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Heart, Lungs and Blood > valvular dysfunction > Flashcards

valvular dysfunction Flashcards

1
Q

What happens in normal valve function?

A

The valve opens fully, allowing blood to flow through, and then closes tightly to prevent blood from flowing backwards.

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2
Q

What are the two types of valve disease?

A

Stenosis and regurgitation.

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3
Q

What happens in valve stenosis?

A

The valve doesn’t open all the way, so not enough blood passes through.

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4
Q

What happens in valve regurgitation?

A

The valve doesn’t close all the way, so blood leaks backwards.

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5
Q

What are the common causes of valvular heart disease?

A

Degenerative, congenital, rheumatic disease, infective endocarditis, and annular dilation.

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6
Q

What are the symptoms of heart valve disease?

A

Breathlessness, lightheadedness, and chest pain.

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7
Q

What is the first heart sound?

A

The first heart sound is represented by the “Lub” sound and is caused by the closure of the mitral and tricuspid valves at the start of systole.

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8
Q

What is the second heart sound?

A

The second heart sound is represented by the “Dub” sound and is caused by the closure of the aortic and pulmonary valves at the end of systole.

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9
Q

What are the types of left heart murmurs and their timing?

A

The two types of left heart murmurs are aortic and mitral murmurs. Aortic stenosis murmurs are systolic, while aortic regurgitation murmurs are diastolic. Mitral stenosis murmurs are diastolic, while mitral regurgitation murmurs are systolic.

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10
Q

What are some common investigations for heart valve disease?

A

Common investigations for heart valve disease include ECG, echocardiogram (transthoracic or transesophageal), cardiac MR scan, and cardiac catheterization.

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11
Q

What are some symptoms of heart valve disease?

A

Symptoms of heart valve disease may include breathlessness, fatigue, chest pain, lightheadedness, and palpitations.

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12
Q

What are the two heart sounds that occur during the cardiac cycle?

A

The two heart sounds that occur during the cardiac cycle are S1 and S2. S1 is the “lub” sound that occurs at the start of systole and is caused by the closure of the mitral and tricuspid valves. S2 is the “dub” sound that occurs at the end of systole and is caused by the closure of the aortic and pulmonary valves.

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13
Q

What is the aortic valve?

A

It is a semi-lunar valve that lies between the left ventricle and aorta, composed of three cusps attached to a fibrous ring called annulus.

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14
Q

What are the three cusps of the aortic valve and the sinuses they are attached to?

A

Left coronary cusp, right coronary cusp, and non-coronary cusp attached to left, right, and non-coronary sinuses, respectively.

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15
Q

What is aortic stenosis?

A

Aortic stenosis is a common valvular heart disease that causes pressure overload on the left ventricle due to narrowing of the aortic valve.

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16
Q

What are the signs of aortic stenosis?

A

Low volume, slow-rising pulse; forceful impulse at the apex; soft second heart sound; ejection systolic murmur, loudest in the aortic area, and radiated to the neck; and thrill in the aortic area.

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17
Q

What are the ECG findings in aortic stenosis?

A

ECG findings in aortic stenosis include left ventricular hypertrophy, which is characterized by tall complexes and lateral T wave inversion. In some cases, left bundle branch block may also be present, which is characterized by broad complexes and can have many other causes.

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18
Q

What are the echocardiogram findings in aortic stenosis?

A

Echocardiogram findings in aortic stenosis typically include left ventricular hypertrophy and aortic valve calcification with restricted mobility.

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19
Q

What is the medical treatment for aortic stenosis?

A

There are no good medical options for aortic stenosis. Symptomatic patients require a new valve, but as a holding maneuver, diuretics can be used for breathlessness, and beta-blockers can be used for angina. Vasodilators such as ACE inhibitors should be avoided.

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20
Q

What are the surgical/interventional treatments for aortic stenosis?

A

The surgical/interventional treatments for aortic stenosis are:

  • Surgical valve replacement (AVR)
  • Transcatheter aortic valve replacement (TAVR)
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21
Q

What are the types of surgical valve replacement (AVR)?

A

The types of surgical valve replacement (AVR) are:

  • Tissue valve replacement (pig, cow, human)
  • Mechanical valve replacement (requires warfarin)
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22
Q

Who are the candidates for surgical valve replacement (AVR)?

A

Patients who are younger or who need coronary artery bypass grafting (CABG) are candidates for surgical valve replacement (AVR).

