Valvular Dysfunction Flashcards
When putting on the limb leads in an ECG how can we remember where to put them?
- Ride = Red on rigth arm
- Your = Yellow on left arm
- Green = Green on left leg
- Bike = Black on right leg
What does stenosis and regurgitation refer to in heart valves?
- stenosis = narrowing of valve
- regurgitation = leaking of valve backwards
What is the most common cause of valvular dysfunction in UK?
- degenerative
What is the most common cause of valvular dysfunction worldwide (not really in western world), which generally causes inflammation and damages cardiac tissue?
- rheumatic infection
- inflammation damages valves (most commonly mitral stenosis)
Which artery has the highest pressures in the body, therefore, making it more inclined to become pathological?
- aorta
What is the most common cause of aortic stenosis?
- degenerative (ageing and ware and tear)
What is the most common cause of mitral stenosis?
- rheumatic fever causing inflammation
What are the 3 most common clinical symptoms that patients with valvular dysfunction may present with?
- breathlessness = ⬆️ pressure on pulmonary system
- light headedness = lack of blood to head
- chest pain = lack of blood to coronary circulation
In heart sounds 1 and 2, what causes the first heart sound, the so called ‘LUB’?
- closure of the Mitral and Tricuspid valve
- occurs at end of diastole and start of systole
- low pitched sound
In heart sounds 1 and 2, what causes the second heart sound, the so called ‘DUB’?
- aortic and pulmonary valves close
- occurs at end of systolic and start of diastolic
- high pitched sound
All the valves in the heart have 3 leaflets, except one which only has 2. Which valve is this?
- mitral valve
Is systolic or diastolic generally longer?
- systolic
- this is why in mean arterial pressure we multiply DBP x 2
When trying to understand when stenosis and regurgitation occur in the aortic and mitral valves during systolic and diastolic, how can we remember this?
- ASK MR ARMS - underlined = systolic then comes diastolic
- AS = aortic stenosis
- MR = mitral regurgitation
- AR = aortic regurgitation
- MS = mitral stenosis
When trying to remember the order of the valves from the right atrium to the left ventricle, what does Toilet Paper My Arse refer to?
- Toilet = Tricuspid
- Paper = Pulmonary
- My = Mitral
- Arse = Aortic
If someone has suspected valvular dysfunction, what are the common investigations to perform?
- ECG
- Echocardiogram
- Cardiac MRI
- Cardiac Catheterisation
When trying to understand what heart murmors caused by stenosis and regurgitation occur in what valves in systolic, what does the mnemonic Please Sneak A**way _**S**lowly **MR** **T**_ige**R mean?
- Please Sneak = Pulmonary Stenosis
- Away Slowly = Aortic Stenosis
- MR = mitral regurgitation
- TigeR = mitral regurgitation
When trying to understand what heart murmors caused by stenosis and regurgitation occur in what valves in diastolic, what does the mnemonic ARMS PaRTS mean?
- ARMS = Aortic Regurgitation
- ARMS = Mitral Stenosis
- PaRTS = Pulmonary Regurgitation
- PaRTS = Tricuspid Stenosis
How many leaflets does the aortic valve have, and what are these called?
- 3 leaflets called semi-lunar valve (as they look like moons)
There are 3 cusps in the aortic valve. Two of them serve an important purpose during diastole. What is this purpose?
- 1 supplies left coronary
- 1 supplies the right coronary
What is the fibrous ring surrounding the aoetic valve called?
- annulus
Out of all valvular dysfunctions, what is the most common in the western world and is the leading indication for surgery?
- aortic stenosis
Aortic stenosis is the most common valvular dysfunction in the western world. What is the main cause for this in >70 and <70 year olds?
- >70 years = degenerative
- <70 years = bicuspid valve inherited abnormality
Aortic stenosis is the most common valvular dysfunction in the western world. Does aortic stenosis cause a pressure or volume overload on the left ventricle?
- pressure overload
- leads to left ventricular hypertrophy
In aortic stenosis there is a lack of blood being pumped out of the heart, what can this do to the pulse?
