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Cardiology finals > Valve disease > Flashcards

Valve disease Flashcards

1
Q

Describe the epidemiology of aortic regurgitation

A

3rd commonest valve disease
Increases w age
M > F

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2
Q

Describe the aetiology of aortic regurgitation

A

2 main groups of causes:

  1. Disease of aortic valve leaflets:
    - Bicuspid aortic valve
    - Rheumatic heart disease
    - IE
  2. Dilatation of aortic root:
    - Marfan’s
    - Aortitis
    - Dissection
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3
Q

Describe the pathophysiology of aortic regurgitation

A

Blood flows back over aortic valve during diastole

  • > LV pressure increases, LVH to compensate
  • > eventually systolic dysfunction + CCF
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4
Q

Describe the presentation of chronic aortic regurgitation

A
  • Usually asymptomatic for many years, detected on examination
  • Awareness of heartbeat at night
  • Palpitations
  • Decreased exercise tolerance
  • CCF
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5
Q

Describe the signs of aortic regurgitation

A

Hands: Corrigan’s pulse (collapsing), wide PP
Chest: displaced apex, EDM over aortic region w exacerbation leaning forward on end-exp at LSE
Eponymous signs:
-Quincke’s: nail bed pulsation
-De Musset’s: head bobbing
-Traube’s: pistol shot over femorals

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6
Q

Describe the investigations for aortic regurgitation

A
  • ECG: LAD, LVH
  • CXR: cardiomegaly
  • Echo
  • Extra special tests: exercise, catheterisation
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7
Q

Describe the management of aortic regurgitation (chronic)

A

Conservative:
-Most individuals will be managed conservatively w regular followup eg yearly echo

Medical:
-Management of any symptoms (end-stage)

Surgical/interventional:

  • For any symptomatic/LV dysfunction/dilatation
  • AV replacement or repair
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8
Q

Describe the epidemiology of aortic stenosis

A

Most common valve disease

Increases with age

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9
Q

Describe the aetiology of aortic stenosis

A
  1. Calcification of normal valves (age)
  2. Congenital biscuspid valve
  3. Rheumatic heart disease
  4. Connective tissue disease
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10
Q

Describe the pathophysiology of aortic stenosis

A

Impaired flow through the aortic valve during systole

  • > LVH for compensation
  • > systolic dysfunction (reduced CO) and CCF
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11
Q

Describe the presentation of aortic stenosis

A 
May be detected when asymptomatic on exam
Classic triad of symptoms:
-Angina
-Dizziness/syncope
-SOB especially on exertion 
CCF symptoms
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12
Q

Describe the signs of aortic stenosis

A

Hands: slow-rising pulse, narrow PP
Chest: thrusting apex, ESM over aortic area radiating to the carotids +/- AR, quiet S2

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13
Q

Describe the investigations for aortic stenosis

A

ECG: LVH, LAD
CXR
Echo
Extra tests: stress etc

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14
Q

Describe the management of aortic stenosis

A

Conservative:
-Mild/mod disease can be Mx with regular monitoring

Medical:
-To relieve symptoms as needed/not suitable for intervention

Surgical/interventional:

  • For symptomatic/severe disease/LV dysfunction
  • AV replacement/repair or TAVI if frail (>80years)
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15
Q

Describe the epidemiology of mitral regurgitation

A

2nd commonest valve disease
F > M
Younger/middle aged

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16
Q

Describe the aetiology of mitral regurgitation

A

Chronic: mitral valve prolapse (young F), connective tissue disease, rheumatic heart disease

Acute: chordae tendonae or papillary muscle dysfunction (MI, rupture), IE

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17
Q

Describe the pathophysiology of mitral regurgitation

A

Back flow of blood over mitral valve

  • > increased LA pressure + dilatation
  • > pulmonary HTN + CCF
18
Q

Describe the presentation of mitral regurgitation

A
  • May be initially asymptomatic, detected on exam
  • AF commonly occurs- palpitations, dizziness, syncope
  • Exertional dyspnoea, fatigue
  • CCF
19
Q

Describe the signs of mitral regurgitation

A

Hands: irregularly irregular pulse
Chest: pansystolic blowing murmur at apex, radiation to axilla. Quiet S1, displaced apex

20
Q

Describe the investigations for mitral regurgitation

A

ECG: AF, LVH
CXR: enlarged LA
Echo

21
Q

Describe the management of mitral regurgitation

A

Conservative:
-Mild/mod disease, monitored with echo

Medical:
-If required for symptoms, AF

Surgical/interventional:

