Valvular heart disease Flashcards
mitral stenosis causes
one of the commonest, caused by rheumatic heart disease, lupus erythematosus, rheumatoid arthritis, can be congenital
what happens in mitral stenosis
mitral orifice less than 2cm^2, A-V pressure gradient increases left atrium pressure increases, pulmonary venous and capillary pressure increases, pulmonary vascular resistance increases, pulmonary artery pressure increases, pulmonary hypertension develops, right heart dilatation with tricuspid regurgitation and pulmonary regurgitation. left ventricle pressures and systolic function normal
mitral stenosis severity depends on
trans valvular pressure gradient, transvalvular flow rate. becomes clinically relevant when tachycardia during exercise, acute illness, pregnancy, atrial fibrillation
clinical manifestations of mitral stenosis
dyspnoea (from mild exertion dyspnoea to pulmonary oedema), haemoptysis, systemic embolisation (LA and LAA enlargement), IE, chest pain, hoarseness due to (compression of the L recurrent laryngeal nerve)
clinical examination of mitral stenosis
purple discolouration of cheeks and nose, pulse- normal, JVP- prominent a wave, tapping apex beat and diastolic thrill, RV heave, auscultation- quiet murmur in diastole
investigations of mitral stenosis
ECG- signs of right ventricular hypertrophy or elevated P wave lasting longer than usual, cardiac catheterisation, CXR shows LA enlargement, echocardiography- thickening and scarring of leaflets, fusion of commissures, cardiac magnetic resonance
mitral stenosis treatment
diuretics and restriction of Na intake, AF: SR restoration or ventricular rate control, anticoagulation: all those with AF, debatable in SR, valvotomy, mitral valve replacement
mitral regurgitation causes
rheumatic heart disease, mitral valve prolapse, IE, degenerative, functional MR due to LV and annular dilatation
mitral regurgitation pathophysiology
effective regurgitant orifice not fixed and is dependent on the preload, after load, LV contractility and LV compensation change. acute- ESP and ESV decreases, wall tension decreases. Chronic- EDV decreases and ESV returns to normal, eccentric left ventricular hypertrophy
clinical manifestations of acute mitral regurgitation
valve perforation, chordal/papillary muscle rupture, breathlessness- pulmonary oedema, cardiogenic shock
clinical manifestations of chronic mitral regurgitation
develop slowly over years, fatigue, exhaustion, right heart failure, dyspnoea or palpitations due to Afib
clinical examination of mitral regurgitation
pulse normal or reduced in heart failure, brisk and hyper dynamic apex beat, prominent JVP in right heart failure, RV heave, auscultation- reduced s1 and split s2 early a2 and loud p2
investigations mitral regurgitation
ECG- LA enlargement, RVH, CXR- cardiomegaly, LA enlargement, calcification of mitral annulus, cardiac catheterisation- LV angiography- obsolete, echocardiography- LV dimension, cause of MR, severity of MR and pap
causes of MR
leaflet dysfunction, chordae rupture, papillary muscle rupture, annular disease
treatment of mitral regurgitation
acute- preload and after load reduction by vasodilators, dobutamine, IABP
chronic- lack of evidence that any therapy is beneficial for haemodynamic improvement, LV function preservation. if necessary mitral valve replacement or apparatus repair
aortic stenosis can be
degenerative, rheumatic, bicuspid (congenital)
aortic stenosis clinical signs
long asymptomatic phase, chest pain, syncope/dizziness, breathlessness on exertion, heart failure
aortic stenosis examination
pulse small volume and slow rising, JVP prominent if RH failure, low BP, vigorous and sustained apex beat, RV heave, auscultation- normal s1, s2 less audible A2
aortic stenosis investigations
ECG- LVH voltage criteria, ST/T changes, CXR- calcification, cardiac catheterisation- peak LV peak aortic gradient- obsolete, echocardiograph- demonstrates the Av cusp mobility, LV function and hypertrophy, doppler hamody namic assessment of pressure gradient and Aortic Valve area
aortic stenosis treatment
limited to those who develop heart failure, aortic valve replacement or repair if needed
aortic regurgitation clinical signs
chronic- long asymptomatic phase, exertion breathlessness. acute- poorly tolerated as wall tension cannot be adapt
aortic regurgitation examination
large volume and collapsing pulse, wide pulse pressure, hyper dynamic, displaced apex beat, auscultation is normal s1 and normal s2, early diastolic, decrescendo, soft murmur
aortic regurgitation investigations
ECG- ST/T changes, Left axis deviation, CXR- cardiomegaly in chronic AR, cardiac catheterisation- obsolete, previously aortgram performed, echocardiogram- demonstrates the AV cusp anatomy, LV function, dilatation and hypertrophy, doppler haemodynamic assessment of regurgitant flow
what happens in aortic stenosis
increased left ventricular systolic pressure, severe concentric hypertrophy and increased LVmass, increased LVEDP, increased myocardial oxygen consumption, myocardial ischaemia, LV failure
aortic regurgitation can be due to
dilated aorta, connective tissue disorders, bicuspid aortic valve, rheumatic heart disease, endocarditis, myxomatous degeneration
what happens in aortic regurgitation
LV accommodated both SV and regVol, increased LVEDV and Lv systolic pressure, Lv hypertrophy and Lv dilatation, increased myocardial oxygen consumption, myocardial ischaemia, Lv failure
aortic regurgitation treatment
vasodilator therapy shown to delay timing for surgical intervention, aortic valve replacement or repair if needed
