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Cardiovascular System > Mitral Stenosis, Mitral Regurgitation, Aortic Valve Stenosis, Aortic Valve Regurgitation (pathology) > Flashcards

Mitral Stenosis, Mitral Regurgitation, Aortic Valve Stenosis, Aortic Valve Regurgitation (pathology) Flashcards

1
Q

What is mitral stenosis?

A

Mitral valve orifice <2cm^2

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2
Q

What is the pathophysiology of mitral stenosis (5)?

A
  • ↑ AV pressure
  • ↑ LA pressure
  • Pulmonary hypertension
  • ↑ TPR
  • Right Heart dilatation + tricuspid & pulmonary regurgitation
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3
Q

What are the symptoms of mitral stenosis (6)?

A
  • SOB due to pulmonary oedema
  • Haemoptysis due to thin-walled veins rapture
  • Left atrium and atrial appendage enlargement leading to systemic emboli
  • Infective endocarditis
  • Chest pain
  • Hoarseness due to compression of recurrent laryngeal nerve by enlarged LA
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4
Q

What are the signs of mitral stenosis (7)?

A
  • Mitral facies (purple discoloration of cheeks and nose)
  • Normal pulse
  • Prominent JVP
  • Tapping apex beat
  • Diastolic thrill
  • Right ventricle heave
  • Diastolic murmur – opening snap-> ↑ pressure gradient LA-LV
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5
Q

What are the investigations for Mitral stenosis? (What can be seen from these investigations?)

A 
ECG 
-	Signs of right ventricular hypertrophy 
-	Taller R waves in V1 V2 
-	LA enlargement P > 0.12 sec
Cardiac catheterisation 
– determine LA pressure indirectly
CXR 
-	Left atrium enlargement -> straight left heart border 
Echo 
-	Thickening + scarring of leaflets 
-	Fusion of commissures 
-	‘elbowing’ of anterior leaflet 
-	Velocity of transmitted flow at rest & exercise-> determine severity of MS 
MRI 
-	Enlarged LA
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6
Q

What is the medical treatment for mitral stenosis?

A
  • Diuretics + restrict salt
  • Restore sinus rhythm in AF
  • Anticoagulation-> stroke prevention
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7
Q

What is the surgical treatment for mitral stenosis?

A
  • Valvotomy

- Mitral valve replacement if MVA on echo < 1.5 cm2

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8
Q

What is the difference between a biological and mechanical valve replacement? How does the follow up treatment differ?

A

Biological valve= no warfarin but worn-out valve after 15 years –ELDERLY
Mechanical valve= warfarin for life, valve lasts > 40 years – YOUNG

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9
Q

What is mitral regurgitation?

A

Leaky valve

Annular enlargement—> ↑ regurgitant volume—> LV compensation

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10
Q

What is acute vs chronic Mitral regurgitation?

A 
Acute= heart contracts more forcefully= ↓ESV and ↑ESP 
Chronic= ↑EDV, normal ESV , ↑↑ contractility= LEFT VENTRICULAR HYPERTROPHY
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11
Q

What is the aetiology of mitral regurgitation (4)?

A
  • Rheumatic heart disease
  • Mitral valve prolapse – Myxomatous degeneration
  • Infective endocarditis
  • Functional mitral regurgitation due to enlarged LV and annular dilatation
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12
Q

What are the causes of acute mitral regurgitation (2)?

A

Valve perforation

Chordal/papillary muscle rupture

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13
Q

What are the symptoms of acute mitral regurgitation?

A

EMERGENCY!

  • SOB due to pulmonary oedema and Cardiogenic shock
  • decreased BP & very high Heart rate
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14
Q

What are the symptoms of chronic mitral regurgitation (3)?

A
  • Fatigue, exhaustion due to ↓CO
  • Right heart failure
  • SOB or palpitations due to AFib
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15
Q

What are the signs of mitral regurgitation (7)?

A
  • Normal pulse or reduced in HF
  • Prominent JVP if RH failure
  • Brisk and hyperdynamic apex beat
  • RV heave (abnormally large beating heart)
  • Reduced S1 because valve leaflets cannot find each other
  • Holosystolic murmur of MR- radiates to axilla
  • Split S2: early A2, loud P2
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16
Q

What investigations for mitral regurgitation? (What would they show)

A

ECG
- Left Atrial enlargement P> 0.12 sec
- Right ventricular hypertrophy tall R waves in V1 V2
CXR
- Cardiomegaly, LA enlargement, mitral annulus calcification
Transoesophageal echo
- Assess LV dimensions
- Identify causes of MR (leaflet dysfunction, rapture of chordae/papillary muscles
- Assess disease severity with Pulmonary arterial pressure-> prognostic indicator
MRI
- Accurate cardiac volumes
- Volumetric determination of regurgitant volume

17
Q

What is the medical treatment for acute mitral regurgitation?

