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BSMS 103 > Theme 3 - Valvular Heart Disease > Flashcards

Theme 3 - Valvular Heart Disease Flashcards

1
Q

What gives the S1 heart sound?

A

AV valves slamming shut after diastole

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2
Q

What time point is the S1 heart sound heard?

A

After diastole

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3
Q

What gives the S2 heart sound?

A

Aortic and pulmonary valves slamming shut

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4
Q

What time point is the S2 heart sound heard?

A

After systole

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5
Q

What is a murmur?

A

unusual sounds during a heart beat cycle

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6
Q

What heart sounds does a pan systolic murmur span?

A

S1 and S2

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7
Q

What is the character if an ejection systolic murmur?

A

reaches a crescendo during systole then decrescendos

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8
Q

what are the three types of systolic murmur?

A

mid systolic, pan systolic and late systolic

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9
Q

what is the most common murmur?

A

mid systolic murmur due to aortic stenosis

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10
Q

how are mid, pan and late systolic murmurs characterised?

A

mid - aortic or pulmonary stenosis or atrial septal defect
pan - mitral or tricuspid regurgitation or VSD
late - mitral valve prolapse

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11
Q

what are the two types of diastolic murmur?

A

early and mid/late

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12
Q

how are early and mid/late diastolic murmurs characterised?

A

early - aortic/pulmonary regurgitation
mid/late - mitral or tricuspid stenosis

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13
Q

what type of oedema is caused by tricuspid regurgitation?

A

peripheral oedema

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14
Q

what type of oedema is caused by mitral regurgitation?

A

pulmonary oedema

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15
Q

what is the most common cause of VHD?

A

ageing

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16
Q

what does rheumatic fever principally causes?

A

mitral stenosis

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17
Q

name one type of VHD a strep can cause

A

Infective valve disease or rheumatic valve disease

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18
Q

what is the most common cause of degenerative heart disease?

A

aortic stenosis

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19
Q

what valves are most likely to be affected by infective VD?

A

can affect any valve but IV drug users more likely to affect the right valve

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20
Q

what valves are most likely to be affected by congenital VD?

A

any valve

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21
Q

what are the three main pathologies of VHD?

A

fibrosis (fusion of leaflets), calcification (leaflets are immobile) and dilation (stretched ventricle pulls on valve cusp so it cant close)

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22
Q

is stenosis an opening or closing problem?

A

opening (SO!)

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23
Q

name three characteristics of stenosis

A

1) narrowing of valve orifice where blood moves through
2) leaflets open less wider
3) narrowed valve causes pressure build up

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24
Q

what can be a result of stenosis

A

increased back pressure and therefore a loss of stroke volume

25
Q

is regurgitation an opening or closing problem?

A

closing problem (REgurg, REverse)

26
Q

name three characteristics of regurgitation

A

1) valves dont close properly so leaflets dont meet in systole
2) blood flows in reverse at diastole
3) volume problem

27
Q

what three things can cause aortic stenosis?

A

degenerative VD, rheumatic VD, bicuspid instead of truicuspid aortic valve

28
Q

How does calcium play a part in aortic stenosis?

A

Calcium is deposited over time in the valve so it doesn’t open as well as it did before

29
Q

what is the consequence of aortic stenosis on the LV wall?

A

thicker as its working harder - then over time the heart is hypertrophic (thin walls and symptoms develop)

30
Q

what are 6 symptoms of aortic stenosis?

A

SAD (syncope, angina and dyspnoea), fatigue, sudden death and arrhythmia

31
Q

what are two key features of aortic stenosis and what do they cause?

A

1) obstruction of flow - causes SAD, fatigue, palpitation and murmur (only when severe, early has no symptoms)
2) Pressure overload - genereates high systolic pressure in LV to force blood through thee obstruction (initially thick LV then thinning of whole heart)

32
Q

what causes a baggy and non functional heart chamber?

A

pressure overload in aortic stenosis

33
Q

what heart sounds are heard in aortic stenosis?

A

normally - crescendo then decrescendo
when severe - quiet murmur as LV is so weak its a low pressure system and less turbulent flow

34
Q

what are the two main causes of aortic regurgitation?

