valvular heart disease Flashcards by Maryam Mahmood

4 main valvular heart conditions

Aortic Stenosis
Mitral regurgitation
Aortic Regurgitation
Mitral Stenosis

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define aortoc stenoss

obstruction of lv outflow resulting in decrease CO

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murmur for Aortic stenosis

ejection systolic murmur radiating to carotids and apex

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what is normal aortic valve ares

3-4cm2

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causes of aortic stenoss

degenerative calcification
rheumatic heart disease
rare causes

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most important cause of aortic stenosis

ageing calcification

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pathophysiology of aortic stenosis

-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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presentation of aortic stenosis

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

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physical signs of aortic stenosis

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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investigation for aortic stenosis

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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general management of AS

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

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medical management of AS

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

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what is TAVI

Transcatheter Aortic Valve Implantation

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DEFINE mitral regurgitation

Backflow of blood from the LV to the LA during systole

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etiologies of MR

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

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PATHOPHYSIOLOGY OF mr

regurgitation into left atrium
-left atrial dilation
-left atrial enlargement
LVH
-PULMONARY HYPERTENSION
-right ventricular dysfunction

auscultation for MR would show

pansystolic murmur radiating to left axilla

physical signs and symptoms

auscultatipn pansystolic
exertion dysponoea
heart failure
displaced thrusting apex

Investigations in MR

-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

management of MR

vasodilators- ACEi
rate control - bb
diuretics- Furosemdie

Indications for surgery in severe MR

If EF <60%,

define aortic regurgitation

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

ETIOLOGY of AR

Bicuspid aortic valve
Rheumatic
Infective endocarditis

PATHOPHYSIOLOGY OF AR

Combined pressure AND volume overload

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

what would you see on auscultation for AR

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

PROGRESSIVE SYMPTOMS OD AR

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

general management of AR

consider IE prophylaxis

medical management of AR

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

INDICATIONS for surgery for AR

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

Define mitral stenosis

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

normal MV area?

4-6cm2

predominant cause of MS

rheumatic carditis

etiology of MS

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

pathophysiology of MS

-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

PHYSICAL SIGNS OF MS

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

heart sounds in MS FOR diastolic

-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

evaluation of MS

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

medical management of MS

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

indications for mitral valve replacement

ANY SYMPTOMATIC Patient with NYHA Class III or IV Symptoms Asymptomatic moderate or Severe MS with a pliable valve suitable for PMBV