L02: Valve Disease Flashcards
What are the 4 main valves in the heart
Pulmonary valve
Aortic valve
Mitral valve (left)
Tricuspid valve (right)
What are the 2 things that can happen to a valve
Stenosis
Regurgitation
What type of murmus is a aortic stenosis
Harsh crescendo decresendo systolic ejection murmur
Where does a carotid stenosis murmur radiate to
To the carotids
What type of murmus is a aortic regurgitation
Diastolic murmur with a decresendo
What type of murmus is a mitral stenosis
Delayed diastolic murmus with a decresendo
What is a mitral regurgitation murmur like
Holosytolic murmus
Where does mitral regurgitation murmur radiate to
Axilla
What type of murmus is a pulmonary stenosis murmur
Cresendco decresendo systolic murmur
Where does pulmonary stenosis murmur radiate to
To the back
In valvular stenosis what happens to the pressures in the upstream and downstream chamber
Upstream chamber pressure is higher than the downstream pressure so blood can flow through
In valvular regurgitation what happens to the flow of blood when the valve is closed
There is a leak so the blood flows back to the upstream chamber
What is the most common valvular disease in the ageing population
Aortic stenosis
What are the causes of aortic stenosis
Congenital
Acquired: calcific degenerative aortic stenosis and rheumatic aortic stenosis (due to rheumatic fever causing inflammation and repair)
What features can we see with aortic stenosis
Left ventricular hypertrophy Angina: due to reduced blood flow to the coronary arteries Breathlessness and heart failure Collapse/syncope Death
What is the management of aortic stenosis
Medical therapy
Valvuloplasty- put a balloon to stretch the valve
Valve replacement: mechanical valve or tissue valve from pigs
Percutaneous valve replacement: TAVR, TAVI
How do we investigate for aortic stenosis and find out if it is severe
echocardiogram
What are the signs and symptoms of aortic regurgitation
Wide blood pressure differnce; systolic pressure increases due to blood flowing back to the ventricle and diastolic pressure decreases
Collapsing pulse
Displaced apex beat
Early diastolic murmur/systolic murmur
What are the causes of aortic regurgitation
Dilatation of the aortic root due to:
Hypertension
Marfans syndrome
Syphillis
Abnormality of aortic leaflet:
Prolpase
Fenestration
Damage to aortic leaflet:
Rheumatic fever
Endocarditis
What is the treatment of aortic regurgitation
Valve replacement
Tavr
Mechanical valves: bileaflet, tilting disc, ball in cage
What are the causes of mitral regurgitation
Mitral valve prolapse at birth
Rheumatic heart disease
Infecitve endocarditis
Collagen vascular disease
Secondary:
Ischaemic heart disease
Non ischaemic cardiomyopathy
What are the symptoms of mitral valve regurgitation
Breathlessness
Fatigue
Right heart failure
What are the signs of mitral valve regurgitation
Pan sytolic murmus radiating to the apex
Right heart failure
Pulmonary hypertension
What is the treatment for mitral valve regurgitation
Medical therapy
Valve replacement
Valve repair
Mitraclip
What are the causes of mitral stenois
Rheumatic fever
Congenital mitral stenosis
What are the symptoms of mitral stenosis
breathlesness Haemoptysis Embolisatipn Atrial fibrillation Rv heave Presystolic and rumbling diastolic murmur
What is the management of mitral stenosis
Medical therapy- anti coagulation
Valve treatment: open mitral valvotomy, percutaneous mitral commissuoromty, valve replacement
Do mechanical valves require anticoagulant
Yes
Do tissue walves require anticoagulant
No but last around 10 years
