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103 Theme 3 - Cardiovascular System > Valvular dysfunction > Flashcards

Valvular dysfunction Flashcards

1
Q

Complete the diagram

A
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2
Q

Complete the diagram of auscultation

A
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3
Q

What 5 things can you hear in the heart?

A
  • Opening and closing of the heart valves
  • Turbulent blood flow
  • Through the heart
  • Across the valves
  • Filling of the heart
  • Valvular pathology
  • Structural heart disease
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4
Q

What valves make the lub dub noises?

A
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5
Q

Systole or diastole?

A
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6
Q
A
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7
Q

What is the 4 catagories of the epidemeology of valvular heart disease?

A

DEGENERATIVE VALVE DISEASE

•Reflects aging population

RHEUMATIC VALVE DISEASE

  • Post Streptococcal Rheumatic Fever
  • Children and young adults
  • Disease of poverty, overcrowding

INFECTIVE

  • Most common on ‘abnormal’ valves
  • Virulent organisms – normal valves, Staph/strep
  • Immunocompromised

CONGENITAL VALVE DISEASE

Low, static incidence in all populations

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8
Q

Which valve is affected most in degenerative valvlular heart disease?

A

Aortic > Mitral

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9
Q

Which valve is affected most in rheumatic valvlular heart disease?

A

Mitral > Aortic

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10
Q

Which valves is most affected in infective valvular heart disease?

A
  • Any valve (left heart more than right)
  • Right – atypical organisms – IVDU
  • Bacterial, Fungal, Culture –ve (autoimmune)
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11
Q

What valves is most affected in congenital valvular heart disease?

A

Any valve

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12
Q

What are the 3 pathologies involved in valvular heart disease?

A
  • CALCIFICATION - immobility of leaflets
  • FIBROSIS - fusion of leaflets
  • DILATATION of valve ring
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13
Q

What is stenosis?

A
  • 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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14
Q

What is regurgitation?

A
  • Failure of leaflets to meet in systole
  • Leaflets fail to close completely
  • Allows reverse flow of blood during relaxation of the heart
  • Also called “incompetence”
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15
Q

What is the most common age of presentation for -

  1. Congenital syndromes
  2. Bicuspid valves
  3. Degenerative
  4. As always post rheumatic fever
A
  1. Congenital syndromes (paediatrics, <60)
  2. Bicuspid valves (40 -60 years)
  3. Degenerative (>60)
  4. As always post rheumatic fever (<60)
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16
Q

What disease is this?

A

Aortic stenosis

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17
Q

What are the symptoms in a severe aortic stenosis?

A

(SAD Triad)

Syncope upon exertion,

Angina (chest pain)

Dyspnoea (Shortness of breath - especially on exertion), fatigue, palpitations,

Sudden death (rare in asymptomatic) due to arrhythmias from pressure overload

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18
Q

What are the symptoms in mild-moderate aortic stenosis?

A

Asymptomatic, Murmur discovered on routine physical exam

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19
Q

How does aortic stenosis cause LV decompensation/dilatation?

A

Generation of high LV systolic pressure to force blood through the obstruction

Results in left ventricular hypertrophy

Eventual LV decompensation/dilatation

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20
Q

Name the pathology

A
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21
Q

What 2 heart sounds are heard in aortic stenosis and why are they heard?

A

Systolic or 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 rises, 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
22
Q

What are the 2 types of aortic regurgatation and name some examples

A

1.Aortic dilatation

  • loss of support
  • connective tissue disease (e.g. rheumatoid arthritis)
  • hypertension, aortic dissection, degenerative, cystic medial necrosis, syphilis

2.Valvular

  • Bicuspid valve
  • Infective endocarditis
23
Q

Name the 5 causes of aortic regurgatation

A
24
Q

What are the 3 physiological consequences of aortic regurgatation?

A
  • Volume overload - in the ventricle because blood falls back into LV during diastole
  • LV dilatation - to accommodate volume, typical result of volume overload
  • Late decompensation of LV function
25
Q

How does aortic regurgatation cause pulmonary oedema?

A
26
Q

What 2 heart sounds are heard in aortic stenosis and why are they heard?

A

Early diastolic murmur

  • At the end of systole the pressure in the ventricle drops and the aortic (and pulmonary) valves close.
  • If the aortic valve leaflets fail to come together and are damaged blood under high pressure in the aorta rushes back into the ventricle (with turbulence)
  • This happens the most when the pressure in the ventricle is the lowest at the beginning of diastole

Concomitant systolic murmur

  • Often, not always
  • Because in this disorder the aortic valve is often structurally abnormal, there is often turbulence as the blood exits the ventricle during systole
27
Q

What are the symptoms of aortic regurgatation?

A
  • Often asymptomatic
  • Chest pain (due to decreased coronary perfusion and diastolic BP reduces)
  • Breathlessness
  • Syncope – uncommon
  • Catastrophic decompensation if acute – fulminant pulmonary oedema
28
Q

What are the 3 causes of mitral regurgatation?

