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HLB > Valvular Dysfunction > Flashcards

Valvular Dysfunction Flashcards

1
Q

Stenosis

A

narrowing

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2
Q

Regurgitation

A

leaky

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3
Q

common causes of valvular heart disease:

A
  • degenerative (wears out as you get older)
  • congenital (born with it)
  • rheumatic disease (after rheumatic fever)
  • infective endocarditis (valve infections)
  • annular dilation (chronic strain)
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4
Q

Heart sounds

A
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5
Q

What is the most common aetiology of single valvular heart disease?

A

Degeneration

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6
Q

Valvular Heart Disease Investigations:

A
  • ECG
  • echocardiogram: transthoracic, transoeophageal
  • cardiac MR scan
  • cardiac catheterisation
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7
Q

Aortic Valve:

A
  • LV and aorta
  • semi lunar valve
  • 3 cusps
  • attached to a fibrous ring (annulus)
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8
Q

Anatomical names vs clinical names for cusps of aorta:

A
  • left coronary = left
  • right coronary = right
  • non-coronary = posterior
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9
Q

Aortic Stenosis blood pressure

A

insert
- peak to peak analysis of left ventricle pressure vs
peak of aortic pressure
- severe aortic stenosis = big difference in peaks
- 80mmHg difference = severe
- 35mmHg = moderate

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10
Q

What is the most common severe valvular abnormality in the West?

A

aortic stenosis

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11
Q

Most common cause for aortic stenosis for over 70s?

A

degeneration of tricuspid valve (50%)

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12
Q

Most common cause of aortic stenosis in under 70s?

A

Degeneration of bicuspid valve (congenital defect) (50%)

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13
Q

Signs of aortic stenosis (5):

A
  • low volume, slow rising carotid pulse
  • force impulse at the apex
  • soft second heart sound (cusps don’t slam shut)/
    absent
  • ejection systolic murmur = loudest in the aortic area,
    radiates to the neck
  • thrill in the aortic area
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14
Q

Aortic Stenosis on an ECG:

A
  • left ventricular hypertrophy (thickening):
    - tall complexes
    - lateral T wave inversion
    - 80% of patients with severe AS
  • Left bundle branch block: (always pathological)
    - broad complexes
    - many other causes
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15
Q

What is the diagnosis?

A

Aortic stenosis

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16
Q

Aortic Stenosis Echocardiogram:

  • what will you see
  • what will classify mild, moderate and severe aortic
    stenosis?
A
  • left ventricular hypertrophy
  • aortic valve: calcified, may be bicuspid, restricted
    mobility
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17
Q

Aortic Stenosis Treatment (4)(1):

A
  • symptomatic patients need a new valve
  • as a holding maneuver:
    - diuretic for breathlessness
    - beta blocker for angina/chest pain
  • AVOID vasodilators (eg ACE inhibitors and nitrites)
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18
Q

Why do we avoid vasodilators when treating aortic stenosis?

A

ACE inhibitors drop preload, preload affects how much the heart expands, decreasing force of contraction and can lead to patient fainting

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19
Q

Aortic Stenosis Surgical Treatment:

A
  • AVR = surgical valve replacement:
    - tissue valves, mechanical valves (need warfarin)
  • TAVR = transcathetor aortic valve replacement:
    - implantation of a tissue valve via a peripheral
    artery
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20
Q

AVR: mechanical or tissue?

A
  • younger patients, patients also needing CABG may
    use a mechanical valve as it lasts longer
  • but would be on warfarin/anticoagulants to prevent
    blood clots forming around the valve
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21
Q

TAVR advantages:

A
  • less invasive
  • via femoral artery
  • implanted into native valve
  • outcomes comparable to surgery for routine patients
  • good for patients that are older and have a lot of co-
    morbidities that would not be able to have a normal
    surgery
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22
Q

Mitral valve:

A
  • LA and LV
  • 2 cusps (anterior and posterior)
  • cusp tips attached to left ventricular muscles via
    chordae tendineae
  • attached to a fibrous ring (annulus)
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23
Q

Mitral Valve Regurgitation:
- how common to have surgery
- aetiologies
- consequences

A
  • second most common indication for valve surgery
  • congenital valve leaflet prolapse (floppy valve)
  • chordal/ papillary muscle rupture due to MI
  • causes torrential significant acute mitral regurgitation
  • causes a significant increase in pressure on capillaries
    in lungs and results in pulmonary oedema
  • causes:
  • acute MI
  • infective endocarditis
  • rheumatic
  • myocardial ischaemia (LV distortion/ papillary muscle
    dysfunction)
  • annular dilation: LV dilation in heart failure; if left ve
    dilates it stretches annulus, cause leaflets to have a
    gap when collapsing, so valve leaks
24
Q

Causes of mitral regurgitation:

A
25
Q

Haemodynamic consequences of mitral regurgitation?

A
  • volume overload of LV: LV dilation
  • volume overload of LA: LA dilation, atrial rhythm
    disturbances
26
Q

Mitral Regurgitation Signs (4)(3):

A
  • displaced, forceful apex beat (LV+)
  • palpable parasternal impulse (RV+)
  • pansystolic murmur = leaky ventricle:
    - loudest in mitral area
    - radiates to the left axilla
  • thrill in the mitral area
27
Q

Which value dysfunction?

A

Mitral regurgitation

28
Q

Which value dysfunction?