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23
Q

What is transcatheter aortic valve replacement (TAVR)?

A

Transcatheter aortic valve replacement (TAVR) is a procedure where a tissue valve is implanted via a peripheral artery, without open heart surgery.

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24
Q

Who are the candidates for transcatheter aortic valve replacement (TAVR)?

A

Older patients or patients with co-morbidities are candidates for transcatheter aortic valve replacement (TAVR).

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25
Q

How do the outcomes of TAVR compare to surgical valve replacement (AVR)?

A

The outcomes of TAVR are comparable to surgery for routine patients, and it will become the treatment of choice for most patients.

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26
Q

Where is the mitral valve located

A

The mitral valve is located between the left atrium and the left ventricle.

27
Q

How many leaflets does the mitral valve have?

A

The mitral valve has two leaflets, the anterior and posterior leaflets.

28
Q

What are the chordae and papillary muscles in relation to the mitral valve?

A

The chordae are fibrous cords that connect the mitral valve leaflets to the papillary muscles in the left ventricle.

29
Q

What is the most common cause of mitral regurgitation?

A

Mitral regurgitation can be caused by various factors, but the most common cause is mitral valve prolapse, a congenital abnormality where the mitral valve leaflets bulge back into the left atrium during systole.

30
Q

What are some other causes of mitral regurgitation?

A

Other causes of mitral regurgitation include chordal rupture or papillary muscle rupture, infective endocarditis, rheumatic heart disease, myocardial ischemia, and annular dilation.

31
Q

What are the symptoms of mitral regurgitation?

A

Symptoms of mitral regurgitation can include shortness of breath, fatigue, palpitations, and swelling in the legs and feet.

32
Q

How is mitral regurgitation treated?

A

Treatment for mitral regurgitation depends on the severity of the condition, but can include medications to manage symptoms, surgery to repair or replace the mitral valve, or minimally invasive procedures such as transcatheter mitral valve repair or replacement.

33
Q

What is mitral regurgitation?

A

It is a condition where there is a backflow of blood from the left ventricle to the left atrium due to a leaky mitral valve.

34
Q

What are the causes of mitral regurgitation?

A

The causes include degenerative MR caused by mitral valve prolapse, degenerative MR caused by flail leaflet, volume overload of LV, volume overload of LA, atrial rhythm disturbances, infective endocarditis, rheumatic fever, and myocardial ischemia.

35
Q

What are the signs of mitral regurgitation?

A

The signs include displaced, forceful apex beat, palpable parasternal impulse, pansystolic murmur, and thrill in the mitral area.

36
Q

What is P mitrale in mitral regurgitation?

A

It is a broad P wave on the ECG, indicating left atrial dilation.

37
Q

What is left ventricular hypertrophy in mitral regurgitation?

A

It is a thickening of the left ventricular walls due to increased workload caused by the backflow of blood.

38
Q

What is left bundle branch block in mitral regurgitation?

A

It is a conduction abnormality on the ECG that causes a delay in the ventricular contraction.

39
Q

What is the echo appearance of mitral regurgitation?

A

It shows left ventricular and left atrial dilation, prolapse or rupture of mitral valve leaflets, calcification or thickening of mitral valve, and difficulty in assessing the severity of leaky valves.

40
Q

What is the medical treatment for mitral regurgitation?

A

Diuretics for breathlessness, ACE inhibitors for LV dilation, beta blockers and anticoagulation for atrial fibrillation.

41
Q

What are the surgical intervention options for mitral regurgitation?

A

Surgical valve replacement (MVR) with mechanical or tissue valve replacement for degenerate valves, surgical valve repair for MVLP or chordal rupture, and transcatheter options such as mitraclip for very symptomatic patients with no surgical option.

42
Q

What is aortic regurgitation?

A

Aortic regurgitation is a condition where the aortic valve fails to close completely, causing blood to leak back from the aorta into the left ventricle during diastole.

43
Q

What are the consequences of aortic regurgitation?

A

Aortic regurgitation leads to left ventricular volume overload, which can result in left ventricular dilation and dysfunction.

44
Q

What are the causes of aortic regurgitation?

A

Aortic regurgitation can be caused by valvular issues such as bicuspid valve, infective endocarditis, or rheumatic disease. It can also be caused by aortic diseases such as hypertension, aortic dissection, connective tissue disease (e.g. ankylosing spondylitis), or syphilis.

45
Q

What is aortic regurgitation?

