Valvular Diseases Flashcards
Valve stenosis
Failure of love to open completely prevents normal forward flow of blood into a chamber or vessels
Evolve incompetence or regurgitation
Failure of valve to close completely
Failure to prevent refax of bread oh reversed flow after contraction of a cardiac chamber
Etiology Of aortic stenosis
Rheumatic fever (post inflammation scarring)
calcific aortic stenosis
congenital abnormalities
idiopathic
First rheumatic aortic valve stenosis
Thickened, rigid, partly adherent cusp
True or false
post rheumatic aortic valve stenosis usually combined with incompetence
True
Calcific aortic stenosis
Thickened cusps by fibrosis and nodules of calcification (project frlm surface of cusp)
Narrowing of orifice -> slit
Difference between calcific aortic stenosis and rheumatic aortic stenosis
Mitral valve also stenosed in rheumatic , but normal in cacilfic
No incompetence and cusp fusion associated as well in calcific compared to postrheumatic
Main reason of aortic stenosis
Congenital bicuspid aortic valves (80%)
Congenital aortic stenosis
Cusps fuse and form diaphragm with central opening
Y
Aortic stenosis pathophysiology
Reduced valve orifice
Afterload increases so more pressure in left ventricle required
Concentric left ventricular hypertrophy
Aortic pressure below normal during diastole
Reduced coronary perfusion
Angina Fainting attacks Left ventricular failure (cause death) Ventricular dilatation Increased left atrial pressure Pulmonary congestion with Oedema (death by cor pulmonale)
Sudden death in 20% cases due to ventricular fibrillation
Aortic incompetence causes
Cusps abnormalities (Rheumatic heart disease , Calcific aortic stenosis , bicuspid aortic valves with grossly unequal cusps,infective endocarditis with cusp rupture)
Aortic disease leading to stretching/ dilatation or root distortion (inflammatory like in syphilis and rheumatoid arthritis , or non inflammatory like in marfans syndrome )
Aortic incompetence pathophysiology
Volume overload in left ventricle During diastole
Left ventricle has to expel extra blood from diastole that was regurgitated
High preload leads to increased systolic blood pressure
Diastole has rapidly falling aortic pressure felt like a rapidly rising pulse that suddenly collapses ( collapsing/ water hammer / corrigan pulse)
Because of excess blood , dilatation of left ventricle and hypertrophy
Coronary blood flow compromised due to sudden decrease in diastolic pressure
Low coronary perfusion -> angina
Possibility of arrythmias and sudden death
Left ventricular failure in 3 years
Mitral stenosis cause
Post rheumatic scarring
Rheumatoid arthritis (fibrous thickening and distortion )
Post rheumatic mitral stenosis
Thickened Distorted Vascularised Fibrotic Infiltration by chronic inflammatory cells Irregular calcifications Fusion of cusps with central hole
Mitral stenosis pathophysiology
Accumulation of blood in left atrium
Limited hypertrophy of left atrium
Obstruction to blood flow during atrial systole
High atrial pressure
Blood backflow
Pulmonary venous congestion
Increased pulmonary venous pressure
Pulmonary arterial hypertension
Right ventricle hypertrophy
Right ventricle failure
