valve disease (see DM for more info) Flashcards
2 mechanisms of valve disease
disease of the valve leaflets (e.g. stenosis); stretching if the structure the valve is attached to
3 mechanisms of acquired valve disease
rheumatic, endocarditis (infective), degenerative
what is secondary/functional regurgitation
regurgitation caused by dilation of the valve e.g. due to RV dilation
conditions that can cause LV dilation - MR (3)
ischemic heart disease; dilation cardiomyopathy; hypertension
Conditions that can cause aortic root dilation - AR
cystic medial necrosis (due to marfans, aging HTN etc.); bicuspid Aortic valve; aortic dissection
what can high LA pressure result in?
pulmonary oedema (backflow of blood)
what can high RA pressure result in?
increased JVP; ascites; peripheral oedema
what is rheumatic heart disease
a long term consequence of recurrent rheumatic fever; inflammatory condition involving heart, skin, connective tissue; can involve all 3 heart layers (endo - valve, myo - chest pain, peri - chest pain)
pathogenesis of rheumatic heart disease
strep sore throat -> acute cardiac inflammation -> chronic cardiac inflammation -> valve damage
prevention of rheumatic heart disease (4)
primordial - improved living conditions; primary - penicillin for all confirmed strep cases; secondary - extended antibiotics; vaccine (not yet available)
ways in which valve disease can present (5)
incidental findings - murmur, echo;
signs of heart failure - swollen legs, fatigue, SOB
what condition is mitral valve disease associated with
AF
what condition is aortic valve disease associated with
angina, dizziness, sudden death
components of mitral valve (7)
papillary muscles; chordae tendineae; posterior leaflets; anterior leaflet; anterior annulus; anteromedial commissure; posterolateral commissure
what is the main cause for mitral stenosis (MS)
rheumatic fevr
what happens to the LA in MS
become dilated due to increased pressure and volume (bc blood not flowing out) - could give rise to AF
what murmur is heard in MS
mid diastolic murmur with a snap (after S2), loud S1; severity directly related to volume of murmur; low rumbling sound
where does MS murmur radiate to and how is it best heard?
left side, best if lying on left side, pt breathes in; use bell
what murmur does MR have and where does it radiate to
pan systolic, radiates to axilla
what causes MR
Mitral valve apparatus dysfunction or dilation; most commonly mitral valve prolapse
what murmur is heard in MVP
mid systolic click
what does a bicuspid aortic valve increase the likelihood of
aortic stenosis/regurg; aortopathy; infective endocarditis
what murmur is heard in AS and where does it radiate to?
ejection systolic; radiates toward carotid artery
wall thickness, pressure gradient equation
LV wall stress in ejection (afterload) ∝ (pressure in LV x radius)/wall thickness
why is there reduced myocardial O2 supply in AS
coronary perfusion pressure is the driving force for pushing blood into the coronary arteries; CPP = aortic diastolic pressure - LVEDP (high as AV is stiff)
most common cause of AS
calcification
what is the AR murmur and how is it best heard
early diastolic murmur; lean pt forward and listen over tricuspid region, breath in/out and hold
why is there reduced myocardial O2 supply in AR
in severe AR, aortic diastolic pressure is low => CPP is low ( CPP = aortic diastolic pressure - LVEDP)
what causes a collapsing pulse
aortic regurgitation - sudden fall in diastolic pressure in the aorta, which is due to regurgitation of blood from the aorta, or “aortic run-off,” into the left ventricle through the leaky valve
what can cause tricuspid regurgitation
RV enlargement
TR murmur
systolic at LSE
what causes tricuspid stenosis
rare, due to rheumatic heart disease
what causes pulmonary stenosis
congential (rare)
what causes pulmonary regurgitation
dilated pulmonary artery; pulmonary hypertension
tricuspid stenosis presentation
fatigue, ascites and peripheral oedema; opening snap and early diastolic murmur
pulmonary stenosis presentation
dyspnoea, fatigue, oedema and ascites; ejection systolic murmur that radiates to L shoulder
