Valvular Disease Flashcards
What is the most common valvular defect?
Aortic stenosis 2-7% of over65s
What are the causes of aortic stenosis ?
Rheumatic heart disease, senile calcification, congenital I.e. Bicuspid valve
What sort of symptoms can you expect in atrial stenosis ?
Syncope followed by angina followed by HF also SOB and CP
What signs can you expect to see on examination in someone with AS ?
Ejection systolic murmur, loudest on expedition and radiating to carotid arteries (bell)
Slow raising pulse
Signs of left hypertrophy
Name 3 major investigations and findings when diagnosing AS
ECG: LEFT hypertrophy, p-mitrale, AV block
Echocardiogram: flow obstruction
CXR: cardio eagle if HF, AORTIC ring calcification, post stenosis dilation of aorta
What is the non-surgical management of AS and how good is it ?
Survival 1-3 years
Risk reduction: diet and exercise
Medication: statins, anti-IHD and HTN therapy
Symptom treatment I.e. AF, HF
What are the surgical options of As treatment
Transcatheter aortic valve implant(TAVI): good method for frail with 30 day mortality of 5-15%. May be complicated by VT, temponade, stroke, aortic dissection
Aortic valve replacement (AVR): definitive therapy but higher risk
Balloon valvyloplasty: short term solution in patients unfit for surgery
What complications can you expect in AS
Sudden death, HF, CCF, pulmonary oedema, infective endocarditis, emboli
What are the causes of aortic regargitation
Rheumatic heart disease, congenital, degenerative
What are the symptoms of AR
Dyspnoea , Orthopnoea paraxysmal nocturnal dyspnoea palpitations, angina, syncope
What are the major signs of AR
Early diastolic decrushendo high peach murmur
Wide pulse pressure
Hypertrophic displaced apex
What are the key investigations for AR
ECG: LVH
CXR
ECHO
How would you exacerbate left sided heart murmur?
Loudest on expiration
Right sided murmurs are louder on inspiration
What are the major causes of valvular disease
- Rheumatic fever
- Congenital
- Except AS: SLE, infective endocarditis
what are the major investigations for valvular heart disease
ECG,CXR and ECHO
What does TAVI stands for
Transcatheter aortic valve implantation
What does AVR stands for
Aortic valve replacement
what is the management of ARE based on risk assessment
- Severe symptoms => surgery
* Less severe: ECHO every 2 years or more frequently with ↑symptoms
what are the indications for surgery in AR
symptoms and LVEF
what sort of surgery is available for AR
aortic valve replacement or repair
What is the role of medications in AR
manage symptoms
what is the prognosis of AR
- If severe => haemodynamic instability
- LV dilation and HF
- Mortality in symptomatic patients: 10-20%
what are the causes of MS
- Rheumatic fever (the most common cause).
- Degenerative calcification (elderly).
- Congenital
- Rheum: SLE, RA
- Infective endocarditis (large vegetation)
what are the symptosm o MS
• Dyspnoea (on exercise) o Orthopnoea o Paroxysmal nocturnal dyspnoea • Atrial fibrillation/palpitations • Haemoptysis: (chronic bronchitis-like picture) • Chest pain • Symptoms of emboly
what are the signs of MS
- Malar flash of cheeks (↓CO)
- Low-volume pulse, AF
- Rumbling mid-diastolic murmur: on expiration and patient on the left with (bell)
- Opening snap
- ↑JVP
- RV heave and Signs of RV failure
what are the investigations for MS and the findings
- ECG: AF, RV hypertrophy, P-mitrale
- CXR: oedema, LA hypertrophy, valve calcification, prominent pulmonary vessels
- Echocardiogram: Evaluation of stenosis and pulmonary pressure
what is the purpose of medical management of MS
symptom control
what does PMC stand for and what is it
Percutaneous mitral commissurotomy
what are the indications for PMC
symptomatic patients and with pulmonary hypertension
what are the complications of PMC
emboli, severe regerg, hemopericardiun
what are the complications of untreated MS
Pulmonary hypertension • Dilated left atrium • Atrial fibrillation • Thromboembolic events • Right heart failure • Infective endocarditis
what is the prognosis of MS
- 5 year survival in symptomatic patients without valvotomy: 44%
- No symptoms/minimal 80% at ten years
- Less than 3 year survival with pulmonary hypertension
what are the primary causes of MR
IHD, prosthetic valve dysfunction, SLE, Rheumatic fever, congenital
what are the secondary causes of MR
Idiopathic or ischaemic cardiomyopathy
What are the symptoms of MR
- Dyspnoea, Fatigue, Palpitations
* Infective endocarditis
What are the signs of MR
- Pansystolic murmur at the apex radiating to axilla
- AF, Displaced hyperdynamic apex
- RV heave, Pulmonary hypertension
what investigations are useful in diagnosis of MR and what are the results
- ECG: AF, P-mitrale, LVH
- CXR: left cardiomegaly, calcification, pulmonary oedema
- Echocardiogram/Doppler echo
- BNP levels
- Angiography: CAD disease
What is the management for MR
Management
Medical: symptoms control
• Rate control and anticoagulation with fast AF
