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BDS2 BAMS Cardiovascular > Valves, malformations & endocarditis > Flashcards

Valves, malformations & endocarditis Flashcards

1
Q

what are the right valves

A

pulmonary

tricuspid

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2
Q

what are the left valves

A

aortic

mitral/bicuspid

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3
Q

why are the left valves more likely to fail

A

they are at the highest pressure.

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4
Q

what are the two ways valves can fail

A

stenosis

incompetence

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5
Q

what is stenosis

A

the valve cannot open properly and so doesn’t allow blood through properly

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6
Q

what is incompetence

A

when the valve cannot close properly

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7
Q

what does a valve problem lead to

A

increase the risk that the patient will develop heart failure therefore when someone has a valve that does not work properly they must be replaced with a prosthetic one before permanent damage to the heart occurs thus early treatment is important!

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8
Q

how can an MI lead to valve problems

A

Heart valves are little cusplets of collagen and they are attached to the papillary muscles through tendons called chordinae tendinea
The papillary muscles keep the valves under tension and keep it shut. If you have an MI then this can cause damage to the papillary muscles and end up with valve function problems

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9
Q

if the mitral valve does not open properly what does it lead to

A

it causes an increase in pressure in the atrium and a lack of blood in the ventricle causing a decreased cardiac output and an increase in pressure in the pulmonary system.

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10
Q

what happens in rheumatic heart disease

A

the body forms an antibody against bacteria, but it also targets the tissue of the heart valve due to having the same protein structure which causes damage to the valves.

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11
Q

what can cause valve disease

A

congenital abnormality
myocardial infarction
rheumatic fever
dilation of the aortic root

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12
Q

how does congenital abnormality lead to valve disease

A

o Formed incorrectly during development
o Cannot do the job you want it to do
o Bicuspid aortic valve instead of normal tricuspid aortic valve

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13
Q

how does MI cause valve disease

A

o Papillary muscle rupture

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14
Q

how does rheumatic fever lead to valve disease

A

o Immunological reaction to streptococci

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15
Q

how does dilation of the aortic root lead to valve disease

A

o If you dilate the aortic root then it is stretched and the valve gets pulled apart so cannot do their job – issue here is not to do with the valve but with the aorta
o Syphilis
o Aneurysm formation

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16
Q

how can you investigate valve disease

A

ultrasound of the heart
dye allows for better assessment
can see different directions of blood
if working properly should be moving only in one direction

17
Q

what is the most common valve replacement

A

Valve replacements are generally mechanical, they are made in a workshop and will essentially be made of metal.

18
Q

what is the advantage of mechanical valve replacement

A

long lasting

19
Q

what is the disadvantage of mechanical valve replacement

A

lifetime of anticoagulants

20
Q

why do pig valves not attract clots

A

they contain the normal collagen leaflets

21
Q

who are pig valves used for

A

those in extremes oof life

22
Q

what do those with valve replacements have risk of

A

endocarditis

23
Q

what is a congenital heart defect

A

These happen as the embryo is forming

It is the failure of the fusion of the heart

24
Q

what is an ASD

A

When there is overfusion of the atria there is a hole from the left to the right side of the atria however the atria is a low pressure system and the differences in pressures is not great so for many cases the effect is not noticeable

25
Q

what are VSD

A

in the ventricles and these are a high pressure system and there is a difference between the left and right. When the left ventricle contracts some of the blood goes through to the right ventricle increasing the workload of the right side which can lead to right sided heart failure. You need to repair most VSDs

26
Q

what is ductus arteriosus

A

a bypass between pulmonary circulation and systemic circulation because an unborn child does not need to use their lungs

27
Q

what is patent ductus arteriosus

A

failure of closure of arteriosus

28
Q

what are congenital heart defects

A

ASD
VSD
patent ductus arteirosus
great vessel malformation

29
Q

what is cyanosis

A

exists when there is 5g/dl or more of deoxygenated Hb in the blood
makes it difficult to get enough oxygen to the tissues and you go blue if you have it

30
Q

what is central cyanosis due to

A

due to congenital heart disease – people with this are blue all over, even in tissues that are usually pink.

31
Q

what is peripheral cyanosis

A

Peripheral cyanosis is due to the cold environment

32
Q

what is finger clubbing

A

Much not understanding of it but causes swelling in the terminal tissues of the fingers – due to chronically low blood levels of oxygen

33
Q

what happens in VSD

A

Portion of the blood in the left ventricle is going to the right ventricle and it going back through the pulmonary artery into the lungs.
The left ventricle is having to work harder to maintain the CO and the right ventricle is having to work harder to deal with the increased volume

34
Q

what happens in correction of the aorta

A

When the baby is born a deep breath is taken causing a pressure difference in the lungs meaning that it is better to go through the pulmonary artery than the aorta and as oxygen level builds up and the oxygen tension goes up the ductus shuts. Sometimes the closing goes onto the aorta and results in a narrowed aorta making it difficult to carry blood through the aorta.

35
Q

what happens in patent ductus arteriosus

A

If it remains open it goes through the aorta and back to the lungs and it can lead to heart failure.

36
Q

what are those with congenital abnormalities more at risk of

A

endocarditis – guidance from a cardiologist is required.

37
Q

What is endocarditis

A

infection of the endocardium

usually on the valves

38
Q

How does infective endocarditis happen

A

microbial colonisation of thrombi on endocardial surface abnormalities

39
Q

What are predisposing factors for endocarditis

A

rheumatic fever less common now

prosthetic valves more common now

BDS2 BAMS Cardiovascular (6 decks)

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