Valvular disease Flashcards
Types of valvular disease
- Mitral regurgitation
- Mitral stenosis
- Mitral valve prolapse
- Aortic stenosis
- Aortic regurgitation
- Aortic sclerosis
Mitral regurgitation
Backflow of blood into the atrium during systole
Causes of mitral regurgitation
- LV dilatation
- Calcification (elderly)
- Infective endocarditis
- Rheumatic fever
- Mitral valve prolapse
- Ruptured chordae tendinae
- Papillary muscle dysfunction
- Cardiomyopathy
Symptoms of mitral regurgitation
- Dyspnoea
- Pulmonary oedema
- Palpitations
- Fatigue
Signs of mitral regurgitation
- AF
- Pansystolic murmur at apex radiating to axilla
- Soft S1, split S2, loud P2
Investigations for mitral regurgitation
- ECG - AF, LA LV enlargement/hypertrophy
- CXR
- Echocardiogram (+ cardiac catheterisation to confirm)
Management of mitral regurgitation
- B-blockers if AF
- Anticoagulate if AF, history of embolism, mitral stenosis
- Diuretics
- Vasodilators - hydralazine (CCB)
- Surgery for deteriorating symptoms - prosthetic valve
Mitral valve prolapse
Valve flaps bulge upwards into the left atrium. Most common valvular abnormality
Symptoms of mitral valve prolapse
Usually asymptomatic. May develop palpitations, atypical chest pain
Signs of mitral valve prolapse
Mid-systolic click/late systolic murmur
Investigations or mitral valve prolapse
- Echo is diagnostic
2. ECG may show T wave inversion
Management of mitral valve prolapse
- B-blockers for symptom relief
2. Surgery if severe
Pathophysiology of mitral stenosis
- Progressive dyspnoea (worse with exercise) - pulmonary HTN and fluid overload
- Increased trans-mitral pressure - LA enlargement and AF
- Right HF symptoms
- Haemoptysis due to bronchial vessel rupture
Causes of mitral stenosis
- Infective endocarditis
- Rheumatic fever - most common
- Calcification
- Congenital
- Malignant carcinoid
Mitral stenosis orifice area
Normal orifice area = 4-6cm2, symptoms begin when <2cm2
Symptoms of mitral stenosis
- Dyspnoea
- Hoarse voice (recurrent laryngeal nerve compression due to enlarged LA)
- Haemoptysis
- Bronchial obstruction
- Fatigue
- Palpitations
- Chest pain
Signs of mitral stenosis
- Malar flush
- Signs of RVF
- Low volume pulse
- AF common (LA enlargement)
- RV heave
- Rumbling mid-diastolic murmur
Investigations for mitral stenosis
- ECG - AF common
- CXR - LA enlargement
- Echo (diagnostic) - assess mobility
Management of mitral stenosis
- AF control
- Drugs - b-blockers, CCB, digoxin, diuretics
- Serial echocardiography
- Balloon valvuloplasty
- Mitral valve replacement
Typical presentation of aortic stenosis
Elderly person with chest pain, exertional dyspnoea or syncope.
Causes of aortic stenosis
- Senile calcification (most common)
- Congenital
- Rheumatic heart disease
Define aortic stenosis
Narrowing of aortic valve opening, restricting blood flow. Usual opening 3-4cm2. Symptoms occur at 1/4th the size of normal.
Pathophysiology of aortic stenosis
- Pressure gradient develops between left ventricle and aorta (increased afterload)
- LV pressure initially maintained by LV hypertrophy
- Compensatory pressure exhausted, LV function decline
Symptoms of aortic stenosis
- Classic triad - angina, syncope, HF
- Exertional dyspnoea
- Dizziness
- Systemic emboli (if infective endocarditis)
Signs of aortic stenosis
- Slow rising pulse with narrow pulse pressure
- Aortic thrill
- Ejection systolic murmur (heard at base left sternal edge radiating to carotids) crescendo-decrescendo
- Heaving, non-displaced apex beat
Investigation for aortic stenosis
- ECG
- CXR
- Echo - diagnostic - shows valve area, LV size and function
Management of aortic stenosis
- Valve replacement
2. TAVI - transcatheter aortic valve implantation
Define aortic sclerosis
Senile degeneration of the valve
Signs of aortic sclerosis
Ejection systolic murmur with no radiation to carotids. Normal pulse and S2.
Define aortic regurgitation
Leakage of blood into the LV during diastole due to ineffective coaptation of the aortic cusps
Causes of acute aortic regurgitation
- Infective endocarditis
- Chest trauma
- Ascending aortic coarctation
Causes of chronic aortic regurgitation
- Congenital
- Rheumatic fever
- Connective tissue disorder (e.g Marfan’s)
- Rheumatoid arthritis
Pathophysiology of aortic regurgitation
Pressure and volume overload. Compensatory mechanisms -> LV dilation -> heart failure
Clinical features of aortic regurgitation
- Breathlessness
- Orthopnoea
- Palpitation
- Diastolic blowing murmurs
Investigations for aortic regurgitation
- CXR - enlarged cardiac silhouette and aortic root enlargement
- Echo
- Cardiac catheterisation - assess severity
Management for aortic regurgitation
- Vasodilators
- Serial echocardiograms
- Surgery
