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case two > valvular disease > Flashcards

valvular disease Flashcards

1
Q

name the four heart valves

A

aortic pulmonary tricuspid mirtal

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2
Q

what causes the first heart sound (S1)

A

closure of tricuspid and mitral valves

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3
Q

what causes the second heart sound (S2)

A

closure of the aortic and pulmonary valves

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4
Q

when is a heart murmur heard?

A

when blood flow through the heart is turbulent (which is in most causes abnormal)

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5
Q

describe mitral regurgitation

A

Backflow through the mitral valve during systole

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6
Q

what are the symptoms of mitral regurgitation?

A

Shortness of breath fatigue palpitations

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7
Q

what can mitral regurgitation increase the risk of?

A

increase the risk of atrial fibrillation (AF) and heart failure.

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8
Q

name potential causes of mitral regurgitation

A
  • Functional: if the left ventricle becomes dilated, the mitral valve annulus dilates too, meaning the leaflets cannot meet properly
  • Annular calcification: calcification of the mitral valve annulus can occur with increasing age
  • Infective endocarditis
  • Mitral valve prolapse: when closed, leaflets of the mitral valve prolapse abnormally back into the left atrium
  • Myocardial infarction (MI): MI can damage/rupture the chordae tendinae or papillary muscles
  • Rheumatic heart disease: the mitral valve is the valve most commonly affected by rheumatic heart disease
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9
Q

describe rheumatic fever

A

Rheumatic fever is caused by an immune reaction to infection with Group A streptococcus bacteria. Antibodies produced by the immune system to attack the bacteria cross-react with other parts of the body, causing damage.

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10
Q

what causes rheumatic heart disease?

A

when antibodies produced by the immune system to fight rheumatic fever damage the cardiac valves

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11
Q

what can be observed when examining for mitral regurgitation?

A
  • a pan-systolic murmur can be heard which radiates to the axilla, so can be heard when listening to the left axilla
  • displaced, forceful apex beat due to enlarged LV
  • atrial fibrillation (irregularly irregular pulse)
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12
Q

describe aortic stenosis

A
  • Narrowing of aortic valve causing reduced flow in systole
  • causes progressive obstruction to the left ventricular outflow during systole
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13
Q

list symptoms of aortic stenosis

A
  • chest pain (due to reduced flow to the coronary arteries)
  • breathlessness
  • syncope (fainting)
  • fatigue
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14
Q

name main causes of aortic stenosis

A
  • Age-related calcification
  • Bicuspid aortic valve
  • rheumatic heart disease - can cause thickening and calcification of aortic valve
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15
Q

describe age-related calcification

A

Age-related calcification: the main cause is age-related calcification of the aortic valve. As patients age an inflammatory process causes thickening of the aortic valve with lipoproteins, which become calcified, increasing leaflet stiffness. Older men who smoke and have high blood pressure, cholesterol and diabetes are at higher risk.

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16
Q

describe bicuspid aortic valve

A

Bicuspid aortic valve: The other main cause, which tends to present at a younger age, is due to a bicuspid aortic valve. The normal aortic valve is tri-leaflet (three valve leaflets). 2% of people are born with a two-leaflet Bicuspid aortic valve. This is the most common congenital cardiac abnormality. A bicuspid aortic valve is at a higher risk of aortic stenosis, as well as aortic root dilatation and aortic dissection, which can be fatal. Patients should have regular echocardiography follow-up.

17
Q

what can be found upon examination for aortic stenosis?

A
  • crescendo-decrescendo ejection systolic murmur caused by ejection of blood through stenosed valve
  • radiates up to the carotids
  • slow rising pulse - builds in intensity
  • may be signs of heart failure
18
Q

describe aortic regurgitation

A

Back flow of blood from aorta, through the aortic valve into the left ventricle during diastole

19
Q

what does aortic regurgitation do?

A

increases the end diastolic volume in LV. The LV then needs to pump out more blood in systole, so increases in size and is less efficient. Perfusion to the coronary arteries is reduced, leading to ischaemia and left ventricular heart failure.

20
Q

what are the symptoms of aortic regurgitation

A
  • Symptoms of heart failure (e.g. shortness of breath)
  • palpitations
  • anginal chest pain
21
Q

what are the main causes of aortic regurgitation?

A

Dilation of the aortic valve leaflets:

  • Rheumatic heart disease
  • Infective endocarditis
  • Bicuspid aortic valve
  • Age-related degeneration

Dilation of the aortic root:

  • Connective tissue disorders e.g. Marfan’s syndrome and Ehlers-Danlos syndrome
  • Untreated syphilis infection
  • Aortic dissection
22
Q

what would you see upon examination for aortic regurgitation?

A
  • early diastolic murmur best heard at the left lower sternal edge
  • wide pulse pressure (large diff between systolic and diastolic pressure), causing a collapsing pulse - a pulse with a rapid upstroke and rapid descent
23
Q

describe mitral stenosis

A

narrowing of mitral valve

24
Q

what does mitral stenosis do, what are the negative effects on the hear and what symptoms do these cause?

A

reduces flow of blood from the LA to the LV in diastole

LA has to work harder and becomes enlarged

stretch increases the risk of atrial fibrillation and the enlarged left atrium can press on nearby structures (causing hoarseness, difficulty swallowing)

pressure causes high pressure in the pulmonary circulation, which leads to shortness of breath, haemoptysis and right heart failure

25
Q

what is the most common cause of mitral stenosis?

A

rheumatic fever

26
Q

what can be observed upon examination for mitral stenosis?

A
  • Malar flush - back pressure of blood in the venous system leads to build-up of carbon dioxide (CO2) in the venous system, including the veins of the face. CO2 is a natural vasodilator - the dilated blood vessels cause a red discolouration.
  • atrial fibrillation
  • right ventricular hypertrophy/failure - e.g. left parasternal heave
27
Q

what are the main causes of tricuspid regurgitation?

A
  • right ventricular dilation
  • rheumatic fever
  • infective endocarditis (particularly in IV drug users, who inject infected material into the venous system which reaches the tricuspid valve first)
  • congenital abnormalities
  • carcinoid syndrome (due to a tumour which secretes plaques into the venous system which settle on the tricuspid valve)
28
Q

what is main cause of tricuspid stenosis?

A

rheumatic heart disease

29
Q

what are the causes of pulmonary stenosis?

A

usually congenital - e.g. Tetralogy of Fallot

can be caused by rheumatic heart disease or carcinoid syndrome

30
Q

what is the main cause of pulmonary regurgitation?

A

any cause of pulmonary hypertension

case two (10 decks)

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