  • Symptomatic disease/raised LA pressures/rEF
  • Mitral valve replacement/repair (valvuloplasty)
22
Q

Describe the epidemiology of mitral stenosis

A

Uncommon valve disease

More common in developing countries

23
Q

Describe the aetiology of mitral stenosis

A
  1. Rheumatic heart disease by far most common

- Carcinoid syndrome, SLE, drugs

24
Q

Describe the pathophysiology of mitral stenosis

A

Reduced flow over mitral valve during diastole
-> increased LA pressure
-> pulmonary HTN, reduced CO -> CCF
+ RVH, TR, etc

25
Q

Describe the presentation of mitral stenosis

A

Dyspnoea and fatigue commonly
AF: palpitations, syncope etc
-CCF symptoms
-Emboli -> ischaemia

26
Q

Describe the signs of mitral stenosis

A

Hands: AF
Face: malar flush
Chest: tapping apex, opening snap + rumbling diastolic murmur at apex, radiating to axilla
With complications: parasternal heave, crackles, oedema

27
Q

Describe the investigations for mitral stenosis

A

ECG: AF, RVH
CXR
Echo

28
Q

Describe the management of mitral stenosis

A

Conservative:
-If mild disease. Monitor

Medical:

  • AF
  • Symptomatic as needed
  • Prevention of RHD relapse

Surgical:

  • For severe symptomatic cases
  • Valve replacement/repair/balloon valvotomy
29
Q

Describe the epidemiology of tricuspid regurgitation

A

Very common to have mild disease (50-60% of young adults)

30
Q

Describe the aetiology of tricuspid regurgitation

A
  1. As a consequence of L heart disease (usually mitral regurgitation)
  2. RHD
  3. IE
31
Q

Describe the pathophysiology of tricuspid regurgitation

A

Back flow of blood over TV during systole

-> increased RA pressures

32
Q

Describe the presentation of tricuspid regurgitation

A

May be detected on investigation of severe MR/left heart disease
-RHF: Peripheral oedema

33
Q

Describe the signs of tricuspid regurgitation

A
  • AF
  • Raised JVP (absent a waves in AF)
  • Pansystolic murmur in tricuspid area, heard best on end-inspiration
  • Pulsatile liver
34
Q

Describe the investigations for tricuspid regurgitation

A

ECG: AF, RVH
CXR
Echo
Bloods: LFTs, etc

35
Q

Describe the management of tricuspid regurgitation

A

Conservative:
-Mild/mod disease

Medical:

  • Managing assoc symptoms
  • AF

Surgical/interventional:

  • Tricuspid valve replacement/repair
  • (deal with the cause eg. mitral valve replacement)
36
Q

Describe the aetiology of pulmonary hypertension

A

1: pulmonary arterial HTN: idiopathic, familial, drugs
2: PH from left heart disease (cor pulmonale)
3: PH from chronic hypoxic lung disease
4: chronic thromboembolic PH
5: unknown aetiology

37
Q

Describe the pathophysiology of pulmonary hypertension

A

Depends on the cause

  • Left heart disease: increased L sided pressures -> increased pressure in pulmonary circulation
  • Hypoxic lung disease: V/Q mismatch -> vascular remodelling -> increased pressures
38
Q

What are normal pulmonary pressures?

A

PAP: <25mmHg

PAWP (measure for L sided heart disease): <15 mmHg

39
Q

Describe the presentation of pulmonary hypertension

A

PAH: chronic progressive dyspnoea, exercise intolerance, fatigue
May also have symptoms of L heart failure: chest pain, syncope
Chronic: RHF (oedema, early satiety)

40
Q

Describe the signs of pulmonary hypertension

A

Initially normal exam

  • > JVP V wave, parasternal heave, loud P2
  • > raised JVP, oedema, pulsatile hepatomegaly
41
Q

Describe the investigations for pulmonary hypertension

A 
History and exam
-ECG: RVH 
-Bloods: general screen, BNP, D-dimer
-CXR
-Echo 
-Cardiac catheterisation for pressures
\+ HRCT etc
42
Q

Describe the management of pulmonary hypertension

A

Depends on class
Conservative:
-If mild symptoms

Medical:

  • Treat cause eg. bronchodilator/steroids for lung disease
  • Treat symptoms: CCBs, prostanoids, sildenafil, nitrates

Surgical/interventional:

eg. valve replacement
- Lung transplant

Cardiology finals (4 decks)

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