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Cardiovascular system > Valve disease > Flashcards

Valve disease Flashcards

1
Q

What are the inflow valves?

A

mitral and tricuspid

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2
Q

What are the outflow valves?

A

aortic and pulmonary

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3
Q

What is valve stenosis?

A

valve does not open fully
not enough blood gets through

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4
Q

What is valve regurgitation?

A

valve does not close fully
blood leaks backwards

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5
Q

What are the 2 most common valves to be affected by valve disease?

A

aortic and mitral

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6
Q

2 general causes of valve disease (related to structure)

A

disease of the valve leaflets
stretching of the structure the valve is attached to

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7
Q

Congenital and acquired causes of disease of the valve leaflets

A

congenital = born with abnormal valve that wears out faster than normal (eg. bicuspid aortic valve)

acquired = degenerative, rheumatic, endocarditis

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8
Q

What does stretching of the structure the valve is connected to cause?

A

leakage
called secondary/functional regurgitation

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9
Q

What can cause a dilated left ventricle and what does it cause?

A

causes mitral regurgitation

ischaemic heart disease
dilated cardiomyopathy
hypertension

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10
Q

What can cause a dilated aortic root and what does it cause?

A

causes aortic regurgitation

cystic medial necrosis (due to ageing, hypertension, Marfan’s)
bicuspid aortic valve
aortic dissection

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11
Q

Describe rheumatic fever

A

inflammatory condition involving heart, skin and connective tissues
usually affects children/young adults
50% have cardiac involvement
heart disease development usually due to recurrent episodes

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12
Q

How can rheumatic heart disease be prevented?

A

penicillin after sore throat or rheumatic fever

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13
Q

What causes valve damage in rheumatic fever?

A

due to abnormal tissue response to group A strep

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14
Q

How does valve disease present?

A

incidental finding (hearing a murmur, finding valve disease on an echo)

heart failure symptoms (fatigue, breathlessness, swollen legs)

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15
Q

What is mitral valve disease often associated with?

A

atrial fibrillation

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16
Q

What can aortic valve disease be associated with?

A

angina
dizziness
sudden death

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17
Q

Status of aortic and mitral valves in systole

A

mitral valve closed
aortic valve open

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18
Q

Status of aortic and mitral valves in diastole

A

mitral valve open
aortic valve closed

19
Q

Anatomical cause of mitral stenosis

A

commisural fusion and leaflet thickening

20
Q

Most common cause of mitral stenosis

A

rheumatic heart disease

21
Q

What position accentuates the mitral stenosis murmur?

A

left lateral
place bell lightly at apex

heard as low frequency rumbling heard in mid diastole

22
Q

Mitral stenosis treatment

A

anticoagulation (if AF present)
balloon valvotomy

23
Q

Mitral regurgitation treatment

A

surgery if severe and symptomatic or asymptomatic with left ventricular impairment
mitral valve repair is treatment of choice

24
Q

What is the commonest congenital heart defect?

A

bicuspid aortic valve

25
Q

Describe the pathophysiology of aortic stenosis

A

thickening of aortic valve causes obstruction to outflow
pressure gradient develops across the valve and turbulent flow causes a loud murmur in systole
left ventricle is pressure loaded because of obstruction to flow and hypertrophies

26
Q

Aortic stenosis symptoms

A

heart murmur
angina pectoris
syncope
air hunger (difficult breathing)

27
Q

Signs of aortic regurgitation

A

collapsing pulse
wide pulse pressure
prominent carotid pulsation
laterally displaced apex beat

28
Q

Symptoms of aortic regurgitation

A

asymptomatic for many years
develop left ventricular failure (dyspnoea, orthopnoea, fatigue)
chest pain

29
Q

What signs can be seen in aortic regurgitation?

A

Corrigan’s sign
De Musset’s sign
Quincke’s sign
Traube’s sign
Austin Flint murmur
Duroziez’s sign

30
Q

What is Corrigan’s sign?

A

carotid pulsation

31
Q

What is De Musset’s sign?

A

head nodding with each heartbeat

32
Q

What is Quincke’s sign?

A

capillary pulsations in nail bed

33
Q

What is Traube’s sign?

A

‘pistol shot’ sound over the femoral arteries

34
Q

What is Austin Flint murmur?

A

mid diastolic murmur over cardiac apex

35
Q

What is Duroziez’s sign?

A

systolic and diastolic bruit over femoral arteries on gentle compression by stethoscope

36
Q

What position can accentuate the sound of aortic regurgitation?

A

sit up
lean forward
exhale completely
hold breath in full expiration
press diaphragm firmly at left sternal edge

37
Q

Describe tricuspid valve disease

A

mild tricuspid regurgitation = so common it’s a normal variant
significant TR usually functional and due to right ventricle enlargement

38
Q

What causes tricuspid stenosis?

A

rare
rheumatic heart disease

39
Q

Describe pulmonary valve diseases

A

pulmonary stenosis = rare and usually congenital

pulmonary regurgitation = usually functional due to dilated pulmonary artery caused by pulmonary hypertension

40
Q

What is the key investigation for valve disease and what can it tell you?

A

echocardiography

  • severity of stenosis
  • degree of regurgitation
  • ventricular size and function
  • atrial size
  • estimated pulmonary artery pressure
41
Q

Medical therapy for valve disease

A

treat heart failure
AF:
- prevent embolism = anticoagulate (warfarin)
- rate control = beta blockers and digoxin

42
Q

Surgical/interventional options for valve disease

A

valvotomy (open valve up) - mainly for mitral stenosis, can be for aortic temporarily/palliative

tricuspid valve repair (surgical/percutaneous with balloon)

repair valve surgically - almost always mitral valve

valve replacement:
- mechanical valve
- tissue valve (animal/human)
- TAVI (transcatheter aortic valve implantation)

43
Q

Compare mechanical vs tissue vs repair vs catheter implanted for valve disease treatment

A

mechanical = durable but must anticoagulate

tissue = lasts less time, no anticoags unless AF

repair = best if can be done but only mitral, long-lasting, no anticoags, better function

percutaneous implant = only aortic

TAVI = good alternative to standard surgical aortic valve replacement

44
Q

Factors that increase the risk of valve surgery

A

age
general physical state and comorbidities
damage already done to the heart - particularly to LV in chronic cases
renal function
cerebral and carotid arteries - these determine risk of stroke

Cardiovascular system (33 decks)

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