A

endocarditis and ageing

35
Q

what are two characteristics of aortic regurgitation?

A

dilation of the aortic valve ring due to hypertrophy and bicuspid aortic valve

36
Q

what is the main consequence of aortic regurgitation

A

volume overload - blood flows back into the LV in diastole
- LV stretches to compensate for increased volume and eventually the LV walls dont recoil back

37
Q

Name two instances where there may be aortic regurgitation due to high volume circulation

A

pregnancy and anaemia

38
Q

what are the sequence of consequences of aortic regurgitation?

A
  • High volume in LV due to blood leaking back in diastole
  • LV dilates and fails
  • LA enlargement due to high pressure from LV
  • Increased fluid in LA which goes to lungs and alveoli = pulmonary vein hypertension
  • Fluid in the alveoli causes pulmonary oedema
39
Q

what type of heart failure can be a consequence of aortic regurgitation?

A

congestive (starts on left and spreads to right)

40
Q

what are the main symptoms of aortic regurgitation

A

often asymptomatic

  • dyspnoea due to increased pressure n lungs
  • can be acute - sudden PE which is fatal
41
Q

what type of murmur does mitral regurgitation give?

A

pan systolic

  • leaflets fail too close due to stretch/damage
  • blood LV to LA with turbulence (through the whole of systole)
42
Q

what are the three principal causes of mitral regurgitation

A

1) valvular - prolapse of valve, infection or degeneration
2) muscular - chordal rupture or papillary muscle failure
3) dilation - valve ring stretched and pulled due to LV dilation

43
Q

what are the two main causes of mitral regurgitation

A

degenerative or infective

44
Q

is there an increase in pressure in mitral regurgitation?

A

No
- LV and LA have time to compensate and dilate so there is increase volume but not effect on pressure

45
Q

How is acute mitral regurgitation characterised?

A

no time for compensation so increased pressure in the lungs causing pulmonary oedema

46
Q

what can be a serious consequence of mitral regurgitation?

A

PE - volume overload in the LV therefore blood flows to LA - blood to lungs and PE

47
Q

what are the symptoms of mitral regurgitation?

A
  • dyspnoea (due to increased pressure on lungs)
  • lethargy and decreased exercise tolerance
  • palpitations (AF due to high pressure in atria)
  • peripheral oedema (compensation)
    angina
48
Q

what causes a mid systolic click to be heard?

A

mitral valve prolapse
- leaflet prolapses back into the LA and causes regurgitation

49
Q

what is the principle cause of mitral stenosis?

A

rheumatic fever

50
Q

what does mitral stenosis cause?

A

LA volume increases which increases back pressure on the lungs and right haert

51
Q

is mitral stenosis volume or pressure overload?

A

pressure (due to narrowed valve orifice)

52
Q

what are the main consequences of mitral stenosis?

A
  • dyspnoea due to increase pressure on lungs and right heart
  • increased pressure close to lungs therefore increased risk of PE
53
Q

what type of murmur is heard in mitral stenosis

A

late diastolic murmur

54
Q

what are the main symptoms of mitral stenosis?

A

LUNG SYMPTOMS

  • dyspnoea
  • peripheral oedema
  • haemoptysis (pressire in LA pushes on trachea)
  • palpitations and systemic emboli due tot AF
  • fatigue
  • compressive symptoms - pressing on trachea and oesophagus therefore dysphagia
55
Q

what are three principle ways to manage VHD?

A
  • medical - deal with consequences eg give HF medication
  • surgical - valve repair or replacement
  • percutaneous - BAV/TAVI
56
Q

what are the two types of valve replacement?

A
  • mechanical - requires lifelong warfarin but lasts longer
  • biological - may only last for 10 years
57
Q

how doe transcatheter valve replacement work?

A
  • percutaneously - pushes old valve aside and puts in a new one
  • catheter put into large artery. and inflate a balloon to push the old one aside then deliver a new valve eon the balloon
58
Q

what group is transcatheter valve replacement good for?

A

elderly - non surgical and shorter recovery

BSMS 103 (23 decks)

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