A

Aortic regurgitation is a condition in which the aortic valve fails to close properly, leading to blood leaking back from the aorta into the left ventricle during diastole.

46
Q

What are the causes of aortic regurgitation?

A

Causes of aortic regurgitation include valvular factors such as bicuspid valve, infective endocarditis, and rheumatic fever, as well as aortic diseases such as hypertension, aortic dissection, and connective tissue disorders.

47
Q

What are the signs of aortic regurgitation?

A

Signs of aortic regurgitation include a large volume, “collapsing” pulse, high systolic and low diastolic blood pressure, a displaced forceful apex beat (LV+), and an early diastolic murmur best heard at the lower left sternal border during expiration.

48
Q

How is aortic regurgitation diagnosed?

A

Diagnosis of aortic regurgitation typically involves an echocardiogram to evaluate valve function, left ventricular and aortic size, and cardiac function. An ECG may also show left ventricular hypertrophy.

49
Q

What is the treatment for aortic regurgitation?

A

Symptomatic patients with aortic regurgitation usually require surgical valve replacement. As a holding maneuver or if the patient is too ill for surgery, diuretics and ACE-inhibitors may be used. Repair of the proximal aorta is often required as well, and there is no good trans-catheter option for aortic regurgitation.

50
Q

What are the causes and effects of mitral stenosis?

A

Causes of mitral stenosis include rheumatic heart disease, degenerative changes, and congenital defects. Mitral stenosis results in leaflet thickening and fusion, causing pressure overload on the left atrium, pulmonary vasculature, pulmonary hypertension, and right heart failure.

51
Q

What are the signs of mitral stenosis?

A

Signs of mitral stenosis include a loud first heart sound, parasternal heave indicating right ventricular hypertrophy, and a low-pitched rumbling mid-to-late diastolic murmur that is loudest in the mitral area and louder when the patient is lying on their left side.

52
Q

What does an ECG show in mitral stenosis?

A

An ECG may show P mitrale (big, M-shaped p waves) and atrial fibrillation in mitral stenosis.

53
Q

What does an echo show in mitral stenosis?

A

An echo may show commissural fusion +/- calcification/immobility and left atrial/right heart dilation in mitral stenosis.

54
Q

What is the medical treatment for mitral stenosis?

A

The medical treatment for mitral stenosis includes diuretics for breathlessness/oedema and beta-blockers for rate control in atrial fibrillation. Anticoagulation with warfarin is also necessary due to the high thrombotic risk. Surgical treatment is reserved for patients who remain symptomatic despite medical treatment.

55
Q

What is the treatment of choice for non-calcified mitral stenosis valves?

A

Trans-catheter balloon valvotomy is the treatment of choice for non-calcified mitral stenosis valves.

56
Q

What are the two types of surgical valve replacement options for mitral stenosis?

A

The two types of surgical valve replacement options for mitral stenosis are mechanical valve replacement and tissue valve replacement (pig, cow).

57
Q

What is the first form of valve surgery for mitral stenosis, and is it still commonly performed?

A

The first form of valve surgery for mitral stenosis is surgical valvotomy. It is rarely performed now.

58
Q

What is the most common cause of tricuspid regurgitation?

A

The most common cause of tricuspid regurgitation is annular dilation, which is usually secondary to left heart disease or pulmonary hypertension.

59
Q

What is the main cause of tricuspid stenosis?

A

Tricuspid stenosis is very rare and is most commonly caused by rheumatic valve disease.

60
Q

What is the typical presentation of tricuspid regurgitation?

A

Tricuspid regurgitation is typically associated with elevated jugular venous pressure (JVP).

61
Q

What is the typical presentation of pulmonary stenosis?

A

Pulmonary stenosis is usually a congenital condition and may be part of a complex disease like Fallot’s tetralogy. It is treated with transcatheter balloon dilation, usually when the patient is a child.

62
Q

What are the possible causes of pulmonary regurgitation?

A

Pulmonary regurgitation is uncommon and may be secondary to pulmonary hypertension or balloon dilation.

63
Q

What are the two types of murmurs that can occur in the pulmonary valve?

A

Pulmonary stenosis (systolic) and pulmonary regurgitation (diastolic).

64
Q

What are the two types of murmurs that can occur in the tricuspid valve?

A

Tricuspid stenosis (diastolic) and tricuspid regurgitation (systolic).

Heart, Lungs and Blood (51 decks)

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