Left heart valve disease Flashcards
WHat is arotic stenosis
The narrowing of the aortic valve orifice
What are the main causes of aortic stenosis
Age related calcific aortic stenosis, congenital bicuspicd ortic valve, rheumatic fever
Describe the pathophysiolgogy of aortic stenosis
Age related degeneration involves calcification of valve leaflets. Valve orifice area lowered. Increased afterload causes left ventricular hypertrophy (initially adaptive) but then hypertrophic response decompensates, patients transition to heart failure.
WHat are the clinical features of aortic stenosis?
Triad of symptoms on exertion: SAD
Syncope, angina, dyspnoea
WHat are the examination findings of aortic stenosis including auscultation?
Slow rising, delayed pulse, narrow pulse pressure (not much difference between systolic and diastolic), LV heave on apex,
Auscultation: Crescendo-decrescendo ejection systolic murmur radiating to both carotids.
What are the investigations for aortic stenosis
Echocardiography and doppler, ECG, Chest radiograph
Second line is cardiac MRO, cardiac catheterisation
How is aortic stenosis managed?
No medical therapy really, but CAD is common in AS patients, atherosclerotic risk factor midification recommended.
Medical therapy is a bridge for intervention or surgery. ACE inhibitors, digoxin, diuretics
Aortic valve replacement is the definitive treatment.
What is aortic regurgitation?
Backflow of blood though aortic valve during diastole
What causes acute aortic regurgitation
IE, ascending aortic dissection, chest trauma
WHat causes chronic aortic regurgitation
Rheumatic feverm congenital, CTDs, aortic dilatation, bicuspid valve disease, vasculitis, RA, SLE
WHat is the pathophysiology of aortic regurgitation
Blood flows back to LV from aorta, so lv has to overcome increased volume Causes increased heartrate and contractility to overcome preload. LV hypertrophy in chronic, remodelling
In acute, LV is normal size, unable to compensate, giving SOB, Pulmonary oedema due to backwards transmission of pressure
WHat clincial features are found in aortic regurgitation?
Dyspnoea, pulmonary oedema
Chronic presents with symptoms of heart failure
What examination findings are seen in aortic regurgitation?
Pulsus bisiferens, collapsing pulse, laterally displaced apex, wide pulse pressure,
Auscultation: High pitched early diastolic murmur, may have third heart sound, mid diastolic murmur suggests severe
What are the investigations of aortic regurgitation
CXR, ECG, echocardiogram
Second line is cardiac catheterisation
How is acute aortic regurgitation managed
Immediate surgery, haemodynamic support may be needed beforehand (inotropes and nitrates)
How is chronic aortic regurgitation managed?
Medical therapy - Treatment of hypertension, symptomatic patients may need surgery. WHen surgery contraindicated, ACE inhibitors and beta blockers may be needed. Definitive treatment os Aortic valve replacement.
