Lecture: valvular disease Flashcards
What often causes mitral stenosis?
Rheumatic heart disease
What causes acute mitral regurgitation?
- infective endocarditis
- Ischaemic heart disease
- Mitral valve prolapse
- Chest trauma
What are the morphological changes that occur after mitral valve regurgitation?
Leads to atrial dilation and ventricular hypertrophy
Increased pulmonary pressure (pulmonary oedema)
What often causes aortic stenosis?
Old age-related valve degeneration
What are the three classic symptoms of aortic stenosis?
- Angina pectoris (average survival drops to 5 years)
- Chronic heart failure (1-2 years survival)
- Syncope or sudden death
What can cause venous ulcers?
Varicose veins Previous DVT Obesity Pregnancy Phlebitis
What can cause arterial ulcers?
Diabetes
Hypertension
Smoking
Previous vascular disease
What can cause neuropathic diabetic ulcers?
Diabetes
Trauma
Prolonged pressure
What can cause pressure ulcers?
Limited mobility
Where is the ulcer location of venous ulcers?
Area between the lower calf and the medial malleolus
Where is the ulcer location of arterial ulcers?
Pressure points
Toes and feet
Lateral malleolus and tibial areas
Where is the ulcer location of diabetic ulcers?
Plantar aspect of the foot
Tip of the toe
Lateral to fifth metatarsal
Where is the ulcer location of pressure ulcers?
Bony prominences
Heel
What is the ulcer characteristic of venous ulcers?
Shallow and flat margins
Moderate-to-heavy exudate
Slough at base with granulation tissue
What is the ulcer characteristic of arterial ulcers?
Punched out and deep, irregular shape, unhealthy wound bed, presence of necrotic tissue, minimal exudate unless infection
What is the ulcer characteristic of neuropathic diabetic ulcers?
Deep, surrounded by callus, insensate
What is the ulcer characteristic of pressure ulcers?
Deep, often macerated
What is the condition of the leg of venous ulcers?
Hemosiderin staining, thickening and fibrosis, eczematous and itchy skin
Limb oedema, normal capillary refill
What is the condition of the leg of arterial ulcers?
Thin, shiny skin Reduced hair growth Cool skin Pallor on leg elevation Absent or weak pulses Delayed capillary refill
What is the condition of the leg of neuropathic diabetic ulcers?
Dry, cracked, insensate, calluses
What is the condition of the leg of pressure ulcers?
Atrophic skin, loss of muscle mass
What is the treatment for venous ulcers?
Compression therapy
Leg elevation
Surgical management
What is the treatment for arterial ulcers?
Revascularisation
Anti-platelet medication
Management of risk factors
What is the treatment for diabetic ulcers?
Off-loading of pressure
Topical growth factors
What is the treatment for pressure ulcers?
Off-loading of pressure
Reduction of excessive moisture, shear and friction
Adequate nutrition
