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Cardiovascular > Valve Disease > Flashcards

Valve Disease Flashcards

1
Q

What is aortic stenosis?

A
  • Obstruction of blood flow across the aortic valve due to pathological narrowing.
  • It is a progressive disease.
  • Can be congenital or acquired.
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2
Q

How does aortic stenosis present?

A
  • Presents after a long subclinical period with the following symptoms:
    • Decreased exercise capacity
    • Exertional chest pain (angina)
    • Syncope
    • Heart failure
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3
Q

What are the causes of congenital aortic stenosis?

A
  • Bicuspid aortic valve
  • Subaortic (e.g. fibromuscular) ring
  • Supravalvular (e.g. Williams syndrome)
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4
Q

What are the causes of acquired aortic stenosis?

A
  • Senile calcification is the most common cause of aortic stenosis.
  • Rheumatic heart disease.
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5
Q

What are the risk factors for developing aortic stenosis?

A
  • Age >60
  • Congenitally bicuspid aortic valve
  • Rheumatic heart disease
  • Chronic kidney disease
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6
Q

Which investigations would be carried out to diagnose aortic stenosis?

A
  • Transthoracic echocardiogram
  • ECG
  • Cardiac MRI
  • Cardiac cathaterisation
  • ECG exercise stress testing
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7
Q

What are the signs of aortic stenosis?

A
  • Slow rising pulse with narrow pulse pressure
  • Heaving, non-displaced apex beat
  • Left ventricular heave
  • Aortic thrill
  • Ejection systolic murmur
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8
Q

Describe the pathophysiology of aortic stenosis.

A
  • Causes increased afterload.
  • Results in failure to increase cardiac output during exertion.
  • Due to increased myocardial oxygen requirement, it causes progressive left ventricular hypertrophy.
  • Due to decreased myocardial oxygen delivery, it causes decreased systemic coronary flow.
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9
Q

What is aortic regurgitation?

A
  • Diastolic leakage of blood from the aorta into the left ventricle.
  • Can be acute or chronic.
  • Occurs due to inadequate coaptation of valve leaflets resulting from either intrinsic valve disease or dilation of the aortic root.
  • Can remain asymptomatic for decades before patients present with irreversible myocardial damage.
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10
Q

What are the presenting symptoms of aortic regurgitation?

A
  • Exertional dyspnoea
  • Orthopnoea
  • PND
  • Palpitation
  • Angina
  • Syncope
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11
Q

What are the risk factors for developing aortic regurgitation?

A
  • Bicuspid aortic valve
  • Rheumatic fever
  • Endocarditis
  • Connective tissue disease
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12
Q

Which investigations would be used to diagnose aortic regurgitation?

A
  • ECG
  • CXR
  • Echo
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13
Q

What are the causes of acute aortic regurgitation?

A
  • Infective endocarditis
  • Ascending aortic dissection
  • Chest trauma
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14
Q

What are the causes of chronic aortic regurgitation?

A
  • Congenital
  • Connective tissue disorders (Marfan’s; Ehlers-Danlos)
  • Rheumatic fever
  • Rheumatoid arthritis
  • Hypertension
  • Osteogenesis imperfecta
  • Syphylitic aortitis
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15
Q

Describe the pathophysiology of aortic regurgutation.

A
  • Due to the diastolic reflux of blood back into the left ventricle, there is a volume overload.
  • Can cause left ventricular dilation.
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16
Q

What is mitral stenosis?

A
  • Narrowing of the mitral valve orifice.
  • Normal mitral valve orifice is ~5-6cm. Symptoms usually begin when orifice becomes <2cm.
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17
Q

What are the signs of mitral stenosis?

A
  • Malar flush on cheeks (due to decreased cardiac output).
  • Low volume pulse.
  • Right ventricular heave.
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18
Q

Which investigations would be used to diagnose mitral stenosis?

A
  • ECG
  • CXR
  • Trans-thoracic echo
19
Q

What are the risk factors for developing mitral stenosis?

A
  • Streptococcal infection
  • Femle sex
  • Serotogenic medications and ergot medications
    • Ergot alkaloids used to treat throbbing headaches or migraines
20
Q

Describe the pathophysiology of mitral stenosis.

A
  • Obstruction of normal transmitral flow.
  • In order to maintain flow, there is an increased pressure in the left atrium, which leads to dilation of the left atrium.
  • Due to increased pulmonary venous pressure, there is pulmonary congestion.
  • Secondary to mitral stenosis:
    • Right heart failure
    • Tricuspid regurgitation
21
Q

What is mitral regurgitation?