A

Aortic stenosis

29
Q

Mitral Regurgitation ECG:

A
  • broad P waves “P mitrale”: LA dilation
  • Left ventricular hypertrophy: tall complexes, lateral T
    wave inversion
  • LEFT BUNDLE BRANCH BLOCK: broad complexes,
    other causes
  • atrial arrhythmias (atrial fibrillation)
30
Q

What is the diagnosis?

A

Mitral regurgitation

31
Q

Mitral Regurgitation Echocardiogram:
- what can you see?
- classification of severity?
- INSERT

A
  • left ventricular dilation
  • left atrial dilation
  • mitral valve: prolapse, chordal rupture,
    calcified/thickened
  • severity of leaky valves is harder than for narrow
    valves
  • insert
32
Q

Mitral Regurgitation Treatment:

A
  • symptomatic patients need a new valve
  • holding maneuver/ too ill for surgery:
    - diuretic for breathlessness
    - ACE inhibitor for LV dilation
    - Beta blocker and anticoagulation for atrial fibr
33
Q

Mitral Regurgitation Surgical (3):
- what options are unsuitable under which conditions?
- invasiveness

A
  • MVR: surgical valve replacement: mechanical, tissue,
    for degenerate valves are unsuitable for repair
  • Surgical Valve Repair: treatment of choice for MVLP or
    chordal rupture, minimally invasive
  • transcatheter options: not yet established, mitraclip
    for very symptomatic patients with no surgical options
34
Q

Aortic Regurgitation is and haemodynamic consequences:

A
  • leaflets fail to close completely
  • blood leaks back from the aorta into LV: leakage in
    DIASTOLE
  • left ventricular volume overload: LV dilation, LV
    dysfunction
35
Q

Aortic Regurgitation Causes (2)(3)(4):

A
  • Valvular:
    - bicuspid valve
    - infective endocarditis
    - rheumatic
  • Aortic Disease:
    - hypertension
    - aortic dissection
    - connective tissue disease (ankylosing spondylitis)
    - syphilis
36
Q

Aortic Regurgitation Signs:

A
  • pulse: large volume, collapsing
  • BP: high systolic, low diastolic
  • displaced forceful apex beat (LV+)
  • early diastolic murmur:
    - at the lower left sternal border, best heard
    during expiration
37
Q

Which value dysfunction?

A

Aortic regurgitation

38
Q

aortic Regurgitation ECG:

A
  • left ventricular hypertrophy
39
Q

Aortic Regurgitation echocardiogram:

A
  • bicuspid valve?
  • aortic dilation
  • LV dilation/ dysfunction
40
Q

Aortic Regurgitation Severity

A
41
Q

Aortic Regurgitation Treatment:

A
  • symptomatic patients need a new valve
  • holding maneuver/ too ill for surgery:
    - diuretic for breathlessness
    - ACE inhibitor for LV dilation/ dysfunction
  • surgical valve replacement:
    - often also require repair of the proximal aorta
    - no good transcatheter options
42
Q

Aortic Regurgitation causes diagram

A

insert

43
Q

Mitral stenosis cause:

A
  • rheumatic (most common)
  • degenerative
  • congenital
  • leaflet thickening and fusion
44
Q

Mitral Stenosis Effect:

A
  • pressure overload on:
    - left atrium (atrial fibrillation)
    - pulmonary vasculature: pulmonary
    hypertension,
    right heart failure
45
Q

Mitral Stenosis Signs (3):

A
  • loud 1st heart sound
  • parasternal heave (RV+)
  • low pitched rumbling/mid late diastolic murmur:
    - loudest in the mitral area
    - louder with the patient lying on their left
46
Q

Which value dysfunction?

A

.mitral stenosis

47
Q

Mitral Stenosis Imaging

A

insert

48
Q

Mitral Stenosis ECG:

A
  • P mitrale (big, M shaped P waves)
  • atrial fibrillation
49
Q

Mitral Stenosis echocardiogram:

A
  • commisural fusion +/- calcification/ immobility
  • LA dilation
  • right heart dilation
50
Q

Mitral Stenosis Severity

A
51
Q

Mitral Stenosis Treatment:

A
  • surgical only for patients who remain symptomatic
    despite medical Rx
  • diuretics for breathlessness/ oedema
  • atrial fibrillation:
    - rate control (beta blockers)
    - anticoagulation with warfarin (high thrombotic
    risk)
    - cardioversion to sinus rhythm
52
Q

Mitral Stenosis Surgical:

A
  • replacement usually best option as most structures
    are thickened so repair is difficult
  • MVR: mechanical valve replacement, tissue valve
  • Trans-catheter balloon valvotomy:
    - treatment of choice for non-calcified valve
    - unsuitable if valve is also regurgitant
  • surgical valvotomy: first form of valve surgery, rarely
    performed now, into femoral artery, cut through from LV to LA
53
Q

Tricuspid Regurgitaiton:

A
  • common but rarely a primary pathology
  • usually secondary to annular dilation due to: left heart
    disease pulmonary hypertension, all as a result of pulmonary
    hypertension
  • elevated JVP +++
54
Q

Tricuspid Stenosis:

A
  • very rare
  • rheumatic valve disease
55
Q

Pulmonary Stenosis:

A
  • uncommon
  • usually congenital
  • may occur as a part of balloon dilation eg Fallot’s
    tetralogy
  • treatment: transcatheter balloon dilation (as a child)
56
Q

Pulmonary Regurgitation:

A
  • uncommon
  • may be secondary to:
    - pulmonary hypertension
    - balloon dilation

HLB (49 decks)

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