Valvular heart disease Flashcards
What is the definition of a valve?
A device for controlling the passage of fluid through a pipe or duct, especially an automatic device allowing movement in one direction only
What are the 4 heart valve?
- Pulmonary
- Mitral
- Tricuspid
- Aortic
Which valve does blood pass through when it moves from the left atrium to the left ventricle?
mitral
Which valve does blood pass through when it moves from the left ventricle to the aorta?
Aortic
Which valve does blood pass through when it moves from the right atrium to the right ventricle?
Tricuspid
Which valve does blood pass through when it moves from the left ventricle to the pulmonary artery ?
Pulmonary
What are the semilunar valves?
Aortic and pulmonary
How do the semilunar valves work?
They are made up of cusps, blood flowing backwards fill up the pockets so they close
How does the naming of the aortic valve leaflets work?
Right, left and non coronary. Named depending on if there is a coronary artery originating from the valve pocket or not
What are the components of an atrioventricular valve?
- Valve leaflets
- Chordae tendinae
- Papillary muscles
What pathology can affect the valve leaflets?
- Calcification
- Thickening
- Degeneration
- Infection
- Prolapse
What pathology can affect the apparatus/annulus?
- Annular dilation
- Annular calcification
- Apparatus tethering/thickening/rupture
- Regional wall motion abnormality
What causes stenosis?
Pressure overload
What causes regurgitation?
Volume overload
What are the symptoms of acute rheumatic fever?
Painful joints, fever, rash
How does rheumatic fever predispose to valvular heart disease?
- Antibody cross reactivity affects the connective tissue
* Cardiac injury is generated by recurrent inflammation and fibrinous repair and scarring
What causes aortic stenosis?
•Increased LV cavity pressure •Pressure overload due to left ventricular hypertrophy •Due to: - thickening - calcification - rheumatic valve disease - congenital
What are the symptoms of aortic stenosis?
- Shortness of breath
- Presyncope
- Syncope
- Chest pain
- Reduced exercise capacity
What are the signs of aortic stenosis?
- Ejection systolic murmur
- Soft/quiet second heart sound
- Narrowed pulse pressure
- heaving apex beat
- Signs of heart failure
What are the causes of aortic regurgitation?
- Volume overload
- LV dilation
- due to:
•Degeneration
•Rheumatic valve disease
•Aortic root dilation
•Systemic disease associated with marfans, Ehlers danlos, ankylosing spondylitis, SLE
•Endocarditis
What are the symptoms of aortic regurgitation?
- Shortness of breath
* Reduced exercise capacity
What are the signs of aortic regurgitation?
- Early diastolic murmur
- Increased pulse pressure
- Collapsing pulse
- Signs of heart failure
- Eponymous signs: corrigans, Quinkes and De mussets
What is Corrigan’s sign
Carotid pulsation
What is Quinke’s sign?
Nail bed pulsation
What is De Musset’s sign?
Head nodding
What are the names of the leaflets of the mitral valve?
Anterior and posterior
What are the causes of mitral regurgitation?
- Can be multifactorial (leaflets, annulus and apparatus)
- Volume overload of the LA/LV
- LV and LA dilation
- Pulmonary hypertension
- Secondary right heart dilation
- Atrial fibrillation
What are the symptom of mitral regurgitation?
- Shortness of breath
- Palpitation
- right heart failure symptoms
What are the signs of mitral regurgitation?
- Pansystolic murmur
- Quiet first heart sound
- Displaced apex beat
- Signs of heart failure
What are the causes of mitral stenosis?
- Rheumatic heart disease
- Pressure overload
- Dilated left atrium
- Atrial fibrillation
- Pulmonary hypertension
- Secondary right heart dilation
What are the symptoms of mitral stenosis?
- Shortness of breath
- Palpitation
- Chest pain
- Haemoptysis
- Right heart failure
What are the signs of mitral stenosis?
- Diastolic murmur
- Quiet second heart sound
- Heaving apex
- Signs of heart failure
How many leaflets do each of the right sided valve have?
- Pulmonary has 3
* Tricuspid has 3
How can you asses valvular heart disease?
- History
- Examination
- Blood pressure
- ECG
- Echo
- CT
- MRI
- Exercise tolerance test
- CPET
- Left heart catheterisation
- Right heart catheterisation
Compare the mechanical and tissue valve
- Mechanical is usually recommended if younger but you will need anticoagulation for the rest of your life which is contra indicated if they do contact sport or want to get pregnant
- Mechanical lasts around 10-20 years
- Tissue valve lasts around 5-10 years
What is the procedural intervention for valvular heart disease?
- TAVI
- Mitraclip
- Valvuloplasty