A
  • Backflow through the mitral valve during systole.
  • The mitral valve apparatus consists of anterior and posterior leaflets, chordae tendinea, anterolateral and posteromedial papillary muscles and mitral annulus. Any abberations
22
Q

What are the possible causes of mitral regurgitation?

A
  • Leaflets - rheumatic or degenerative
  • Chordae tendinea - myxomatous (floppy mitral valve syndrome)
  • Papillary muscles - ischaemic or functional
  • Annulus - congenital or infective (for example endocarditis)
23
Q

What are the risk factors for developing mitral regurgitation?

A
  • Mitral valve prolapse
  • Hx of rheumatic heart disease
  • Infective endocarditis
  • Hx of cardiac trauma
24
Q

What are the signs of mitral regurgitation?

A
  • AF
  • Displaced, hyperdynamic apex
  • Pansystolic murmur at apex radiating to axilla
  • The more severe these signs, the larger the left ventricle
25
Q

How does mitral regurgitation present?

A
  • Dyspnoea
  • Fatigue
  • Palpitations
  • Symptoms of the causative factor
26
Q

What is tricuspid stenosis?

A

Defined by an abnormally elevated pressure gradient across the tricuspid valve during diastolic filling of the right ventricle.

27
Q

How does tricuspid stenosis present?

A
  • Fatigue
  • Ascites
  • Oedema
28
Q

Which investigations would be used to diagnosi tricuspid stenosis?

A
  • ECG
  • CXR
  • Trans-thoracic echo
  • Doppler transthoracic echo
29
Q

What are the risk factors for developing tricuspid stenosis?

A
  • Group A streptococcal pharyngitis
  • Metastatic carcinoid tumours
  • Artificial tricuspid valve
  • IV drug use
30
Q

What are the signs of tricuspid stenosis?

A
  • Opening snap.
  • Early diastolic murmur heard at the left sternal edge in inspiration.
  • AF can also occur.
31
Q

What is tricuspid regurgitation?

A
  • Occurs when blood flows backwards through the tricuspid valve.
  • Caused by:
    • Rheumatic fever
    • Secondary to right heart dilatoin
    • Secondary to pulmonary hypertension
32
Q

How does tricuspid regurgitation present?

A
  • Fatigue
  • Hepatic pain on exertion
  • Ascites
  • Oedema
  • Symptoms of the causative condition
33
Q

What investigations would be used to diagnose tricuspid regurgitation?

A
  • Transthoracic echo
  • ECG
  • LFTs
  • Serum urea and creatinine
34
Q

What are the risk factors for tricuspid regurgitation?

A
  • Left-sided heart failure
  • Dilated tricuspid annulus
  • Rheumatic heart disease
  • Permanent pacemaker
35
Q

What are the signs of tricuspid regurgitation?

A
  • Right ventricular heave
  • Pansystolic murmur
  • Heard best at lower sternal edge in inspiration
  • Pulsatile hepatomegaly
  • Jaundice
36
Q

What is pulmonary stenosis?

A
  • Obstruction of the blood flow from the right ventricle into the pulmonary bed, resulting in a pressure gradient >10mmHg across the pulmonary valve during systole.
  • It is commonly associated with other factors.
37
Q

How would pulmonary stenosis present?

A
  • Dyspnoea
  • Fatigue
  • Oedema
  • Ascites
38
Q

Which investigations would be used to diagnose pulmonary stenosis?

A
  • ECG
  • CXR
  • Echo with doppler
  • Hb
  • Hct
39
Q

What are the risk factors for developing pulmonary stenosis?

A
  • Black ethnicity
  • Noonan syndrome
  • LEOPARD syndrome
  • Alagille syndrome
40
Q

What are the signs of pulmonary stenosis?

A
  • In mild stenosis, there is ejection click and ejection systolic murmur (which radiates to the left shoulder).
  • In severe stenosis the murmur becomes much longer and obscures A2.
41
Q

What is pulmonary regurgitation?

A

Backflow of blood through the pulmonary valve caused by any disease of the left side of the heart which causes pulmonary hypertension.

42
Q

How would pulmonary regurgitation present?

A
  • Rarely symptomatic but patient may have dyspnoea.
  • Decreased exercise tolerance
  • Diastolic murmur
  • Orthopnoea
43
Q

Which investigations would be used to diagnose pulmonary regurgitation?

A
  • ECG
  • Trans-thoracic doppler echo
  • CXR
44
Q

What are the key diagnostic factors for pulmonary regurgitation?

A
  • Presence of risk factors
  • Decrescendo murmur in early diastole at the left sternal edge

Cardiovascular (12 decks)

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