A 
Acute MR 
-	Reduce preload / afterload 
	•	SODIUM NITROPRUSSIDE – vasodilator 
	•	DOBUTAMINE ↑↑contractility 
	•	Intra-aortic balloon pump = ↑↑CO
18
Q

What is the medical treatment for chronic mitral regurgitation?

A
  • No therapy helps with haemodynamic

- Preserve LV functio

19
Q

What are the surgical treatments for mitral regurgitation?

A
  • Mitral valve repair or replacement
  • Repair> replacement
  • Replacement if severe MVR with blood flow into pulmonary v. on echo
20
Q

What is aortic valve stenosis?

A

Normal AV area= 3-4 cm2

AV Stenosis < 1.5-2 cm2

21
Q

Rheumatic vs degenerative aortic valve stenosis?

A

Rheumatic:
- Fusion of commissures and retraction/stiffening of free cusp margins
Degenerative:
- Due to atherosclerosis, slow inflammatory process, calcification of cusps

22
Q

What is the pathophysiology of aortic valve stenosis?

A

↑↑ LV systolic pressure -> LV hypertrophy -> ↑↑ Left ventricular end diastolic pressure ↑↑ LA pressure
Pulmonary hypertension
↑↑ myocardial O2 use -> ischemia-> LV failure

23
Q

What is the aetiology of aortic valve stenosis?

A
  • Degenerative Most common
  • Rheumatic
  • Bicuspid AV – congenital abnormality- 2 leaflets instead of 3
24
Q

What are the symptoms of aortic valve stenosis?

A
  • Long asymptomatic phase
  • Severe symptoms
    • Angina
    • Syncope/dizziness due to ↓ CO
    • SOB on exertion
    • HF
25
Q

What are the signs of aortic valve stenosis (7)?

A
  • Small volume pulse- slowly rising
  • JVP if RHF
  • Low BP
  • Vigorous sustained apex beat
  • RV heave
  • End systolic murmur-radiate to carotids
  • normal S1 + less audible A2 because of murmur (differentiate from aortic sclerosis)
26
Q

What are the investigations for aortic valve stenosis?

A 
Echo
-	Demonstrate AV cusp mobility 
-	LV function and hypertrophy 
-	Doppler =determine velocity of blood ejected from LV into aorta—> indirectly determine AV area
Cardiac MRI
27
Q

What are the medical and surgical treatments for aortic valve stenosis?

A

Medical
- Limited to those that develop HF
Surgical
- Aortic valve repair or replacement

28
Q

What is aortic valve regurgitation?

A

LV receives systolic volume + regurgitant volume —> ↑↑ LV EDV and LV systolic pressure —> LV hypertrophy + dilatation —> ↑↑ myocardial O2 use—> ischaemia—> LV failure

29
Q

What is the aetiology of aortic valve regurgitation?

A 
Can be due to defect in: 
-	Aorta 
	•	Dilated aorta (Marfan’s, hypertension)
-	Leaflets:
	•	Bicuspid aortic valve 
	•	Rheumatic heart disease 
	•	Endocarditis 
	•	Myxomatous degeneration
30
Q

What are the symptoms of acute and chronic aortic valve regurgitation?

A 
Acute AR – EMERGENCY 
-	↑↑ wall tension 
Chronic AR 
-	Long asymptomatic phase
-	Exertional breathlessness
31
Q

What are the signs of aortic valve regurgitation?

A
  • Large volume collapsing pulse – CORRIGAN SIGN
  • Wide pulse pressure ↑↑ systolic ↓diastolic
  • hyperdynamic displaced apex beat
  • Early diastolic murmur – difficult to hear- ask patient to lean forward
32
Q

What are the investigations for aortic valve regurgitation? (What would they show?

A

ECG
- ST changes due to LV strain, left axis deviation due to left ventricle hypertrophy
CXR
- Cardiomegaly in chronic AR
*Cardiac catheterisation- obsolete
Echo
- AV cusp anatomy
- LV function, dilatation, and hypertrophy
- Doppler assessment of regurgitant flow = ↑↑ pressure difference between systole and diastole= ↑↑ severity
MRI

33
Q

What are the medical and surgical therapies for aortic valve regurgitation?

A

Medical
- Vasodilator therapy
Surgical
- AV repair (rare) or replacement in severe AV regurgitation with LV dilatation

Cardiovascular System (37 decks)

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