced systolic ejection
Apex beat
- Not displaced
- Heaving
Thrill
- If loud murmur
- Over upper R sternal edge
39
Q

What are the characteristics of a murmur due to aortic stenosis?

A

Systolic
Crescendo-decrescendo = ejection systolic
Best heard at upper R sternal edge
Loud murmur may also be heard at apex

40
Q

What is the management of aortic stenosis?

A

Mild-moderate/no symptoms
- Observe
Severe on echo + symptoms
- Replace valve
- Open operation: aortic valve replacement
- Transcatheter aortic valve implant (TAVI)

41
Q

What are the causes of aortic regurgitation?

A 
Aortic leaflet damage
- Endocarditis
- Rheumatic fever
Aortic root dilated > leaflets don't close
- Marfan's syndrome
- Aortic dissection
- Collagen vascular disorders
- Syphilis
42
Q

What are the symptoms of aortic regurgitation?

A

Even severe AR causes no symptoms unless LV decompensates
Then symptoms of heart failure
- SOB
- Ankle oedema

43
Q

What are the signs of aortic regurgitation?

A

Collapsing pulse
Wide pulse pressure
Early diastolic murmur

44
Q

What is the management of aortic regurgitation?

A

Severe
- Follow-up with echocardiography every 6-12 months
When echo indicates early LV decompensation = increased LV size, decreased LV function
- Trigger for operation
- Before symptoms occur

45
Q

What are the causes of mitral regurgitation?

A

Myxomatous degeneration > mitral valve prolapse
Ruptured chordae tendinae > flail leaflet
Infective endocarditis
Myocardial infarct > ruptured papillary muscle
Rheumatic fever
Collagen vascular disease
Cardiomyopathy > change in ventricular shape

46
Q

What are the symptoms of mitral regurgitation?

A

Even severe MR doesn’t cause symptoms unless LV decompensates
Then symptoms of heart failure
- SOB
- Ankle oedema

47
Q

What are the characteristics of a murmur due to mitral regurgitation?

A

Pan-systolic
Best heard in 5th intercostal space in mid-clavicular line
Can radiate to axilla

48
Q

What is the management for mitral regurgitation?

A

Follow-up with echocardiography every 6-12 months for severe MR
When echo indicates early LV decompensation: increased LV size, decreased LV function/pulmonary HTN
- Trigger for operation
- Mitral valve replacement
- Mitral valve repair
- Before symptoms occur

49
Q

What are the causes of mitral stenosis?

A

Rheumatic fever

50
Q

What is the most common lesion due to rheumatic fever?

A

Mitral stenosis, especially in women

51
Q

What are the symptoms of mitral stenosis?

A

When severe

  • SOB
  • Oedema
52
Q

What are the signs of mitral stenosis?

A

In severe prolonged MS

  • Mitral facies = facial flushing
  • Tapping apex beat - correlates with loud S1
53
Q

What are the characteristics of a murmur due to mitral stenosis?

A

Diastolic rumbling - best heard with bell

54
Q

What are the complications of mitral stenosis?

A 
Atrial dilatation
AF
Thrombo-embolism
Pulmonary congestion and oedema
Pulmonary HTN
- Chronic hypoxia > pulmonary vasoconstriction
Right heart failure
55
Q

What is the management for mitral stenosis?

A 
Follow-up with echocardiography
- Mitral gradient
- L atrial size
- Pulmonary artery pressure
Anticoagulation, especially if AF
Treat AF
Diuretics
Mitral valve intervention
56
Q

What are the mitral valve interventions for mitral valve stenosis?

A 
Mitral valvotomy
- Surgical
   - Closed = without major open heart surgery
   - Open - via L atrial incision
Balloon valvuloplasty
Mitral valve replacement
57
Q

What are the causes of tricuspid regurgitation?

A

Usually response to RV failure
- Pulmonary HTN
Endocarditis - especially in IVDU
Pacemaker lead interference with valve

58
Q

What are the signs of tricuspid regurgitation?

A

Same as those for RV failure

  • Peripheral oedema
  • High JVP
  • Liver congestion
59
Q

How is tricuspid regurgitation managed?

A

Diuretics

Tricuspid surgery occasionally needed

60
Q

What is infective endocarditis?

A

Bacterial infection on heart valve/pacemaker lead

61
Q

What are the common organisms causing infective endocarditis?

A

Streptococcus viridans
Streptococcus bovis
Staphylococcus aureus
Staphylococcus epidermidis

62
Q

What is the clinical presentation of infective endocarditis?

A

Fever +/- heart murmur
Signs of inflammation/embolisation now rare
- Splinter haemorrhages
- Osler’s nodes

63
Q

How is infective endocarditis diagnosed?

A

Blood cultures

Echardiogram, especially TOE

64
Q

What do blood results often indicate in infective endocarditis?

A

Inflammation

  • High WCC
  • High ESR
  • High CRP
  • Anaemia
  • Microhaematuria
65
Q

What is the management of infective endocarditis?

A 
Specialist team
- Cardiologist
- Infectious disease physician
- Cardiac surgeon
Prolonged course of Abx
- Via PICC
- Often Hospital in the Home
Valve replacement surgery
- If heart failure/uncontrolled infection

MD2 Surgery and Anaesthesia (31 decks)

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