Valve Defects (2) Flashcards
What is Stenosis?
→ What type of process is it caused by?
What is Regurgitation?
→ What type of process is it caused by?
Which investigations should be done in all cases?
➊ Failure of valve to open fully → Impedes blood flow
→ Chronic, therefore allowing time for compensatory changes to occur
➋ Failure of valve to close fully → Backflow of blood
→ Acute or Chronic
➌ • Examination
• Echo
• CXR
• ECG
Mitral Regurgitation/MR:
What occurs here?
What is its most common cause?
→ What are the other causes?
What is heard O/E?
What is Acute MR usually due to?
→ How does it present?
What is Chronic MR usually due to?
→ How does it present?
How is it managed?
➊ Backflow of blood through incompetent mitral valve during systole
➋ Mitral Valve Prolapse
→ • Mitral Annulus (Valve ring) - LV dilatation, which stretches the valve ring e.g. in HF
• Cusps - MVP, IE, Post-Rheumatic fever
• Papillary muscles - Rupture post-MI, Ischaemia
➌ Pan-systolic murmur
‣ Radiates to the axilla, and is loudest on expiration
➍ Papillary muscle rupture post-MI
→ Sudden symptoms of pulmonary oedema - Exertional dyspnoea, SOB, Fatigue, Palpitations
➎ MVP
→ Due to compensatory changes, pt remains asymptomatic for some time, until the hypertrophied LV decompensates, presenting as LHF
➏ • Treat complications of acute heart failure and AF
• Valve repair or replacement
Mitral Stenosis:
What is it?
What’s its most common cause?
→ What are the other causes?
How does it present?
What is heard O/E?
How is it managed if asymptomatic?
How is it managed if symptomatic?
➊ Impaired opening of the mitral valve affecting blood flow from the LA to LV
➋ Rheumatic heart disease (Strep antigens secondary to bacterial infection cross-react with valve tissue)
→ • Age-related calcification
• Congenital
➌ • Symptoms tend to come on when the degree of stenosis is advanced (< 1.5cm^2)
• Typically presents with gradual exertional dyspnoea and reduced exercise tolerance (haemoptysis and AF also common)
➍ Mid-diastolic murmur
‣ Loudest on expiration
➎ Regular Echo to assess for progression of stenosis
➏ • Treat complications of acute heart failure and AF
• Balloon valvuloplasty, Percutaneous mitral valvotomy, or Open valve repair/replacement
Mitral Valve Prolapse/MVP:
What is it?
What’s it a common cause of?
How does it present?
What is heard O/E?
➊ Abnormal bulging of one or both valve leaflets into the left atrium during systole
‣ Normal dense collagen and elastin matrix of valve is replaced with loose myxomatous connective tissue
➋ Mitral regurgitation
➌ Mainly asymptomatic, and may include dyspnoea, palpitations, chest pain
➍ • Mid-systolic click
• MR (pan-sysotlic) murmur
Aortic Stenosis:
What is its most common cause?
→ What are the other causes?
How does it present?
What is heard O/E?
How is it managed?
→ When should this be considered?
What’s the main differential here?
→ How is it ruled out?
➊ Age-related/Senile Calcification (>50%)
→ * Congenital bicuspid aortic valve
* Rheumatic heart disease - cusps fuse together
➋ Triad of SAD:
* Syncope
* Angina
* Dyspnoea
➌ Ejection-systolic murmur
N.B. AS causes a slow-rising pulse as the stiffened valve requires greater pressure to open so opens later, and when it does open less blood comes out.
➍ * Transcatheter aortic valve implantation (TAVI) - better for older pts w/co-morbidities
* Surgical aortic valve replacement (SAVR) - Better for younger, low risk pts
→ When the valve gradient is ≥50mmHg
➎ Aortic sclerosis
→ Murmur that radiates to the carotids
Aortic Sclerosis:
What is it?
What is heard O/E?
How is it differentiated from Aortic Stenosis?
➊ Calcification and thickening of the valve w/o motion restriction
➋ Ejection-systolic murmur
➌ Murmur doesn’t radiate to the carotids
Aortic Regurgitation:
What is it?
What are the most common causes of Acute AR?
What’s the most common cause of Chronic AR?
How does it present?
What is found O/E?
How is it managed?
➊ Backflow of blood through incompetent aortic valve during systole
➋ * Aortic dissection
* Infective endocarditis
➌ Aortic root dilatation
➍ * Exertional dyspnoea
* Orthopnoea
* PND
➎ * Collapsing pulse
* Early-diastolic murmur heard at Erb’s point (left sternal border at 3rd/4th intercostal space)
‣ Louder on leaning forward and expiration
* Wide pulse pressure (defined as a gap of >100 mmHg)
N.B. AR causes a wide pulse pressure as, backflow into the LV decreases the diastolic pressure in the aorta.
➏ Valve replacement
N.B. B-blockers and/or ARBs can be used to slow down aortic root dilatation by lowering systolic BP, therefore reducing risk of AR progression
