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103-theme 3 > valvular dysfunction > Flashcards

valvular dysfunction Flashcards

1
Q

what are the right sided heart valves? 2

A
  • tricuspid valve

- pulmonary valve

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2
Q

what are the left sided heart valves? 2

A
  • mitral valve

- aortic valve

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3
Q

where do we auscultate? 4

A
  • aortic area
    -pulmonary area
    -tricuspid area
    -mitral area
    we are listening to the valves
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4
Q

what can we hear in the heart? 3

A
  • opening and closing of the heart valves
  • S1-tricuspid and mitral valves close= lub (beginning of systole)
  • S2-aortic and pulmonary valves close= dub (end of systole)
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5
Q

what is rheumatic valve disease normally caused by? 2

A
  • post streptococcal rheumatic fever

- disease of poverty and overcrowding

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6
Q

describe the valvular heart disease aetiology? 5

A
  • degenerative effects aortic valve more than the mitral valve
  • rheumatic affects the mitral more than the aortic
  • infective can affect any valve, but the left heart normally more than the right
  • can occur due to loss of supporting structures
  • congenital can affect any valve
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7
Q

describe the pathology of valvular heart disease? 3

A
  • calcification= immobility of leaflets
  • fibrosis= fusion of leaflets
  • dilatation= of valve ring
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8
Q

what is the result of valvular heart disease? 4

A
  • stenosis
  • narrowing of valve leaflets
  • valve leaflets fail to open completely
  • leads to build of back pressure and loss of stroke volume
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9
Q

what is regurgitation? 4

A
  • failure of leaflets to meet in systole
  • leaflets fail to close completely
  • `allows reverse of blood flow during relaxation of the heart
  • also called incompetence
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10
Q

explain the age of presentation of some valvular diseases? 4

A
  • congenital syndromes (paediatrics, <60)
  • bicuspid valves (40-60 years)
  • degenerative (>60) most common
  • post rheumatic fever (<60)
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11
Q

what are the features of aortic stenosis?

A
  • generally due to obstruction to flow causing decreased cardiac output
  • if severe (SAD) triad
  • syncope upon exertion
  • angina
  • Dyspnoea
  • fatigue and palpitations
  • sudden death due to arrhythmias from pressure overload
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12
Q

explain pressure overload? 3

A
  • generation of high LV systolic pressure to force blood through the obstruction
  • resulting in left ventricular hypertrophy
  • eventual LV decomposition/ dilation
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13
Q

explain the heart sounds of aortic stenosis? 5

A
  • systolic of crescendo/decrescendo murmur
  • the valve doesn’t open fully, producing turbulence as blood passes across it
  • this occurs at the beginning of systole where the pressure gradually rise, and as a result the amount of blood and therefore the amount of turbulence gradually rises, peaks and then falls as the ventricle begins to relax
  • soft second heart sound
  • in more severe cases, if the valve is stiff and thickened, it doesn’t close properly
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14
Q

explain what aortic regurgitation is caused by? 7

A
  • caused by aortic dilatation
  • loss of support
  • connective tissue disease
  • hypertension, aortic dissection, degenerative
  • the structure the valves are attached to is dilated, so the valves don’t close properly
  • can be caused by valvular problems-bicuspid valve- infective endocarditis
  • CREAM congenital, rheumatic damage, endocarditis, aortic dissection, marfans
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15
Q

what are the consequences of aortic regurgitation?

