Valvular disease Flashcards
Describe what can be heard in the heart
Opening and closing of heart valves Turbulent flow through the heart and valves Filling of the heart Valvular pathology Structural heart disease
Where can heart murmurs be heard?
Between the two heart sounds during systole
List the 4 ways valve disease can be caused describing the epidemiology of each
Degenerative- reflects aging population
Rheumatic- post streptococcal infection common in areas of poverty and overcrowding
Infective- common in IV drug abusers and immunocompromised patients
Congenital- Low incidence in all populations
Which valve is affected in degenerative valvular disease?
Aortic > Mitral
Which valve is affected in congenital valvular disease?
Any valve
Which valve is affected in infective valvular disease?
Any valve however more commonly the right if the person is an intravenous drug user
Which valve is affected in Rheumatic valvular disease?
Mitral>Aortic
List the 3 main pathologies behind valvular heart disease
Fibrosis- fusion of leaflets
Calcification- immobility of leaflets
Dilation- of the valve ring
What do the pathologies of valvular heart disease result in?
Either stenosis or regurgitation
Describe stenosis
The narrowing of the leaflets so the leaflets fail to open completely leading to a build up of back pressure and loss of volume
Describe Regurgitation
The leaflets do not meet in systole. The leaflets fail to close completely allowing to reverse flow of blood during the relaxation of the heart
In valvular disease the valves can either be…
Tight or leaky
Give the age of presentation of congenital syndromes causing aortic stenosis
Paediatrics, <60
Give the age of presentation of Bicuspid valves causing aortic stenosis
40-60
Give the age of presentation of degenerative aortic stenosis
> 60
Give the age of presentation of rheumatic aortic stenosis
< 60
Describe the features of aortic stenosis
Symptoms due to obstruction of flow- if severe then fatigue, breathlessness, syncope on exertion, chest pain, palpitations and murmur. If early then no symptoms may be present. The patient may adapt themselves to cope with symptoms and therefore may not notice any.
Pressure overload- Generation of high left ventricular systolic pressure causing left ventricular hypertrophy and eventually left ventricle decompensation/dilation
Describe the heart sounds of aortic stenosis
Crescendo-decrescendo murmur- Turbulent flow of blood since the aortic valve fails to open. At the beginning of systole the pressure gradually rises and as a result the amount of blood and therefore turbulence increases , peaks and then falls as the ventricles begin to relax
Soft second heart sound
What is the cause of most arrhythmias?
Pressure overload
List the symptoms of aortic stenosis
The SAD triad
Fatigue
If aortic stenosis is symptomatic what is more likely to occur?
Sudden death
State the aetiology of aortic regurgitation
Aortic dilatation- loss of support, connective tissue disease, hypertension, aortic dissection, degenerative, cystic medial necrosis and syphilis
Valvular- Bicuspid valve and infective endocarditis
CREAM- congenital, rheumatic, endocarditis, aortic dissection and marfan’s
List the consequences of aortic regurgitation
Volume overload- blood falls back into left ventricle during diastole
LV dilatation- to accomodate greater volume
Late decompensation of LV function
High volume circulation
Describe the pathophysiology of aortic regurgitation
Increase dilatation of the heart and left ventricle never returns to its original state. Therefore lose contractility. Less blood volume going forward. Overtime the volume overload causes pressure overload into the lungs. Manifests as fluid within the lungs
Name the two heart sounds of aortic regurgitation
Early diastolic murmur
Concomitant systolic murmur
Name the symptoms of aortic regurgitation
Often asymptomatic
Breathlessness
Chest pain
Sudden onset pulmonary oedema if acute
Give the aetiology of mitral regurgitation
Valvular- prolapse, infective, degenerative
Chordal rupture/papillary muscle failure
Annular dilation
List the consequences of mitral regurgitation
Decompensation- pulmonary oedema
Left ventricular dilatation
Volume overload in left ventricle
Pressure overload of right heart leading to right ventricular hypertrophy and right heart failure
State the differences between acute and chronic mitral regurgitation
Acute- No dilatation of left ventricle, high LA pressure, pulmonary oedema
Chronic- dilatation of left ventricle and left atrium- pressure dissipated to a degree. No pulmonary odema
Which heart sound is heard when mitral regurgitation is present?
Pan-systolic murmur
State the symptoms of mitral regurgitation
Breathlessness Lethargy Palpitations Peripheral oedema Chest pain
What happens during a mitral prolapse?
Initially valve shuts during the early part of systole but then, either because the leaflet is too ‘baggy’ or because of abnormal subvalvular apparatus the leaflet prolapses back into the left atrium potentially allowing through a jet of regurgitation
Give the names of the two heart sounds heard during a mitral prolapse
Mid systolic click
Late systolic murmur
List the aetiology of mitral stenosis
Rheumatic Congenital- more commonly seen Storage diseases Malignancy Previous endocarditis Mitral valve calcification Systemic disease
What are the consequences of mitral stenosis
Lung/right heart consequences
Breathlessness, congestion, etc
Due to pressure back up because of failure of ejection of left atrial volume
Left ventricle physiology usually preserved
State the heart sounds of a mitral stenosis
Mid-diastolic rumbling murmur
Opening snap
Loud first heart sound
List the symptoms of mitral stenosis
Breathlessness Peripheral oedema Haemoptysis – coughing up blood Palpitations – atrial fibrillation Systemic emboli Fatigue Compressive symptoms: Stridor- vibrating noise when breathing, Dysphagia- difficulty swallowing
Name the medical treatments for valvular disease
Diuresis for heart failure and drugs to slow down the heart for Arrhythmias
Name the percutanous treatments for valvular disease
TAVI
BAV
Name the surgical treatments for valvular disease
Valve replacement
Valve repair
In terms of prosthetic valves, If the first heart sound is metallic which valve could this be?
Mitral or tricuspid
In terms of prosthetic valves, If the second heart sound is metallic which valve could this be?
Aortic or pulmonary
When are heart murmurs from prosthetic valves pathological?
If diastolic
