Valvular disease Flashcards
Define mitral valve prolapse
2mm or more systolic prolapse of one or both valve leaflets
Prevelance of mitral valve prolapse?
2-3% of population
What is meant by myxamatous degeneration>
Deterioration of connective tissue esp in mitral valve
What happens to the mitral valve in people with mitral valve prolapse
It prolapses back into the left atrium during systole
What are the signs of mitral valve prolapse
Ejections click
Late systolic murmur
Name 3 causes of aortic stenosis
- Calcific disease
- Congenital bicuspid valve
- Rheumatic disease
Name the symptoms of aortic stenosis (5)
- Dyspnoea
- Angina
- Syncope
- Left ventricular failure
- Sudden death
Why is there dyspnoea in aortic stenosis
Increased diastolic pressure in still non- compliant left ventricle
Why is there angina in aortic stenosis
Increased oxygen demand of hypertrophied left ventricle
Why is the syncope in aortic stenosis?
Either due to paroxysmal ventricular arrythmias or exertional cerebral hypoperfusion
Why is the left ventricular failure in aortic stenosis
Contractile failure as ventricle dilates
Why can sudden death occur in aortic stenosis
Ventricular arrythmias
3 signs of aortic stenosis
- Slow rising carotid pulse
- S4 noise with or without ejection click
- Ejection systolic murmu
3 indications for surgery to treat aortic stenosis?
- Any symptoms of AS
- Echo evidence of worsening LV dilation
- Peak systolic pressure gradient >50mmHg
Define aortic stenosis
Narrowing of aortic valve opening
Define aortic regurgitation
Blood goes back from aorta to left ventricle
What aortic valve leaflet diseases can lead to aortic regurgitation (4)
- Calcific disease
- Congenital bicuspid valve
- Rheumatic disease
- Infective endocarditis
What aortic root dilating diseases can lead to aortic regurgitation
- Ankylosing spondylitis
- Marfan syndrome
- Aortic dissection
Symptoms of aortic regurgitation
- Often none
- Dyspnoea
- Angina
Why can dyspnoea be seen in aortic regurgitation
Contractile failure as ventricle dilates
Why can angina be seen in aortic regurgitation
- Dyspnoea due to contractile failure as ventricle dilates
- Angina due to increased oxygen demand of dilated and hypertrophied LV
Signs of aortic regurgitation (3)
- Rapidly rising carotid pulse
- Early diastolic murmur
- Ejection murmur
Why is there a rapidly rising carotid pulse in aortic regurgitation
Vigorous ejection of volume loaded left ventricle
Why can an early diastolic murmur be heard in aortic regurgittaion
Aortic backflow
Why can an ejection murmur be heard in aortic regurgitation?
Turbulent ejection from volume loaded left ventricle
Main cause of mitral stenosis
Rheumatic fever
Symptoms of mitral stenosis (4)
Dyspnoea
Right ventricular failure
Palpitation
Systemic emboli
Why is dyspnoea present in mitral stenosis
Left atrial pressure increases
Why is right ventricular failure a symptom of mitral stenosis
Passive consequence of increased left atrial pressure and reactive pulmonary vasoconstriction
Why are palpitation a symptom of mitral stenosis
Atrial fibrillation
Why is systemic emboli a symptom of mitral stenosis
Static blood within dilated fibrillating left atrium predisposes to thrombosis
What can be auscultated in mitral stenosis
Loud first heart sound
Mid-diastolic rumble
Pre-systolic murmur (sometimes)
What is pulse like of somebody with mitral stenosis
Atrial fibrillation
What symptoms does a volume overload cause in mitral stenosis
Raised JVP
Basal creps
Ankle oedema
What are the requirements to be able to treat mitral stenosis with a valvuloplasty?
Noncalcified valve
No mitral regurgitation
No LA thrombus
What mitral valve leaflet diseases can cause mitral regurgitation
Mitral valve prolapse
Rheumatic disease
Infective endocarditis
What subvalvular diseases can lead to mitral regurgitation
Chordal rupture
Papillary muscle dysfunction
Papillary muscle rupture
Symptoms of mitral regurgitation
- Dyspnoea
- Palpitation
- Sytemic emboli
Explain the symptoms of mitral regurgitation
Dyspnoea happens due to increased LA pressure
Palpitations happen due to af
Sytemic emboli happens due to static blood within dilated fibrillating LA
What is pulse like in something with mitral regurgitation
AF PULSE
What can be heard when ausculatin somebody with mitral regurgitation
Pansystolic murmur
S3
What medical (non-surgical) treatments can be used for valve disease
Diuretics to treat fluid retention
Vasodilators
BB, digoxin to treat AF
Anticoagulants to prevent embolism
