Intro To Valvular Pathology Flashcards
Where do we usually hear murmurs? 4
- Aortic valve
- Tricuspid valve
- Pulmonary valve
- Mitral valve
What valvular pathology might murmurs represent? 4
- Diastolic rumble heard @ apex
- Thrill heard at carotid
- Diastolic murmur - LUSB
- Pan- systolic LLSB murmur
Valvular diseases may be caused by a number of pathologies, including what? 4
- Calcification
- Rheumatic
- Congenital
- Acquired
Crac
Calcific valve disease occurs when there is what?
Build up of calcium on the valve
Who do we commonly see with calcific Disease?
In elderly patients
What does calcific affect in the heart? Where most commonly?
- The underside or annulus of the valve, as opposed to leaflet tips
- Most commonly AV, MV
Calcific disease might cause what? 2
Immobility of valve which leads to
1. Stenosis
2. Regurgitation
M-Mode with severe AS can be difficult to see what?
The Cusps with significant calcific AS
AV sclerosis can look like what? Where does it occur? 2
- Cusp tips look thin and pliable
- Underside of AV is calcified
What does MAC stand for?
Mitral annular calcification
Where does MAC start and where does it progress? Is anything spared? 3
- Starts at the annulus (usually posterior)
- Progresses inward on to leaflets
- Leaflet tips usually spared
What conditions are associated with Mitral annular calcification? 2
- Systemic HTN
- Diabetes
Rheumatic valve disease is caused by what?
Scarring from rheumatic fever
What are the dieseases associated with rheumatic heart disease inflammation condition? 2
- Strep throat
- Scarlet fever
What disease does the acute phase of Rheumatic heart disease involve?
Endocardial vasculitis- swelling leads to valve damage
During Rheumatic heart disease cusp tissue is infiltrated with what? What does this cause? 2
- Cusp tissue is infiltrated with fibrous tissue causing them to shorten and retract.
- Cusps can no longer come together to coapt
What is the percentage of rheumatic heart disease affect either the MV or the AV? 2
- MV 75-80%
- AV 20-25%
MAC usually causes what artifact?
Shadowing
Rheumatic heart disease usually coincides with what MV heart conditions?
MV stenosis and regurgitation
What condition is Rheumatic heart usually associated with?
Some degree of AS
How often does rheumatic heart disease affect PV/TV?
5%
Rheumatic heart disease may _________ __________ or Lead to __________ __________
- Resolve completely
- Progressive scarring
There has been a _____ ______ ______ in North America and Europe since the 1950s for rheumatic fever
Decrease six fold
Rheumatic heart disease is seen as a chronic disease in which population?
Older population
Rheumatic heart disease is common where? 2
- In other parts of the world
- May be chronic or acute from other countries
Where does rheumatic MV disease start at?
Leaflet tips
During Rheumatic MV disease commissaries become what? 3
- Thickened
- Fibroses
- Fused
For Rheumatic MV disease what happens to the chordae tendonae?
Matting and shortening
What kind of appearance is common of rheumatic MV disease?
Leads to a fish mouth appearance of the orifice
Rheumatic TV disease almost never occurs in what?
Isolation
For Rheumatic TV disease what is almost always involved?
MV
What does the Rheumatic TV disease look like? 2
- Thickened and retracted TV leaflets
- Diastolic doming of the TV leaflets seen in 2D (stenosis)
Most TV/PV disease is what?
Congenital
How likely is it to find Congenital valve disease in an adult echo?
Unlikely
What is ebstein’s anomaly?
Abnormal apical displacement of the TV
What are acquired valve diseases? 2
- Annular dilation
- Valve cannot close due to annular stretch from chamber dilation
What is an example of Acquired valve disease?
Carcinoid heart disease
What is carcinoid heart disease? 2
- Rare malignant tumour causing RT heart valve damage only
- Valves become thickened, retracted and fixed (TR and TS)
What is the consequence of valvular disease in terms of volume overload?
Dilation
What is the consequence of valvular disease in terms of pressure overload?
Hypertrophy
What is the AS afterload effect on LV in terms of process? 4
- Outflow obstruction leading to increasing afterload
- LV systolic pressure rises
- To keep SV normal there is an increase of force of contraction
- LVH develops (concentric) due to pressure overload
What are some MR: volume overload adaption for the LV?
Eccentric hypertrophy/ remodelling of the muscle fibres leading to dilation with little change in LV thickness
What are some acute chronic disease causes? 3
- HTN
- Trauma
- Infarction
What are some LA adaptions for MR volume overload?
Dilation»_space; PV congestion»_space; Afib»_space;> CHF
Does Acute heart disease result in hypertrophy? Why?
No, because there is no slow build up
What are two types of regurgitation? 2
- Organic regurgitation (AKA Primary)
- Functional regurgitation (AKA secondary)
What is organic regurgitation?
Regurgitation due to an abnormality of the cusps: a structural abnormality of the valve
What are three organic regurgitation types? 3
- Valvular prolapse
- Calcific disease
- Masses on the valve
What is functional regurgitation?
Regurgitation due to annular dilation which leads to poor cusp coapt action in an otherwise normal valve
What are some signs and symptoms of Functional regurgitation? 2
- HTN (AV)
- MI (poor LV function leads to LV dilation)
What is a valvular prolapse?
When One of both valve leaflets bow behind the valve annulus, causing the valve to leak
If one leaflet prolapses during valvular prolapse, what will happen?
Regurgitation will be eccentric
What is valvular prolapse often linked to?
Connective tissue disorders
What valve is valvular prolapse most common on?
MV
From left to right name the etiology? 3
- Normal
- Rheumatic
- Calcific
What does the two images demonstrate?
Left a normal valve and a calcified valve on the right
What is this an example of?
M-Mode with Severe AS
What does this image demonstrate?
A normal (left) AV valve and a calcified (right) one 2
What is this an example of?
Mitral annular calcifcation: Notice how the calcifcation
- Starts at the annulus (posterior)
- Progresses inward on leaflets
What does this image demonstrate? 3
Rhematic TV disease: Notice the
- MV is involved
- Thickened and retracted TV leaflets
- Diastolic doming
What does this image demonstrate?
Bicuspid AV
What does this image demonstrate?
Ebstein’s anomaly notice the abnormal apical displacement of the TV
