Valvular Disease Flashcards
Papillary muscles?
5 in total
3 in RV and support tricuspid valve via chordae tendinea
2 in LV and on mitral valve
Semilunar valves
Pulmonary valve- The valve consists ofthreecusps left, right andanterior
Aortic valve - consists of threecusps – right, leftandposterior.
Stenosis vs regurgitation
Stenosis - valve opening problem : calcification, degeneration. Increases afterload
Regurgitation - valve closing problem : annular dilation, ventricular attachment disorders
Systole vs Diastole
Systole= closing of mitral and tricuspid valves
opening of aortic and pulmonic valves
Diastole= closing of aortic and pulmonic valves
opening of mitral and tricuspid valves
Auscultation
2nd intercostal space, right upper sternal border- aortic area
2nd intercostal space, left upper sternal border- pulmonic area
4th intercostal space, left- tricuspid area
5th intercostal space, left- mitral area
Aortic Stenosis
Causes
Symptoms
tight aortic valve, increases afterload, poor perfusion to systemic circulation
Causes -
Congenital - bicuspid aortic valve (male higher)
Age related calcification ( deposited on central part of cusps - stellate shaped systolic orifice)
Rheumatic fever - triangular systolic orifice, fusion of edges
Symptoms - SAD Syncope Angina Dyspnoea
Pulsus parvus et tardus (pulse is small and weak, and slow to rise)
LV hypertrophy
Microangiopathic Haemolytic Anaemia (MAHA) - RBC sheared
Systolic Ejection murmur
Might be an ejection click
Crescendo - decrescendo
Radiates to carotid
Angina
Rheumatic Fever
Diffuse inflammatory disease
median age 10 yrs
Delayed response to infection by Grp A Beta- haemolytic Streptococci esp. S.Pyogenes in strep throat
Affects heart (rheumatic heart disease), joints, CNS, skin, subcutaneous tissues
Acute - pan-carditis
Chronic - valvular fibrosis - stenosis. Starting with mitral valve then aortic valve
AS Symptoms
•SAD
Syncope
Angina
Dyspnoea
•Pulsus parvus et tardus (pulse is small and weak, and slow to rise)
- LV hypertrophy - inc o2 demand
- Microangiopathic Haemolytic Anaemia (MAHA) - RBC sheared
•Systolic Ejection murmur
Might be an ejection click
Crescendo - decrescendo
Radiates to carotid
- Angina
- Prexisting CAD
Aortic Regurgitation
Causes
Symptoms
increases preload Causes - •Widening of aorta - tertiary syphilis, connective tissue disease (marfan syndrome, Ehlers-Danlos syndrome) • Infective endocarditis • Rheumatic Fever
Symptoms - Fatigue Syncope Dyspnoea Palpitations Wide pulse pressure Left Ventricular Dilatation Diastolic Murmur - early, decrescendo
Infective endocarditis
Infection of the heart valves or endocardium of the heart, usually bacterial.
Alteration or abnormality of the surface of the endocardium due to damage, congenital abnormalities or wear and tear lead to the deposition of platelets and fibrin.
Forming a non-bacterial (sterile) thrombotic endocarditis.
Transient bacteraemia occurs when tissues that are normally heavily colonised with bacteria, are damaged (dental, GI, urological invasive procedures)
Bacteria adhere to non-bacterial thrombotic endocarditis leading to vegetative growth.
Infective endocarditis
Commonly - Staphylococcus and Enterococcus bacteria
Mitral Regurgitation
Causes
Symptoms
Pansystolic murmur
blood to back up into the pulmonary veins and reduces the amount of blood flowing into the aorta and systemic circulation
Causes
Anything that lead to dilation of the left ventricle - remodelling post MI, D CM
Rheumatic Fever
Endocarditis
Papillary muscle ( or chordae tendinae) dysfunction or rupture - annular dilatation, papillary muscle rupture, leaflet tethering
Calcification of the valve or area around the valve
Symptoms
Fatigue
Shortness of breath
Pulmonary congestion
Dizziness
Syncope
Left atrial enlargement on echocardiography
Acute - after a papillary muscle rupture following an MI
sudden back up of blood in the left atrium and pulmonary veins and cause a flash pulmonary oedema.
Mitral Valve Prolapse
Causes
Symptoms
valve billows or balloons into the left atrium during systole. not produce a murmur unless the condition degenerates into mitral regurgitation.
Causes
The most common cause of MVP is abnormally stretchy valve leaflets (calledmyxomatousvalve disease)
Idiopathic- no known cause
Secondary to connective tissue disorders (such as Marwan Syndrome and Ehlers-Danlos Syndrome)
Symptoms Asymptomatic Atypical chest Pain (not angina) Palpitations (fast and forceful) Shortness of breath Dizziness Syncope
mid systolic click
Mid to late systolic crescendo
Mitral Stenosis
Causes
Symptoms
the valve does not opening as fully as it should, it become tight.
This prevent blood from entering the left ventricle and it starts to back up into the left atrium and into the pulmonary veins.
Causes
RF
Endocarditis
Symptoms
Fatigue Shortness of breath Exercise intolerance Cough Pulmonary oedema/congestion On echocardiography- left atrial enlargement
diastolic rumble with an opening snap.
Diagnosis of valvular disease
Auscultation with stethoscope
ECG
Chest X-Ray- look for heart dilation
Gold-standard= Echocardiogram (using sound waves to image heart in real time)
Cardiac catheterisation with pressure transducer
Management of valvular disease
Medical Interventions - BB, CCB, ACEi, Diuretics
Surgical Interventions -
Balloon Valvuloplasty-dilate stenotic valves
Open heart surgery- valve replacement
TAVR- minimally invasive valve replacement