- low volume pulse
- slow rising pulse
In aortic stenosis there is a lack of blood being pumped out of the heart, what can this do to the second heart sound?
- quieter heart sound as valve doesnt close properly
- causes ejection systolic murmour
- murmour can be heart in aortic neck and radiates to neck
In aortic stenosis there is a lack of blood being pumped out of the heart, it can result in a thrill, what is this?
- palpable vibration due to turbulen blood flow through the valve
In aortic stenosis there is a lack of blood being pumped out of the heart, what are the tell tail sign of this on an ECG?
- left ventricular hypertrophy (tall QRS complex)
- left bundle branch block
What is the most appropriate investigation in patients with suspected valvular dysfunction?
- echocardiogram
- look for thickening, calcification, mobility, bicuspid
When using an echocardiogram we can measure the velocity of blood that can be converted into pressure. Normal valve area is at least 2sq cm. What is the area and pressure of a severe aortic valve stenosis?
- <1 sq cm and >65mmHg
- severe narrowing of aorta
Medication for aortic stenosis is poor, but whilst patients are waiting for a valve replacement, what medication can they be given?
- BUT diuretics can help with breathlessness
- BUT beta blockers can help with angina
What is one medication that should not be given to patients with aortic stenosis?
- ACE inhibitors and Ca2+ channel blockers
- patients require high pressure to maintain cardiac output
- vasodilation would cause a drop in cardiac output and a black out
In patients who have aortic stenosis and need a valve replacement, what is the most common surgery they undertake and type of valve given?
- open heart surgery
- tissue valve (most common)
- mechanical valve
A new method instead of open heart surgery is called Transcatheter aortic valve replacement (TAVR). What is this?
- catheter inserted into peripheries and to the heart
- new valve inserted squashing old valve
What is the most common valvular abnormality, but does not necessarily the one that needs a valvular intervention?
- mitral regurgitation is most common
- aortic stenosis most common needing valvular intervention
How many leaflets does the mitral valve have, and how is it attached to the heart walls?
- 2 leaflets
- chordae tendinae attach to valve
- papillary muscle attach to chordae tendinae and heart wall
Although mitral regurgitation is more common that aortic stenosis, does it require as much intervention?
- no
Mitral valve prolapse, which can lead to mitral regurgitation is a congenital disorder. What is this?
- chordae tendinae and leaflets are too long
- they valve is floppy as a result
What are the most common causes of mitral regurgitation?
- functional abnormalities caused by heart failure
- left heart dilates and so does the valve
- this leads to a leak
In mitral regurgitation there is a volume overload. Which chamber of the heart is most affected?
- left ventricle causes dilation
- dilation to allow for increased blood
- heart has to pump more blood causing stretching
In addition to LV volume overload some blood can lead back into the left atrium causing a volume overload. What can this do to the left atrium?
- volume overload
- lead to atrial fibrillation
When listening to the heart in mitral regurgitation, what would we expect to hear?
- LV is displaced and forceful
- increased pressure on RV
- pansystolic murmour that is homgenous
When listening to the heart in mitral regurgitation, we may hear a thrill. What is this and where would it be best be heard?
- turbulent blood flow causes thrill
- best heard over the mitral area
What are some common ECG findings in mitral regurgitation?
- Broad P waves
- Left ventricular hypertrophy
- Left Bundle Branch Block
What is the main investigation to perform in mitral regurgitation and what is the cut off in % of dilation that indicates severe mitral regurgitation?
- echocardiogram
- >50% - half blood goes backwards instead of forwards
In patients with mitral regurgitation who are symptomatic and need a valve replacement, what medications can be used to help until they can get a valve replacement?
- ACE inhibitors (Ramipril) for LV dilation
- Diuretic for breathlessness
- Beta-blocker and anticoagulant for atrial fibrillation
In patients who have mitral regurgitation and need a valve replacement, what is the most common surgery they undertake and type of valve given?
