valvular dysfunction Flashcards
what valves do infective valvular heart disease effect?
any valve but usually left side more than right
what valves does congenital valve disease effect?
any valve
what is the most common valve disease in europe?
aortic stenosis
what is calcification in the heart?
immobility of leaflets
what is fibrosis in the heart?
fusion of leaflets
what is stenosis?
narrowing of the heart leaflets or valve leaflets fail to completely open
what does stenosis lead to?
build up of back pressure and loss of stroke volume
what is regurgitation?
failure of leaflets to meet in systole or leaflets fail to close completely
what are the symptoms of aortic stenosis?
- syncope upon exertion
- angina (chest pain)
- dyspnoea
- fatigue, palpitations
- sudden death due to arrhythmia from pressure overload
- can be asymptomatic
- murmur discovered in routine physical exam
what is pressure overload and what does it lead to?
it is the generation of high LV systolic pressure to force blood through the obstruction and it results in left ventricular hypertrophy
what heart sounds do you hear during aortic stenosis?
- systolic or crescendo/decrescendo murmur
- soft heart sound in more severe cases
what is aortic dilatation?
- loss of support
- connective tissue disease
what are the consequences of volume overload?
blood falls back into LV during diastole
what is the typical result of blood volume overload in aortic regurgitation?
LV dilatation to accommodate volume
what heart sounds do you hear in aortic regurgitation?
- early diastolic murmur
- concomitant systolic murmur (often not always)
what symptoms do you get with aortic regurgitation?
- often asymptomatic
- chest pain due to decreased coronary perfusion and diastolic BP reduces
- breathlessness
- syncope: uncommon
- catastrophic decompensation if acute, fulminant pulmonary oedema
what 3 types of mitral regurgitation are there?
1) valvular
2) chordal rupture/papillary muscle failure
3) annular dilatation
what consequences are there of mitral regurgitation?
- volume overload in left ventricle
- pressure overload of right heart
- left ventricular dilatation
- decompensation
what heart sounds do you heart with mitral regurgitation?
pan-systolic murmur
what are the symptoms of mitral regurgitation?
- breathlessness due to back pressure of pulmonary circulation
- lethargy and reduced exercise tolerance due to breathlessness and reduced cardiac output
- palpitations: atrial fibrillation due to pressure overload in atrium
- peripheral oedema
- chest pain
what is mitral valve prolapse?
initially valves shut during the early part of systole but then either because of the leaflet is too “baggy” or because of abnormal subvalvular apparatus the leaflet prolapses back into the left atrium potentially allowing through a jet of regurgitation
what are possible causes of mitral stenosis?
1) rheumatic fever (almost always)
2) congenital
3) storage disease
4) malignancy
5) previous endocarditis
6) mitral valve calcification
7) systemic disease
what are the consequences of mitral stenosis?
- lung/right heart consequences
- left ventricle physiology usually preserved
what heart sounds do you hear for mitral stenosis?
- mid-diastolic murmur
- opening snap
- loud first heart sound
what symptoms do you get for mitral stenosis?
- breathlessness
- peripheral oedema
- haemoptysis
- palpitations
- systemic emboli
- fatigue
- compressive symptoms: stridor, dysphagia
how do you manage valvular heart disease?
- valve repair
- valve replacement
which valve has been replaced if the first heart sound sounds metallic?
mitral
what valve has been replaced if the second heart sound sounds metallic?
aortic
what do you use to fix a mitral valve?
mitraclip
