Valvular Heart Disease Flashcards
What is valvular heart disease?
It refers to a group of conditions in which the heart valves have become damaged or diseased
What are the four valvular heart diseases?
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
What is the function of heart valves?
They are structures which ensure blood flows in only one direction
What are the two classifications of heart valves?
Atrioventricular Valves
Semilunar Valves
How do we remember the location of the heart valves?
From right to left
All (Aortic)
Prostitutes (Pulmonary)
Take (Tricuspid)
Money (Mitral)
What are atrioventricular valves?
They are located between the atria and corresponding ventricle
What are the two atrioventricular valves?
Tricuspid Valve
Mitral Valve
Where is the tricuspid valve located?
It is located between the right atrium and the right ventricle at the right atrioventricular orifice
What is another term for the mitral valve?
Bicuspid valve
Where is the mitral valve located?
It is located between the left atrium and the left ventricle at the left atrioventricular orifice
What are the semilunar valves?
They are located between the ventricles and their corresponding artery
What are the two semilunar valves?
Pulmonary valve
Aortic valve
Where is the pulmonary valve located?
It is located between the right ventricle and the pulmonary trunk at the pulmonary orifice
Where is the aortic valve located?
It is located between the left ventricle and the ascending aorta at the aortic orifice
What are the heart sounds caused by?
They are generated by the beating heart and the resultant flow of blood through it
What is the first heart sound (S1) caused by?
It is caused by the closing of the atrioventricular valves at the start of systolic contraction of the ventricles
What is the second heart sound (S2) caused by?
It is caused by the closing of the semilunar vales once the systolic contraction is complete
What is the third heart (S3) sound caused by?
It is when rapid ventricular filling causes the chordae tendinae to pull to their full length
When is S3 heard?
> 0.1s after S2
In which individuals does S3 suggest pathology? What pathology does it suggest? Why?
Older patients
Heart failure
The ventricles and chordae are stiff and weak so they reach their limit much faster than normal
What is the fourth heart (S4) sound caused by?
It is caused by turbulent blood flow from an atria contracting against a non-compliant ventricle
When is S4 heard?
Directly before S1
What does S4 indicate?
Stiff ventricle
Hypertrophic ventricle
What is mitral stenosis?
It is a condition in which there is narrowing of the mitral valve. This results in an obstruction of blood flow from the left atrium to the left ventricle
In which three locations, does mitral stenosis result in an increased pressure?
Left atrium
Pulmonary vasculature
Right side of the heart
What is the overall result of mitral stenosis?
Left atrial hypertrophy
What are the four causes of mitral stenosis?
Rheumatic fever
Infective endocarditis
Mucopolysaccharidoses
Carcinoid endocardial fibroelastosis
What is the most common cause of mitral stenosis?
Rheumatic fever
What are the five clinical features of mitral stenosis?
Dyspnoea on exertion
Haemoptysis
Chest pain
Malar flush
Atrial fibrillation
What are the five mitral stenosis murmur features?
Mid-Diastolic, Low Pitched, Rumbling Murmur
Louder Murmur on Expiration
Loud S1
Tapping Apex Beat
Low Volume Pulse
What three investigations can be used to diagnose mitral stenosis?
ECG
CXR
ECHO
What three features indicate mitral stenosis on ECG?
Atrial Fibrillation
Broad P wave > 0.12 seconds
P Mitrale
What two features indicate mitral stenosis on CXR?
Left Atrial Enlargement
Pulmonary Oedema
What three features indicate mitral stenosis on ECHO?
Mitral Valve Cross-Section < 1sqcm
Thickening & Scarring of Valve Cusps
Commissure Fusion
What is the normal cross-sectional area of the mitral valve?
4-6 sq cm
When is conservative management of mitral stenosis recommended?
It is recommended in individuals who are asymptomatic
What are the two conservative management options for mitral stenosis?
We manage cardiovascular risk factors
We regularly monitor with ECHO scans
When is pharmacological management of mitral stenosis recommended?
It is recommended as a first line treatment option in individuals who are symptomatic
What are the two pharmacological treatment options for mitral stenosis?
Diuretics
Anticoagulants
How are diuretics used to manage mitral stenosis?
They reduce the fluid build-up in the lungs and heart.
When are anticoagulants administered to treat mitral stenosis?
They administered to individuals who develop atrial fibrillation as a result of their mitral stenosis
When is surgical management of mitral stenosis recommended?
It is recommended as a second line treatment option in individuals who are symptomatic
What three surgeries are used to treat mitral stenosis?
Percutaneous Balloon Mitral Valvuloplasty
Commissurotomy
Mitral valve replacement
What is percutaneous balloon mitral valvuloplasty?
