Heart Valve Disease Flashcards
Define valvular heart disease
Damage to or a defect in one or more of the four heart valves
What are the four valves in the heart?
Mitral - LA to LV
Aortic - LV to Aorta
Tricuspid - RA to RV
Pulmonary - RV to Pulmonary aa
What are the main causes of valvular heart disease?
Congenital
Rheumatic
Degenerative
Cardiac remodelling
Infective endocarditis
Describe congenital VHD
VHD (valvular heart disease) caused by a congenital defect -Aortic stenosis is commonly due to calcification of a congenital bicuspid (mitral) aortic valve
Describe rheumatic VHD
Damage to connective tissue of heart valves caused by rheumatic fever
-mitral/tricuspid/aortic stenosis
(Rheumatic fever = an immune disorder that occurs in children, usually following tonsillitis/pharyngitis caused by group A B-haemolytic strep (GAS))
Describe degenerative VHD
Progressive process of slow degeneration
-mitral/tricuspid
Describe cardiac remodelling VHD
Cardiac remodelling can lead to VHD
- hypertrophy/dilatation leading to regurg
- raised pressure causing stenosis
Describe how infective endocarditis can cause VHD
Heart valves not directly supplied with blood, hard to fight infection
- Collagen exposure; thrombus development in the short term with post-inflammatory scarring leading to long-term functional impairment
- left sided valves more frequently affected
Describe the difference between stenotic and regurgitation valvular disease
Stenosis - narrowing of a valve opening causing lowered blood flow
Regurgitation - blood flows back through valve after leaflets close
What are the main causes of mitral stenosis?
Rheumatic heart disease
What are the main sx/signs of mitral stenosis?
Sx - Dysnpoea, haemoptyis, palpitations (AF), RHF - cor pulmonale (LA unable to empty leading to pulmonary HTN)
Signs - Malar flush, JVP, left parasternal heave
Describe the murmur of mitral stenosis
Low pitched diastolic murmur
-heard loudest at apex
What are the main causes of mitral regurgitation?
- Endocarditis
- Papillary muscle rupture
- post MI
- LV dilation (LVF, HOCM)
- Mitral prolapse
What are the main sx/signs of mitral regurgitation?
Sx - Palpitations (AF), dyspnoea/orthopnoea, RHF/CCF
Signs - Displaced apex beat, systolic thrill
What are the main causes of aortic stenosis?
Calcification of aortic valve
Rheumatic fever
Congenital bicuspid (most common)
What are the main sx/signs of aortic stenosis?
Sx - Angina, exercise induced syncope/dyspnoea
Signs - Small volume, slow rising carotid, narrow pulse pressure, systolic thrill
Describe the murmur of aortic stenosis
Ejection systolic crescendo-decrescendo murmur
-in aortic area, radiates to carotids
Describe the murmur of mitral regurgitation
Pansystolic murmur
-at apex, radiating into axilla
What are the main causes of aortic regurgitation?
Infective endocarditis
Age-related calcification
Dilation of aortic root (syphilis, AS)
What are the main sx/signs of aortic regurgitation?
Sx - Asymptomatic until LVF, angina, dyspnoea
Signs - Bounding/collapsing pulse, wide pulse pressure, LVF
Describe the murmur of aortic regurgitation
Diastolic decrescendo murmur
What non-invasive tests can be used to assess the heart valves?
ECG
CXR
Echo
What is the treatment for Mitral Stenosis?
Treat any AF
Diuretics - Reduce pre-load/congestion
Surgical - Balloon valvuloplasty/valvotomy
What is the treatment for Mitral Regurgitation?
Treat AF
Treat heart failure
Surgery
What is the treatment for Aortic Stenosis?
Prompt valve replacement
Percutaneous valvuloplasty if unfit for surgery
What is the treatment for Aortic Regurgitation?
Replace valve before LV dysfunction
How are mitral valve murmurs best heard?
Pt on left hand side
How are aortic valve murmurs best heard?
Pt lent forward, expiration
How are right sided murmurs best heard?
Loudest in inspiration
Describe tricuspid stenosis
Sx of RHF,
signs of pre-systolic liver thrill
Mid-diastolic murmur
Describe tricuspid regurgitation
Sx of RHF,
signs of systolic liver thrill
Pan-systolic murmur
Describe pulmonary stenosis
Sx of RHF,
signs of RV heave
Ejection systolic murmur
Describe pulmonary regurgitation
Asymptomatic Diastolic murmur
What are the indications for cardiac catheterizations?
Uncertain diagnosis to:
- measure chamber pressure
- assess movement of blood across valves
- measure metabolites, show oxygenation etc.
