HLB > Valvular Dysfunction > Flashcards

Valvular Dysfunction Flashcards

(56 cards)

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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

Study These Flashcards
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:

25
Haemodynamic consequences of mitral regurgitation?
- volume overload of LV: LV dilation - volume overload of LA: LA dilation, atrial rhythm disturbances
26
Mitral Regurgitation Signs (4)(3):
- 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
Which value dysfunction?
Mitral regurgitation
28
Which value dysfunction?
Aortic stenosis
29
Mitral Regurgitation ECG:
- 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
What is the diagnosis?
Mitral regurgitation
31
Mitral Regurgitation Echocardiogram: - what can you see? - classification of severity? - INSERT
- 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
Mitral Regurgitation Treatment:
- 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
Mitral Regurgitation Surgical (3): - what options are unsuitable under which conditions? - invasiveness
- 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
Aortic Regurgitation is and haemodynamic consequences:
- 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
Aortic Regurgitation Causes (2)(3)(4):
- Valvular: - bicuspid valve - infective endocarditis - rheumatic - Aortic Disease: - hypertension - aortic dissection - connective tissue disease (ankylosing spondylitis) - syphilis
36
Aortic Regurgitation Signs:
- 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
Which value dysfunction?
Aortic regurgitation
38
aortic Regurgitation ECG:
- left ventricular hypertrophy
39
Aortic Regurgitation echocardiogram:
- bicuspid valve? - aortic dilation - LV dilation/ dysfunction
40
Aortic Regurgitation Severity
41
Aortic Regurgitation Treatment:
- 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
Aortic Regurgitation causes diagram
insert
43
Mitral stenosis cause:
- rheumatic (most common) - degenerative - congenital - leaflet thickening and fusion
44
Mitral Stenosis Effect:
- pressure overload on: - left atrium (atrial fibrillation) - pulmonary vasculature: pulmonary hypertension, right heart failure
45
Mitral Stenosis Signs (3):
- 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
Which value dysfunction?
.mitral stenosis
47
Mitral Stenosis Imaging
insert
48
Mitral Stenosis ECG:
- P mitrale (big, M shaped P waves) - atrial fibrillation
49
Mitral Stenosis echocardiogram:
- commisural fusion +/- calcification/ immobility - LA dilation - right heart dilation
50
Mitral Stenosis Severity
51
Mitral Stenosis Treatment:
- 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
Mitral Stenosis Surgical:
- 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
Tricuspid Regurgitaiton:
- 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
Tricuspid Stenosis:
- very rare - rheumatic valve disease
55
Pulmonary Stenosis:
- uncommon - usually congenital - may occur as a part of balloon dilation eg Fallot's tetralogy - treatment: transcatheter balloon dilation (as a child)
56
Pulmonary Regurgitation:
- uncommon - may be secondary to: - pulmonary hypertension - balloon dilation
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