It is a procedure in which a catheter, with an attached balloon, is inserted into an artery and guided towards the narrowed valve
Once in position, the balloon is inflated to widen the valve – improving blood flow
The balloon is then deflated, and the catheter with the balloon is removed
What is commissurotomy ?
It is a procedure in which calcium deposits and scar tissue are removed to clear the valve passageway
What is mitral valve replacement?
It is a procedure in which the mitral valve is replaced with a mechanical valve or biological tissue valve
What is another term for mitral regurgitation?
Mitral insufficiency
What is mitral regurgitation?
It occurs when blood leaks back through the mitral valve on systole
This means that blood can flow in two directions during the contraction; into the left atrium and the left ventricle
What is the pathological effect of mitral regurgitation?
It results in congestive cardiac failure as the leaking valve causes a reduced ejection fraction and a backlog of blood into the left atrium
Left atrial dilatation
What is the overall result of mitral regurgitation?
Left atrial dilatation
What is the second most common valve disease?
Mitral regurgittaion
What are the six risk factors for mitral regurgitation?
Female Sex
Low Body Mass
Increased Age
Renal Dysfunction
Myocardial Infarction History
Mitral Stenosis/Prolapse History
What are the five causes of mitral regurgitation?
Mitral Valve Prolapse
Ischaemic Heart Disease (MI)
Infective Endocarditis
Rheumatic Heart Disease
Collagen Disorders
What is the most common cause of mitral regurgitation?
Mitral valve prolapse
What is mitral valve prolapse?
It is a condition in which the flaps of the mitral valve don’t close smoothly or evenly, but instead bulge upwards into the left atrium
What two collagen disorders are associated with mitral regurgitation?
Marfan’s Syndrome
Ehlers-Danlos syndrome
How does mitral regurgitation tend to present?
Asymptomatically
When does mitral regurgitation tend to become symptomatic?
Due to failure of the left ventricle, arrhythmias or pulmonary hypertension
What are the three clinical features of mitral regurgitation?
Fatigue
Shortness of breath
Oedema
What are five murmur features of mitral regurgitation?
Holosystolic, High Pitched, Whistling Murmur
Murmur Radiation To Axilla
Quiet, Soft S1
S3 Sound
Widely Split S2
What are the three investigations used to diagnose mitral regurgitation?
ECG
CXR
ECHO
What are the two signs of mitral regurgitation on ECG?
Broad P wave > 0.12s
Atrial Fibrillation
What are three signs of mitral regurgitation on CXR?
Enlarged Left Atrium
Enlarged Left Ventricle
Pulmonary Oedema
How are ECHO scans used to investigate mitral regurgitation?
It is used to diagnose and to assess the severity
What are the four management options for mitral regurgitation in acute cases?
Nitrates
Diuretics
Positive inotropes
Intra-aortic balloon pump
In what three ways do we conservatively treat chronic mitral regurgitation?
We manage cardiovascular risk factors
We conduct regular monitoring with ECHO scans
We manage complications
When is pharmacological management of mitral regurgitation recommended?
It is recommended as a first line treatment option in individuals who are symptomatic
In what two ways do we pharmacologically treat chronic mitral regurgitation?
Diuretics
Anticoagulants
How are diuretics used to manage mitral regurgitation?
They reduce the fluid build up in the lungs and heart
When are anticoagulants used to manage mitral regurgitation?
They are administered to individuals who develop atrial fibrillation as a result of their mitral regurgitation
When is surgical management of mitral regurgitation recommended?
It is recommended as a second line treatment option in individuals who are symptomatic
What two surgical procedures are used to manage mitral regurgitation?
Mitral Valve Repair
Mitral Valve Replacement
What surgical procedure is preferred to treat mitral regurgitation - repair or replacement?
Mitral valve repair
What is aortic stenosis?
It is a condition in which there is narrowing of the aortic valve
This results in an obstruction of blood flow from the left ventricle to the aorta
What is the overall result of aortic stenosis?
Left ventricular hypertrophy
What is the most common valvular heart disease?
Aortic stenosis
What are the four causes of aortic stenosis?
Degenerative Calcification
Congenital Bicuspid Aortic Valve
William’s Syndrome
Post-Rheumatic Disease
What is the most common cause of aortic stenosis in older patients > 65?
Degenerative calcification
What is the most common cause of aortic stenosis in older patients < 65?
Bicuspid aortic valve
What are the three symptoms of aortic stenosis?
Dyspnoea On Exertion
Syncope On Exertion
Chest Pain
What are the nine murmur features on aortic stenosis?
