Valvular diseases Flashcards
Most common cause of mitral stenosis
Rheumatic heart disease
Pathophysiology of mitral stenosis
Mitral valve between left atrium and left ventricle becomes fused or thick –> obstructs flow –> during diastole increases pressure in left atrium
Primary causes of mitral regurgitation
Leaflet perforation
MV prolapse
Rheumatic valve disease
Infective endocarditis
Secondary causes of MR
Non-ischemic and ischemic cardiomyopathy (dilated LV, which also causes systolic HF)
Systolic HF (especially in HFrEF)
Pathophysiology of MR
Leaflet or supporting structure weaken and unable to close fully –> increase backflow into the left atrium
Valvular diseases with PSM
MR (radiates to axilla)
TR (Pulsatile liver)
VSD (no respiratory variation)
Valvular disease with mid diastolic murmur
MS (better heard on left lateral)
Valvular disease with early diastolic murmur
AR (sit up and lean forward)
PR (RV heave)
valvular disease with ejection systolic murmur
Aortic sclerosis/stenosis (radiates to carotids)
Major criteria for IE
Positive blood cultures for IE
Presence of endocardial involvement in echo
Minor criteria for IE
Predisposition to IE (previous IE, prosthetic valve, cyanotic heart disease)
Fever >38
Vascular phenomenon (janeway leisons)
Immunologic phenomenon (osler nodes)
Microbiologic findings
Common organisms in IE
Viridans strep
Strep bovis
Staph aureus
Enterococcus
HACEK group
How to diagnose IE with the major and minor criteria
2 Major OR
1 major 3 minor OR
5 minor
When is antibiotics prophylaxis needed
- Prosthetic heart valve
- previous IE
- Unrepaired CHD
- Completely repaired CHD, first 6 months after the repair
- Repaired CHD with residual defects
- Cardiac transplant patients with structurally abnormal valve
Aortic stenosis pathophysiology
Obstruction to outflow –> increase pressure in left ventricle –> Decrease left ventricle compliance and lead to inadequate compensation –> lead to decrease in EF
Common causes of aortic stenosis
Bicuspid AV in young
Senile degeneration in old
Primary cause of tricuspid regurgitation
Prolapse
Infection
Congenital
Secondary cause of TR
- AF
- pulmonary hypertension (which could be due to MS and MR as left atrial pressure increases)
- Right heart dilatation (which could also be because of pulmonary hypertension)
Pathophysiology of Aortic regurgitation
Backflow of blood from aorta back into left ventricle –> excess preload and afterload –> lead to LV dilatation and hypertrophy –> may lead to preserved left ventricular EF
Common causes of AR in young
- Bicuspid AV
- Marfan syndrome
- Ankylosing spondylosis
Common causes of AR in old
- Degenerative
- atherosclerotic Aortic dilation
- Leutic disease due to syphilis (not common)
Management of IE
Treat HF
Treat AF
Treat underlying etiology (start Abx early, anticoagulation or thrombolysis for obstructed prosthetic valve, revascularise if ischemic driven)