A
  • volume overload= in the ventricle because blood falls back into the LV during diastole
  • LV dilatation
  • late compensation of the LV
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16
Q

explain the heart sounds of aortic regurgitation? 6

A
  • early diastolic murmur
  • at the end of systole, the pressure in the ventricle stops and the aortic and pulmonary valve close
  • if the aortic valve leaflets fail to come together and are damaged, blood under high pressure in the aorta runs back into the ventricle with turbulence
  • this happens when most of the pressure in the ventricle is the lowest at the beginning of diastole
  • concomitant systolic murmur
  • because in this disorder, the aortic valve is often structurally abnormal, there is often turbulence as blood exits the ventricles during systole
17
Q

what are the symptoms of aortic regurgitation? 4

A
  • often asymptomatic
  • chest pain due to coronary perfusion and diastolic BP reduces
  • syncope
  • catastrophic decompensations if acute- fulminant pulmonary oedema
18
Q

what is mitral regurgitation? 3

A
  • can be valvular= prolapse, infective, degenerative
  • chordal rupture/ papillary muscle failure= acute/chronic
  • annular dilatation= secondary to left ventricular dilatation
19
Q

what are the consequences of mitral regurgitation? 4

A
  • volume overload in the left ventricle= during systole blood ejected backwards into left atrium, extra blood in artium leads to elevation of left atrial pressure and increased ventricular filling during subsequent diastole
  • pressure overload of right heart= can lead to right ventricular hypertrophy or right heart failure, transient elevation of left atrial pressure during systole
  • left ventricular dilatation= response to volume overload
  • decompensation= pulmonary oedema
20
Q

explain the heart sounds of mitral regurgitation? 5

A
  • pan-systolic murmur
  • if the leaflets fail to coapt
  • either because the annulus is stretched with a hole in the middle, or because the leaflets are damaged/ abnormal
  • blood leaks back into the left atrium with turbulence as it passes across the abnormal valve
  • blood regurgitates back in the left atrium almost immediately and for the whole of systole because the LA is a low-pressure chamber and during systole the LV is under high pressure
21
Q

explain the symptoms of mitral regurgitation? 5

A
  • breathlessness due to back pressure of pulmonary circulation
  • lethargy and reduced exercise tolerance due to breathlessness and reduced cardiac output
  • palpitations and AF due to pressure overload in atrium
  • peripheral oedema
  • chest pain
22
Q

explain the mitral valves prolapse? 3

A
  • initially the valve shuts during the early part of systole but then, either because the leaflet is too baggy or because of abnormal dub valvar apparatus, the leaflet prolapses back into the left atrium potentially allowing a jet of regurgitation
  • mid systolic click- as the leaflet prolapses back into the LA
  • late systolic murmur- if the blood then continues to flow into the LA after initial jet of regurgitation
23
Q

what causes mitral stenosis?

A

almost always due to rheumatic fever

24
Q

what are the consequences of mitral stenosis? 5

A
  • lung/ heart consequences
  • breathlessness, congestion
  • due to the pressure back up because of failure of ejection of LA volume
  • left ventricle physiology is usually preserved
  • LV function is compromised when atrial contraction is lost or when there is a high circulating volume
25
Q

explain the heart sounds of mitral stenosis? 5

A
  • mid-diastolic rumbling murmur
  • during diastole, stenosis restricts blood flowing across the mitral valves from the LA to the LV
  • opening snap as the restricted leaflets snap open
  • loud first heart sound
  • if the leaflets are stiff but still relatively mobile, the leaflets will slam shut
26
Q

what are the symptoms of mitral stenosis? 7

A
  • breathlessness
  • peripheral oedema
  • haemoptysis
  • palpitations
  • systemic emboli
  • fatigue
  • compressive symptoms
27
Q

how can valvular heart disease be managed? 3

A
  • medical= dealing with heart failure and arrhythmias
  • surgical= valve repair/ replacement
  • percutaneous= via femoral artery (BAV, TAVI)
28
Q

what are the different types of valve replacement? 2

A
  • mechanical- last 20-30 years, more prone to clots

- biological- last less long, don’t need long term clotting drugs

29
Q

how can you tell the difference between normal and prosthetic heart sounds?

A

metallic sound= prosthetic

30
Q

what is trans-catheter valve replacement? 5

A
  • pulmonary (congenital heart disease)
  • aortic
  • new technology
  • for patients too high risk for conventional AVR
  • shorter recovery time

103-theme 3 (18 decks)

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