Valvular Heart Disease Flashcards
6 common valve lesions
Mitral valve prolapse
Aortic stenosis/
Aortic regurgitation
Mitral regurgitation
Mitral stenosis
Right sided valve lesions
Mitral valve prolapse
> /=2mm systolic prolapse of 1 or both vakve leaflets beyond long axis annular plane during 2d echo
What histological changes occur in valves in mitral valve prolapse
None
Myxomatous degeneration
non-inflammatory progressive disarray of the valve structure caused by a defect in the mechanical integrity of the leaflet due to the altered synthesis and/or remodeling by type VI collagen
Where and when do mitral valve leaflets prolapse into in mitral valve prolapse
Left atrium during systole
Mitral valve prolapse symptoms
Usually asymptomatic
Chest pain
Atrial arrhythmias
Mitral prolapse signs
Ejection click
Late systolic murmur
Aortic stenosis causes
Calcification disease
Congenital bicuspid valve
Rheumatic disease
Aortic stenosis symptoms
Dyspnoea
Angina
Syncope
Left ventricular failure
Sudden death
Aortic stenosis signs
Slow rising carotid pulse
S4
Ejection click
Ejection systolic murmur - diamond
What causes S4 in aortic stenosis
Atrium trying to push blood into stiff left ventricle
Why does aortic stenosis cause dyspnoea
Increased diastolic pressure in stiff non compliant left ventricle
Why does aortic stenosis and aortic regurgitation cause angina
Increased oxygen demand in hypertrophied left ventricle
Why does aortic stenosis cause syncope
Paroxysmal ventricular arrhythmias or exertional cerebral hypoperfusion
Why does aortic stenosis cause left ventricular failure
Contractile failure as ventricle dilates
How can aortic stenosis causes sudden death
Ventricular arrhythmias
Why does aortic stenosis cause high QRS and T inversion on an ECG
Left ventricular strain
What valve area shows severe aortic stenosis
<1cm2
What can aortic valve leaflet disease and aortic root dilating disease cause
Aortic regurgitation
What can cause aortic valve leaflet disease
Calcification disease
Congenital biscuspid valve
Rheumatic disease
Infective endocarditis
What can cause aortic root dilating disease
Ankylosis spondylitis
Marfan syndrome
Aortic dissection
Aortic regurgitation symptoms
Often none
Dyspnoea
Angina
Aortic regurgitation signs
Rapidly rising carotid pulse
Early diastolic murmur
Ejection murmur - possible
Why does aortic regurgitation cause Dyspnoea
Contractile failure as ventricle dilates
What causes the early diastolic murmur in aortic regurgitation
Aortic backflow
What causes the ejection murmur in aortic regurgitation
Turbulent ejection from volume loaded left ventricle
What indicates surgery is needed for sortic regurgitation
Symptoms of aortic regurgitation
Echocardiograohic evidence of worsening left ventricle dilation
Mitral stenosis causes
Rheumatic fever
Mitral stenosis symptoms
Dyspnoea
Orthopnoea
RV failure
Palpitations
Systemic emboli
Mitral stenosis signs
Atrial fibrillation
Loud s1
Opening snap
Mid diastolic rumble
Pre systolic murmur
Incr JVP
Basal creeps
Ankle oedema
WHy does mitral stenosis cause Dyspnoea and Orthopnoea
Incr left atrial pressure
Why does mitral stenosis cause right ventricular failure
Incr left atrial pressure and reactive pulmonary vasoconstriction
How does mitral stenosis cause palpitations
Atrial fibrillation
What does static blood in dilated fibrillating left atrium due to mitral stenosis or regurgitation predispose a patient to
Systemic emboli
What can be heard in chest auscultation of a patient with mitral stenosis
Loud s1
Opening snap
Mid diastolic rumble
Pre systolic murmur
How does mitral stenosis affect left atrium pressure
Increase
What operation can be used to treat mitral stenosis
Valvuloplasty
What conditions can cause mitral regurgitation
Mitral valve leaflet disease
Subvalvar disease
Functional mitral regurgitation
Mitral regurgitation symptoms
Dyspnoea
Orthopnoea
Palpitations
Systemic emboli
Incr left atrial pressure
Atrial fibrillation
Thrombosis
Mitral regurgitation signs
Sinus rhythm or atrial fibrillation
Pansystolic murmur
S3
Incr JVP
Basal creeps
Ankle oedema
How can mitral how can mitral regurgitation be investigated
M-mode echo
M-mode phonogram
M-mode Doppler
Left ventricular angiogram
What indicates a patient needs surgery for mitral valve disease
Symptoms don’t respond to treatment
Worsening cardiovascular complications
Which patients may a Percutaneous MitraClip be used in
Patients too sick for heart surgery
Valvular heart disease treatment
Surgery / valvuloplasty
Diuretics - fluid overload
Digoxin - af
Beta blockers - af
Verapamil - af
Anticoagulants - af
