valvular dysfunction Flashcards
What happens in normal valve function?
The valve opens fully, allowing blood to flow through, and then closes tightly to prevent blood from flowing backwards.
What are the two types of valve disease?
Stenosis and regurgitation.
What happens in valve stenosis?
The valve doesn’t open all the way, so not enough blood passes through.
What happens in valve regurgitation?
The valve doesn’t close all the way, so blood leaks backwards.
What are the common causes of valvular heart disease?
Degenerative, congenital, rheumatic disease, infective endocarditis, and annular dilation.
What are the symptoms of heart valve disease?
Breathlessness, lightheadedness, and chest pain.
What is the first heart sound?
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.
What is the second heart sound?
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.
What are the types of left heart murmurs and their timing?
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.
What are some common investigations for heart valve disease?
Common investigations for heart valve disease include ECG, echocardiogram (transthoracic or transesophageal), cardiac MR scan, and cardiac catheterization.
What are some symptoms of heart valve disease?
Symptoms of heart valve disease may include breathlessness, fatigue, chest pain, lightheadedness, and palpitations.
What are the two heart sounds that occur during the cardiac cycle?
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.
What is the aortic valve?
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.
What are the three cusps of the aortic valve and the sinuses they are attached to?
Left coronary cusp, right coronary cusp, and non-coronary cusp attached to left, right, and non-coronary sinuses, respectively.
What is aortic stenosis?
Aortic stenosis is a common valvular heart disease that causes pressure overload on the left ventricle due to narrowing of the aortic valve.
What are the signs of aortic stenosis?
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.
What are the ECG findings in aortic stenosis?
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.
What are the echocardiogram findings in aortic stenosis?
Echocardiogram findings in aortic stenosis typically include left ventricular hypertrophy and aortic valve calcification with restricted mobility.
What is the medical treatment for aortic stenosis?
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.
What are the surgical/interventional treatments for aortic stenosis?
The surgical/interventional treatments for aortic stenosis are:
- Surgical valve replacement (AVR)
- Transcatheter aortic valve replacement (TAVR)
What are the types of surgical valve replacement (AVR)?
The types of surgical valve replacement (AVR) are:
- Tissue valve replacement (pig, cow, human)
- Mechanical valve replacement (requires warfarin)
Who are the candidates for surgical valve replacement (AVR)?
Patients who are younger or who need coronary artery bypass grafting (CABG) are candidates for surgical valve replacement (AVR).
What is transcatheter aortic valve replacement (TAVR)?
Transcatheter aortic valve replacement (TAVR) is a procedure where a tissue valve is implanted via a peripheral artery, without open heart surgery.
Who are the candidates for transcatheter aortic valve replacement (TAVR)?
Older patients or patients with co-morbidities are candidates for transcatheter aortic valve replacement (TAVR).
How do the outcomes of TAVR compare to surgical valve replacement (AVR)?
The outcomes of TAVR are comparable to surgery for routine patients, and it will become the treatment of choice for most patients.