Valvular Disease Flashcards
What is rheumatic fever?
Damage or defects to 1 or more valves of the heart caused by an infection with Streptococcus pyogenes.
Develops 2-4 weeks after a strep A throat or scarlet fever infection.
What are the common effects of rheumatic fever on heart valves?
Inflammation and scarring leading to valve stenosis or regurgitation, commonly affecting the mitral and aortic valve.
Often results in damage due to a type II hypersensitivity reaction.
What are Aschoff bodies?
Granulomatous nodules found in a rheumatic fever heart.
They are indicative of the inflammatory process associated with rheumatic fever.
What are the major criteria of the Jones criteria for diagnosing rheumatic fever?
- Erythema Marginatum
- Sydenham’s chorea
- Polyarthritis
- Carditis and valvulitis
- Subcutaneous nodules
These criteria help confirm the diagnosis of rheumatic fever.
What are the minor criteria of the Jones criteria for diagnosing rheumatic fever?
- Raised ESR or CRP
- Pyrexia
- Arthralgia
- Prolonged PR interval
These criteria are used in conjunction with major criteria to diagnose rheumatic fever.
What is the first-line treatment for rheumatic fever?
- Antibiotics (oral penicillin)
- Anti-inflammatories (NSAIDs)
Treatment aims to address the underlying infection and inflammation.
What are the complications of rheumatic fever?
- Atrial fibrillation
- Heart failure
These complications can arise as a result of valve damage.
What is aortic stenosis?
The most common type of valve stenosis characterized by narrowing of the aortic valve.
Often caused by chronic mechanical stress and age-related changes.
What is the typical symptom triad associated with aortic stenosis?
- Chest pain
- Dyspnea
- Syncope
Symptoms may only occur during exertion.
What are the signs of aortic stenosis?
- Narrow pulse pressure (120-100)
- Slow rising pulse
These signs can be indicative of the severity of the condition.
What type of murmur is associated with aortic stenosis?
Ejection systolic murmur (ESM) that is crescendo-decrescendo in nature and radiates to the carotids.
This characteristic murmur helps in diagnosing aortic stenosis.
Complication of aortic stenosis
HF and Afib
Pathophysiology of aortic stenosis
- 65+ = Fibrosis and calcification cause the valve harden making it difficult to open.
- <65 = Bicuspid aortic valve
- Other: HCM, congenital, rheumatic heart disease
What is mitral regurgitation?
Condition where the mitral valve fails to shut properly, causing blood to leak back into the left atrium during systole.
Often leads to volume overload of the left atrium.
What are the common causes of mitral regurgitation?
- Mitral valve prolapse
- Rheumatic fever
- Chordae rupture
- Damage to papillary muscles
- Left-sided heart failure
- Infective endocarditis
These factors contribute to the dysfunction of the mitral valve.
What are the symptoms of mitral regurgitation?
- Mostly asymptomatic
- Fatigue
- Shortness of breath (SOB)
- Oedema
Symptoms are often a result of left ventricular heart failure.
What type of murmur is associated with mitral regurgitation?
Holosystolic murmur, high-pitched blowing murmur, best heard in the mitral area and radiating to the axilla.
This murmur is characterized by a loss of clear S1 and S2 sounds.
What is tricuspid regurgitation?
Condition where the tricuspid valve fails to close properly, often due to right ventricular dilation.
Commonly associated with pulmonary hypertension and rheumatic fever.
What is aortic regurgitation?
Condition where the aortic valve does not close fully, allowing blood to leak back into the left ventricle.
Can lead to eccentric left ventricular hypertrophy due to increased end-diastolic volume.
What are the symptoms of aortic regurgitation?
- Increased pulse pressure
- Collapsing pulse (bounding/water-hammer pulse)
These symptoms indicate a hyperdynamic circulation.
What murmur is associated with aortic regurgitation?
Early decrescendo diastolic murmur.
This murmur indicates blood flowing back through the aortic valve.
What is mitral stenosis?
Narrowing of the mitral valve, often caused by rheumatic fever.
This condition can lead to increased pressure in the left atrium.
What are the symptoms of mitral stenosis?
- Dyspnea
- Dysphagia
- Hoarseness
- Hemoptysis
- Malar flush
- Atrial fibrillation
Symptoms arise due to elevated left atrial pressure, leading to pulmonary hypertension.
What type of murmur is characteristic of mitral stenosis?
Snap and diastolic rumble, low-pitched mid-diastolic murmur.
This characteristic sound is due to the turbulent flow across the narrowed valve.
What is the management for mitral stenosis?
Management:
1) MS + AF = anticoagulation
2) Asymptomatic = monitor with echo
3)** Symptomatic **= percutaneous mitral balloon valvotomy or mitral valve surgery
What is a bisferiens pulse?
A pulse characteristic of mixed aortic valve disease.
It indicates a combination of aortic stenosis and regurgitation.
