Valvular dysfunction Flashcards
Outline 3 causes of valve problems
fibrosis: fusion of leaflets
calcification: immobility of leaflets (affects the aortic valve mainly)
dilatations of the valve ring.
What is stenosis
When the valve does not open all the way, not enough blood passes through. leads to a build-up of backpressure and lack of stroke volume.
What is regurgitation
Valve doesn’t close all the way so blood leaks backwards.
What are the causes of aortic stenosis
congenital syndromes
bicuspid aortic valves (40-60)
degenerative (>60)
as always post rheumatic fever (<60)
What are symptoms of aortic stenosis
symptoms due to obstruction to flow:
if severe: SAD triad: syncope, angina, dyspnoea, can lead to sudden death.
pressure overload: generation of high LV systolic pressure to force blood through the obstruction, results in LV hypertrophy and eventual LV dilatation.
Causes of aortic regurgitation
Aortic dilatation: loss of support, connective tissue disease, hypertension
valvular: bicuspid valve, infective endocarditis
C ongential
R heumatic damage
E ndocarditis
A ortic
M arfan’s
Consequences of Aortic regurgitation
Volume overload in the ventricle because blood falls back into the LV during diastole
LV dilatation to accommodate the volume
high volume circulation
Symptoms of aortic regurgitation
often asymptomatic
chest pains, breathlessness, syncope
What are the causes of mitral regurgitation
valvular: prolapse, infective, degenerative
chordal rupture- acute/ chronic
annular dilatation: secondary to left ventricular dilatation.
What are the consequences of mitral regurgitation
volume overload in the left ventricle, blood is ejected backwards into the left atrium
pressure overload of the right heart and can lead to right ventricular hypertrophy or RHF, LV dilatation as a response to volume overload.
Decompensation: Pulmonary oedema
Symptoms of mitral regurgitation
breathlessness (due to backpressure of pulmonary circulation)
lethargy (due to reduced CO and breathlessness)
palpitations (due to pressure overload in atrium)
peripheral oedema ( decompensation)
chest pain
What are the causes of mitral stenosis
Almost always due to rheumatic fever
can be congenital, storage diseases, malignancy, previous endocarditis.
Consequences of mitral stenosis
lung and RH consequences, breathlessness, congestion due to backpressure in the left atrium.
LV function is compromised when atrial contraction is lost or when there is a high circulating volume.
symptoms of mitral stenosis
lung: breathlessness, peripheral oedema, haemoptysis (bleeding in the airways from LA impacting on the trachea
palpitations, systemic emboli, fatigue
compressive symptoms: stridor, dysphagia
VHD management
surgical: valve repair and replacement
ease-out symptom burden can see the valve with echocardiography.