Ejection Systolic, High Pitched Murmur
Crescendo-Decrescendo Murmur
Murmur Radiation To Carotids
Decreased Murmur with Valsalva Manoeuvre
Narrow Pulse Pressure
Slow Rising Pulse
Soft Split S2
S4 Sound
Thrill
What would cause an aortic stenosis murmur to become quieter?
Left ventricular systolic dysfunction
What three investigations are used to diagnose aortic stenosis?
ECG
CXR
ECHO
What are the two features of aortic stenosis on ECG?
ST Segment Depression
T-Wave Inversion
What are the two features of aortic stenosis on CXR?
Aortic Valve Calcification
Left Ventricular Enlargement
How is an ECHO used to diagnose aortic stenosis?
It is used to diagnose and calculate the severity of aortic stenosis
When is conservative management of aortic stenosis recommended?
It is recommended in individuals who are asymptomatic and have a valvular gradient < 40mmHg
What are the two conservative management options of aortic stenosis?
We manage cardiovascular risk factors
We monitor regularly with ECHO scans
In which two circumstances is surgical management of aortic stenosis recommended?
Symptomatic
A valvular gradient > 40mmHg
What are the two surgical management options of aortic stenosis?
Aortic Valve Replacement
Percutaneous Balloon Aortic Valvuloplasty
What is aortic valve replacement?
It is a procedure in which the aortic valve is replaced with a mechanical valve or biological tissue valve
What are the two types of aortic valve replacements?
Transcatheter aortic replacements
Surgical aortic replacements
When is transcatheter aortic valve replacements recommended?
In symptomatic high operative risk patients
When is surgical aortic valve replacement recommended?
In symptomatic low-medium operative risk patients
What is percutaneous balloon aortic valvuloplasty?
It is a procedure in which a catheter, with an attached balloon, is inserted into an artery and guided towards the narrowed valve
Once in position, the balloon is inflated to widen the valve – improving blood flow
The balloon is then deflated, and the catheter with the balloon is removed
When is percutaneous balloon aortic valvuloplasty recommended?
It is selected in in children with no aortic valve calcification
It is selected in adults with critical aortic stenosis who are not fit for valve replacement
What is aortic regurgitation?
It is the leaking of the aortic valve at the end of systolic ejection
This allows blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle
What is the overall result of aortic regurgitation?
Left atrial dilatation
What are the eight causes of aortic regurgitation?
Rheumatic Fever*
Infective Endocarditis
Connective Tissue Diseases
Congenital Bicuspid Aortic Valve
Aortic Dissection
Spondyloarthropathies
Hypertension
Syphilis
What four connective tissue disorders are associated with mitral regurgitation?
Marfan’s syndrome
Ehler-Danlos syndrome
Rheumatoid arhtritis
SLE
What are the four symptoms of aortic regurgitation?
Chest pain
S.O.B
Orthopnea
Syncope
What are the six murmur features of aortic regurgitation?
Early-Diastolic, High Pitched, Blowing Murmur
Collapsing Pulse
Wide Pulse Pressure
Quincke’s Sign
De Musset’s Sign
Austin Flint Murmur
What is a collapsing pulse?
It is a rapidly appearing and disappearing pulse as the blood is pushed out of by the ventricles and then immediacy flows back through the aortic valve back into the ventricles
What is Quincke’s sign?
This is when the pulse is felt in the nailbed
What is de Musset’s sign?
This is when the patient’s head nods in time with their heartbeat
What is an Austin Flint murmur? What is the cause of this?
It is a mid-late diastolic murmur, ‘rumbling’ in character heard at the apex
It is caused by blood flowing back through the aortic valve and over the mitral valve causing it to vibrate
What are three investigations used to diagnose aortic regurgitation?
ECG
CXR
ECHO
What are the two features of aortic regurgitation on ECG?
Enlarged Left Atrium
Enlarged Left Ventricle
What are the three features of aortic regurgitation on CXR?
Left Ventricular Enlargement
Aortic Valve Calcification
Aortic Root Dilation
How are ECHO scans used to diagnose aortic regurgitation?
They are used to confirm the diagnosis of aortic regurgitation and determine its severity
When do we treat aortic regurgitation conservatively?
It is recommended in individuals who are asymptomatic
In what two ways do we manage aortic regurgitation conservatively?
We manage cardiovascular risk factors
We monitor with ECHO scans regularly
When do we treat aortic regurgitation surgically?
It is recommended in individuals who are symptomatic and have severe aortic regurgitation
What are the two ways in which we surgically manage aortic regurgitation?
Aortic Valve Repair
Aortic Valve Replacement
