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Phase 2 (again) > Valvular disease > Flashcards

Valvular disease Flashcards

1
Q

Types of valvular disease

A
  1. Mitral regurgitation
  2. Mitral stenosis
  3. Mitral valve prolapse
  4. Aortic stenosis
  5. Aortic regurgitation
  6. Aortic sclerosis
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2
Q

Mitral regurgitation

A

Backflow of blood into the atrium during systole

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3
Q

Causes of mitral regurgitation

A
  1. LV dilatation
  2. Calcification (elderly)
  3. Infective endocarditis
  4. Rheumatic fever
  5. Mitral valve prolapse
  6. Ruptured chordae tendinae
  7. Papillary muscle dysfunction
  8. Cardiomyopathy
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4
Q

Symptoms of mitral regurgitation

A
  1. Dyspnoea
  2. Pulmonary oedema
  3. Palpitations
  4. Fatigue
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5
Q

Signs of mitral regurgitation

A
  1. AF
  2. Pansystolic murmur at apex radiating to axilla
  3. Soft S1, split S2, loud P2
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6
Q

Investigations for mitral regurgitation

A
  1. ECG - AF, LA LV enlargement/hypertrophy
  2. CXR
  3. Echocardiogram (+ cardiac catheterisation to confirm)
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7
Q

Management of mitral regurgitation

A
  1. B-blockers if AF
  2. Anticoagulate if AF, history of embolism, mitral stenosis
  3. Diuretics
  4. Vasodilators - hydralazine (CCB)
  5. Surgery for deteriorating symptoms - prosthetic valve
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8
Q

Mitral valve prolapse

A

Valve flaps bulge upwards into the left atrium. Most common valvular abnormality

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9
Q

Symptoms of mitral valve prolapse

A

Usually asymptomatic. May develop palpitations, atypical chest pain

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10
Q

Signs of mitral valve prolapse

A

Mid-systolic click/late systolic murmur

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11
Q

Investigations or mitral valve prolapse

A
  1. Echo is diagnostic

2. ECG may show T wave inversion

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12
Q

Management of mitral valve prolapse

A
  1. B-blockers for symptom relief

2. Surgery if severe

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13
Q

Pathophysiology of mitral stenosis

A
  1. Progressive dyspnoea (worse with exercise) - pulmonary HTN and fluid overload
  2. Increased trans-mitral pressure - LA enlargement and AF
  3. Right HF symptoms
  4. Haemoptysis due to bronchial vessel rupture
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14
Q

Causes of mitral stenosis

A
  1. Infective endocarditis
  2. Rheumatic fever - most common
  3. Calcification
  4. Congenital
  5. Malignant carcinoid
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15
Q

Mitral stenosis orifice area

A

Normal orifice area = 4-6cm2, symptoms begin when <2cm2

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16
Q

Symptoms of mitral stenosis

A
  1. Dyspnoea
  2. Hoarse voice (recurrent laryngeal nerve compression due to enlarged LA)
  3. Haemoptysis
  4. Bronchial obstruction
  5. Fatigue
  6. Palpitations
  7. Chest pain
17
Q

Signs of mitral stenosis

A
  1. Malar flush
  2. Signs of RVF
  3. Low volume pulse
  4. AF common (LA enlargement)
  5. RV heave
  6. Rumbling mid-diastolic murmur
18
Q

Investigations for mitral stenosis

A
  1. ECG - AF common
  2. CXR - LA enlargement
  3. Echo (diagnostic) - assess mobility
19
Q

Management of mitral stenosis

A
  1. AF control
  2. Drugs - b-blockers, CCB, digoxin, diuretics
  3. Serial echocardiography
  4. Balloon valvuloplasty
  5. Mitral valve replacement
20
Q

Typical presentation of aortic stenosis

A

Elderly person with chest pain, exertional dyspnoea or syncope.

21
Q

Causes of aortic stenosis

A
  1. Senile calcification (most common)
  2. Congenital
  3. Rheumatic heart disease
22
Q

Define aortic stenosis

A

Narrowing of aortic valve opening, restricting blood flow. Usual opening 3-4cm2. Symptoms occur at 1/4th the size of normal.

23
Q

Pathophysiology of aortic stenosis

A
  1. Pressure gradient develops between left ventricle and aorta (increased afterload)
  2. LV pressure initially maintained by LV hypertrophy
  3. Compensatory pressure exhausted, LV function decline
24
Q

Symptoms of aortic stenosis

A
  1. Classic triad - angina, syncope, HF
  2. Exertional dyspnoea
  3. Dizziness
  4. Systemic emboli (if infective endocarditis)
25
Q

Signs of aortic stenosis

A
  1. Slow rising pulse with narrow pulse pressure
  2. Aortic thrill
  3. Ejection systolic murmur (heard at base left sternal edge radiating to carotids) crescendo-decrescendo
  4. Heaving, non-displaced apex beat
26
Q

Investigation for aortic stenosis

A
  1. ECG
  2. CXR
  3. Echo - diagnostic - shows valve area, LV size and function
27
Q

Management of aortic stenosis

A
  1. Valve replacement

2. TAVI - transcatheter aortic valve implantation

28
Q

Define aortic sclerosis

A

Senile degeneration of the valve

29
Q

Signs of aortic sclerosis

A

Ejection systolic murmur with no radiation to carotids. Normal pulse and S2.

30
Q

Define aortic regurgitation

A

Leakage of blood into the LV during diastole due to ineffective coaptation of the aortic cusps

31
Q

Causes of acute aortic regurgitation

A
  1. Infective endocarditis
  2. Chest trauma
  3. Ascending aortic coarctation
32
Q

Causes of chronic aortic regurgitation

A
  1. Congenital
  2. Rheumatic fever
  3. Connective tissue disorder (e.g Marfan’s)
  4. Rheumatoid arthritis
33
Q

Pathophysiology of aortic regurgitation

A

Pressure and volume overload. Compensatory mechanisms -> LV dilation -> heart failure

34
Q

Clinical features of aortic regurgitation

A
  1. Breathlessness
  2. Orthopnoea
  3. Palpitation
  4. Diastolic blowing murmurs
35
Q

Investigations for aortic regurgitation

A
  1. CXR - enlarged cardiac silhouette and aortic root enlargement
  2. Echo
  3. Cardiac catheterisation - assess severity
36
Q

Management for aortic regurgitation

A
  1. Vasodilators
  2. Serial echocardiograms
  3. Surgery

Phase 2 (again) (24 decks)

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