- open heart surgery
- tissue (most common) or mechanical valve
- surgical repair
- Transcatheter aortic valve replacement
What are the most common causes of aortic regurgitation?
- bicuspid valve (congenital)
- infective endocarditis
- rheumatic
In addition to valvular problems in aortic regurgitation, aortic disease where aortic regurgitation is secondary to the disease, commonly damaging the annulus. What are the most common causes of these?
- hypertension (⬆️ afterload and pressure on valve)
- aortic dissection (tearing of aorta)
- connective tissue damage (valve and collagen are weak)
- syphilis
In aortic regurgitation what can we expect to find on examination?
- pulse will have a large volume
- collapsing pulse (large fast upstroke)
- early diastolic murmur
In aortic regurgitation what what happens to the BP?
- high systolic and low diastolic
What are the 2 best methods for diagnosing aortic regurgitation?
- ECG
- echocardiogram
In aortic regurgitation what % of blood moving backwards is diagnositc of severe aortic regurgitation?
- >50% blood moving backwards
As usual medications for aortic regurgitation are poor. But until the patient can undego a valve replacement, what medications will they be put on?
- diuretci for breathlessness
- ACE inhibitor for LV dilation
In aortic regurgitation there are no good catheter options. In addition to replacing the damaged valve, what else is often repaired?
- surrounding tissue
What are the 3 most common causes of mitral stenosis?
1 - rheumatic infection
2 - degenerative
3 - congenital
In mitral stenosis what happens to the mitral valve?
- leaflets thicken and fuse
- causes pressure overload on left atrium
- can lead to atrial fibrillation
In mitral stenosis in addition to a damaged valve, what else can the pressure overload in the left atrium cause?
- pressure back up to pulmonary system
- pulmonary hypertension
- right heart failure
In mitral stenosis what can we expect to hear on examination?
- loud 1st heart sound
- mitral valve is forced shut by LV pressure
- may feel parasternal heave
- causes low pitch rumbling
What are the best 2 investigations for mitral stenosis?
- ECG
- echocardiogram
In mitral stenosis what is the cut off for pressure drop and valve area to identify severe mitral stenosis?
- >10mmHg (increased due to narrowing)
- <1sq cm (narrowing)
In mitral stenosis what is the most common drug given to patients who remain symptomatic?
- diuretics for breathlessness / oedema
- warfarin for angina and risk of atrial fibrillation
- beta blocker to control heart rate
In mitral stenosis a valve replacement is needed. In addition to standard open heart surgery, what other methods can be used?
- trans catheter balloon valvotomy
What is the main cause of tricuspid valve regurgitation?
- secondary due to annular dilation
- left sided heart disease (pressures move back through to RA)
- pulmonary hypertension (back flow of pressure)
What is potentialy the most under detected tests performed on a patients with suspected tricuspid valve regurgitation?
- jugular vein pressure (JVP)
- can be raised in tricuspid valve regurgitation
Is tricuspid valve stenosis common, and what is the main cause?
- not common
- main cause is rheumatic valve disease
Is pulmonary stenosis and pulmonary regurgitation common?
- no
What is the most common cause of pulmonary stenosis?
- congenital
What is the main cause of pulmonary regurgitation?
- secondary to disease
- pulmonary hypertension
When trying to understand what heart murmors caused by stenosis and regurgitation occur in what valves in systolic, what does the mnemonic Please Sneak Away Slowly MR TigeR mean?
- Please Sneak = Pulmonary Stenosis
- Away Slowly = Aortic Stenosis
- MR = mitral regurgitation
- TigeR = mitral regurgitation
When trying to understand what heart murmors caused by stenosis and regurgitation occur in what valves in diastolic, what does the mnemonic ARMS PaRTS mean?
- ARMS = Aortic Regurgitation
- ARMS = Mitral Stenosis
- PaRTS = Pulmonary Regurgitation
- PaRTS = Tricuspid Stenosis
What is the most common cardiac arrhythmia that can cause people to collapse?
- ventricular fibrilation
