valvular heart disaease Flashcards
what causes mitral stenosis
rheumatic heart disease
congenital mirtal stenosis
systemic conditions
when is the condition of the mitral valve for it to be stenosis
<2cm
what happens in mitral stenosis
left atrium pressure increases
the atrium ventricle pressure gradient increases (effects flow rate - CO, HR as well)
pulmonary venous and cappliary pressure increase
what are the clinical maifestations of mitral stenosis
dyspnoea
haemoptysis - rupture of thin walled veins
chest pain
what would indicate mitral stenois on clinical examination
tapping apex beat, diastolic thrill, RV heave,
murmur after S2
what might you see on the x ray of someone with mitral stenosis
Left atrium enlargement
what medical treatment could be used - mitral stenosis
diuretics and restriction of Na intake
antigoagulation
what interventional treatment could be used
valvotomy (ballon or surgical)
mitral valve replacement ( gold standard)
how might mitral regurgitation occur - why ?
rhematic heart dsease
mitral valve prolapse (due to leaflet dysfunction)
IE (infective endocarditis)
functional MR due to LV and anullar (fiboirus skeleton) dilation
why - its a degenerative disease
what does ERO stand for
effective regurgant orifice (size of the hole in the valve)
what factors effect annular enlargemement
preload
afterload
LV contractility
what are the clinical manifestations of acute Mitral regurgitation
breathlessness, pulmonary odema, cardiogenic shock
what are the clinical manifestations of chronic mitral regurgitation
fatigue, exhaustion (due to low cardiac output), right heart failure
dyspnoea - atrial fibrillation
what sings would you expect to find on clinical examination of patients with mitral regurgitation
normal or reduced in heart failure
prominent JVP in RH failure
RV heave
what might you expect to see on a chest radiograph of someone with mitral regurgitation
cardiomegaly, left atrium enlargement, white spots on mitral valve (calcification of mitral annulus)
what medical therapy helps in chronic mitral regurgitation
nothing
what medical therapy helps with acute mitral regurgitation
sodium nitroprusside, intra aortic balloon pump
all aimed to reduce preaload and afterload
life saving until surgery
what are the interventional treatments for mitral valve regurgitation
mitral valve apparatus repar
or replacement
what is the normal area of the aortic valve
about 3-4cm squared
what is the area of a aortic valve with stenosis
area less than 1.5-2cm squared
what causes aortic stenosis
rheumatic heart disease (adhesion and fusion of commissures - where to valves meet on the vessel at the base)
degenerative (due to atherosclerosis) - calcification of the cusps from base to free margins
what is the patho-physiology pathway once aortic stenosis occurs to lead to LV failure
increased LV systolic (squirts) pressure
hypertorophy of LV myocardium
increased LV end diastolic pressure
increased O2 requirements
myocardial ischaemia
LV failure
what is ‘‘good’’ about aortic stenosis
long asympotomatic phase meaning time without surgery can be postponed
what is heard when osculating a aortic stenosis
a murmur between S1 and S2
what might you see on the chest x ray of aortic stenosis
calcification of the AV
when is treatment given for mitral stenosis - what treatment
limited to those who develop heart failure
aortic valve repair
what can cause aortic regurgitation
Dilated aorta (Marfans, hypertension) Connective tissue disorders
what doews aortic regurgitation lead to
LV hypertorophy, dilataion and eventually LV failure
what are the symptoms of chronic aortic regurgitation
long asymptomatic phase
exertional breathlesness
what are the symptoms of acute atrial regurgitation
Poorly tolerated as wall tension cannot acutely adapt
what woul dyou find on clinical examination of aortic regurgitation (pulse)
larve volume and collapsing pulse
what would yoi hear on auscultatin of aortic regurgitation
soft murmur after S2
what treatment can delay surgery for aortic regurgitation
vasodilator therapy
aortic valve replacement or repair
what are the factors that go into selecting a patient for CABG
adequate lung, hepatic, mental function
ascending aorta and distal coronary targets are ‘‘OK’’
LV ejection fracture is greater than 20%
what blood vessels are often used for CABG
reversed saphenous vein (leg vein - reverse to switch valve direction)
internal mammary arteries
radial arteries
what can occur due to the sternotomy - what is this
(breaking of the sternum)
wire infection
painful wires
what are some post op problems after CABG
cardiac tamponade
death
stroke
what is cardiac tamponade
when fluid fills the pericardium surrounding the heart leading to it losing its ability to contract/expand
what are the symptoms of cardiac tamponade
raised CVP
raised HR
low BP
in turn leading to increase O2 requirements
what is the treatment of cardiac tamponade
chest re opening
what grafts have the best longevity
arterial grafts have BETTER longevity than veins
what are the long term outcomes of CABG
50% no further problems 10 years later
rest have minor problems
with a few needing CABG again
what valvular heart disease can be operated on in adults
mainly aortic and mitral valve
what valvular heart disease can be operated on in peads
all 4 heart valves
what does chronic rheumatic heart disease cause
gradually progressive mirtal valve diseases with/without atrial veal disease
what are the two most common types of bacteria that cause endocarditis
strp viridans (sub acute)
staph aureus (acute)
what antibiotics might be used to treat staph aureus
cephlasporins
what antibiotic might be used to treat strep viridans
glycopeptides (vancomycin)
beta lactams (penicillin’s)
what endocarditis has the better chance of cure
sterp viridans has higher chance
what are the indications for surgery on endocarditis
severe regurgitation
large vegetations on the valves
what is endocarditis
inflammation of the endocardium (which makes up the valves)
what’s give after surgery on endocarditis
IV antibiotics for 6 weeks
what are the type of prosthetic valves in use
biological valves
mechanical valves
what are the pros of biological valves
no warfarin required (antiplatelet agent)
what are the negatives of biological valves
the valve wears out after 15 years
what are the pros of mechanical valves
the valve can last 40+ years
what are the cons of the mechanical valves
warfarin treatment is required
