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cardiology > valvular heart disease > Flashcards

valvular heart disease Flashcards

1
Q

4 main valvular heart conditions

A

Aortic Stenosis
Mitral regurgitation
Aortic Regurgitation
Mitral Stenosis

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2
Q

define aortoc stenoss

A

obstruction of lv outflow resulting in decrease CO

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3
Q

murmur for Aortic stenosis

A

ejection systolic murmur radiating to carotids and apex

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4
Q

what is normal aortic valve ares

A

3-4cm2

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5
Q

causes of aortic stenoss

A

degenerative calcification
rheumatic heart disease
rare causes

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6
Q

most important cause of aortic stenosis

A

ageing calcification

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7
Q

pathophysiology of aortic stenosis

A

-Narrowing of the valve
decrease in stroke volume
increase in afterload
increased left v pressure
compensatory lvh
increased oxygen demand
ischaemia

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8
Q

presentation of aortic stenosis

A

-syncope
-angina
-dysponoea, on exertion due to heart failure
- sudden death (rare)

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9
Q

physical signs of aortic stenosis

A
  • slow rising carotid pulse
    -heart sounds - soft or absent second heart sound S4 gallop due to LVH
  • ejection systolic murmur - cresendo decresendo character
  • loudness does not tell you anything about severity
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10
Q

investigation for aortic stenosis

A

two measurements obtained
a- Left ventricular size and function: LVH, Dilation, and EF
b-Doppler derived gradient and valve area (AVA)

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11
Q

general management of AS

A

Fastidious dental hygiene / care
Consider infective endocarditis prophylaxis in dental procedures

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12
Q

medical management of AS

A

limited role since AS is a mechanical problem. Vasodilators are relatively contraindicated in severe AS

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13
Q

what is TAVI

A

Transcatheter Aortic Valve Implantation

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14
Q

DEFINE mitral regurgitation

A

Backflow of blood from the LV to the LA during systole

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15
Q

etiologies of MR

A

Myxomatous degeneration (MVP)
Ischemic MR
Rheumatic heart disease
Infective Endocarditis
papillary muscle rupture

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16
Q

PATHOPHYSIOLOGY OF mr

A
  • regurgitation into left atrium
    -left atrial dilation
    -left atrial enlargement
  • LVH
    -PULMONARY HYPERTENSION
    -right ventricular dysfunction
17
Q

auscultation for MR would show

A

pansystolic murmur radiating to left axilla

18
Q

physical signs and symptoms

A

auscultatipn pansystolic
exertion dysponoea
heart failure
displaced thrusting apex

19
Q

Investigations in MR

A

-ECG: May show, LA enlargement, atrial fibrillation and LV hypertrophy with severe MR
-CXR: LA enlargement, central pulmonary artery enlargement.
-ECHO: Estimation of LA, LV size and function. Valve structure assessment
TOE v helpful

20
Q

management of MR

A

vasodilators- ACEi
rate control - bb
diuretics- Furosemdie

21
Q

Indications for surgery in severe MR

A

If EF <60%,

22
Q

define aortic regurgitation

A

Leakage of blood into LV during diastole due to ineffective coaptation of the aortic cusps

23
Q

ETIOLOGY of AR

A

Bicuspid aortic valve
Rheumatic
Infective endocarditis

24
Q

PATHOPHYSIOLOGY OF AR

A

Combined pressure AND volume overload

Compensatory Mechanisms: LV dilation, LVH. Progressive dilation leads to heart failure

25
Q

what would you see on auscultation for AR

A

early diastolic murmur ( best heard on expiration with patient sat forward )

26
Q

PROGRESSIVE SYMPTOMS OD AR

A

-Dyspnoea: exertional
-Palpitations: due to increased force of contraction and ectopics
-angina

27
Q

general management of AR

A

consider IE prophylaxis

28
Q

medical management of AR

A

Medical: Vasodilators (ACEI’s potentially improve stroke volume and reduce regurgitation but indicated only in CCF or HTN

29
Q

INDICATIONS for surgery for AR

A

ANY Symptoms at rest or exercise
Asymptomatic treatment if:
EF drops below 50% or LV becomes dilated > 50mm at end systole

30
Q

Define mitral stenosis

A

Obstruction of LV inflow that prevents proper filling during diastole due to thickness of mitral valve

31
Q

normal MV area?

A

4-6cm2

32
Q

predominant cause of MS

A

rheumatic carditis

33
Q

etiology of MS

A

Rheumatic heart disease: 77-99% of all cases
Infective endocarditis: 3.3%
Mitral annular calcification: 2.7%

34
Q

pathophysiology of MS

A

-Progressive Dyspnea (70%): LA dilation  pulmonary congestion (reduced emptying)
worse with exercise, fever, tachycardia, and pregnancy
-Increased Transmitral Pressures: Leads to left atrial enlargement and atrial fibrillation.
-Right heart failure symptoms: due to Pulmonary venous HTN
-Hemoptysis: due to rupture of bronchial vessels due to elevated pulmonary pressure

35
Q

PHYSICAL SIGNS OF MS

A

prominent “a” wave in jugular venous pulsations: Due to pulmonary hypertension and right ventricular hypertrophy

Signs of right-sided heart failure: in advanced disease

Mitral facies: When MS is severe and the cardiac output is diminished, there is vasoconstriction, resulting in pinkish-purple patches on the cheeks

36
Q

heart sounds in MS FOR diastolic

A

-Low-pitched diastolic rumble most prominent at the apex.
-Heard best with the patient lying on the left side in held expiration
-Intensity of the diastolic murmur does not correlate with the severity of the stenosis

37
Q

evaluation of MS

A

ECG: may show atrial fibrillation and LA enlargement
CXR: LA enlargement and pulmonary congestion. Occasionally calcified MV
ECHO: The GOLD STANDARD for diagnosis. Asses mitral valve mobility, gradient and mitral valve area

38
Q

medical management of MS

A

-blockers, CCBs, Digoxin which control heart rate and hence prolong diastole for improved diastolic filling
Duiretics for fluid overload

39
Q

indications for mitral valve replacement

A

ANY SYMPTOMATIC Patient with NYHA Class III or IV Symptoms

Asymptomatic moderate or Severe MS with a pliable valve suitable for PMBV

cardiology (16 decks)

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