A
  1. Valvular - prolapse, infective, degenerative
  2. Chordal rupture/papillary muscle failure – acute/chronic
  3. Annular dilatation - secondary to left ventricular dilatation (i.e. functional or ischaemic)
29
Q

What are the physiological consquences of mitral regurgatation?

A
  • Volume overload in left ventricle
  • Pressure overload of right heart
  • Left ventricular dilatation - response to volume overload
  • Decompensation - pulmonary oedema
30
Q

How does mitral regurgitation cause volume overload in left ventricle?

A
  • During systole blood is ejected backwards into the left atrium
  • Extra blood in atrium leads to elevation of left atrial pressure and increased ventricular filling during subsequent diastole
31
Q

How does mitral regurgatation cause pressure overload of right heart?

A
  • Can lead to right ventricular hypertrophy or right heart failure
  • Transient elevation of left atrial pressure during systole
32
Q

What are the 2 possible results of calcification, fibrosis and dilatation?

A

Stenosis

Regurgitation

33
Q

Which is chronic mitral regurgitation and which is acute mitral regurgitation?

A
34
Q

What heart sounds are heard in mitral regurgitation and why are they heard?

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 or abnormal,
  • blood leaks back into the left atrium with turbulence as it passes across the abnormal valve
  • Blood regurgitates back in atrium almost immediately and for the whole of systole because the left atrium is a low pressure chamber and during systole the left ventricle is under high pressure
35
Q

What are the symptoms of mitral regurgitation?

A
  • 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 – decompensation
  • Chest pain – concomitant CAD
36
Q

What is mitral prolapse?

A

Initially valve shuts during the early part of systole but then, either because the leaflet is too ‘baggy’ or because of abnormal sub-valvar apparatus the leaflet prolapses back into the left atrium potentially allowing though a jet of regurgitation

37
Q

What does this show?

A

Mitral valve prolapse

Initially valve shuts during the early part of systole but then, either because the leaflet is too ‘baggy’ or because of abnormal sub-valvar apparatus the leaflet prolapses back into the left atrium potentially allowing though a jet of regurgitation

38
Q

What 2 heart sounds are heard in mitral valve prolapse and why are they heard?

A
  • Mid-systolic‘click’ – as the leaflet prolapses back into the left atrium
  • Late systolic murmur - if blood then continues to flow into the left atrium after initial jet of regurgitation
39
Q

What 7 things can cause mitral stenosis?

A
  1. Almost always due to rheumatic fever - problem with leaflets as well as the sub-valvular apparatus
  2. Congenital
  3. Storage diseases
  4. Malignancy (e.g. carcinoid)
  5. Previous endocarditis
  6. Mitral valve calcification (i.e. degenerative)
  7. Systemic disease (e.g. SLE, RA)
40
Q

What are the physiological consequences of mitral stenosis?

A
  • Lung/right heart consequences. Breathlessness, congestion, etc due to pressure back up because of failure of ejection of left atrial volume
  • Left ventricle physiology usually preserved
41
Q

When does mitral stenosis cause LV function to be compromised?

A
  • atrial contraction lost (low LV filling) or
  • when high circulating volume (high right heart pressure)
42
Q

What 3 heart sounds are heard in mitral valve prolapse and why are they heard?

A

Mid-diastolic rumbling murmur

•during diastole, stenosis restricts blood flowing across the mitral valve from the LA into LV

Opening snap

•as the restricted leaflets ‘snap’ open

Loud first heart sound

  • if the leaflets are stiff but still relatively mobile
  • as leaflets “slam” shut
43
Q

What are the symptoms of mitral stenosis?

A

Breathlessness

Peripheral oedema

Haemoptysis

Palpitations

Systemic emboli

Fatigue

Compressive symptoms: stridor, dysphagia

44
Q

What is a BAV?

A

BAV: balloon aortic valvuloplasty

45
Q

What is a TAVI?

A

TAVI: transcatheter aortic valve implantation

46
Q

What techniques are there to assess heart murmours?

A

Excersise testing

Stress echocardiogram

MRI

Multislice CT

Cardiac cathereterisation (to evaluate valve function)

47
Q

What are the 2 types of valve replacement?

A

Prosthetic

Animal

48
Q

How do you know which valve is metallic (relacement valve) and which murmour is pathological?

A
  • First heart sound metallic – mitral
  • Second heart sound metallic – aortic
  • Systolic murmurs common and not necessarily pathological
  • Diastolic murmurs usually pathological
49
Q

Which valves undergo trans-catheter valve replacement?

A
  • Pulmonary (congenital heart disease)
  • Aortic
  • New technology
  • Patients considered high risk for conventional AVR
  • Procedures under local anaesthetic
  • Shorter recovery time

•Mitral valve - mitraclip

50
Q

What procedure is this?

A

Trans-catheter valve replacement

103 Theme 3 - Cardiovascular System (19 decks)

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