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Year 1-Cardiovascular System > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What is the most common cause for mitral stenosis?

A

Rheumatic Heart Disease

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2
Q

Can patients be born with mitral stenosis?

A

Yes, it can be congenital

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3
Q

When mitral stenosis occurs, what will the diameter of the mitral orifice be?

A

<2cm squared

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4
Q

What does a decreased mitral orifice cause?

A

Increased ventricular-atrial pressure gradient
LA pressure increases
Increased pulmonary venous pressure
Increased capillary pressure
Increased vascular resistance
Increased pulmonary artery pressure, leading to pulmonary hypertension

->wordy but all links together

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5
Q

What happens to the LV in mitral stenosis?

A

It remains fairly normal because it is not put under any pressure

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6
Q

What two factors influence the severity of mitral stenosis?

A

Trans-valvular pressure gradient
Trans-valvular flow rate

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7
Q

RECAP- what can affect flow rate?

A

Remember Starling’s Law :)

HR
CO

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8
Q

When will people tend to be more tachycardic?

A

Upon exercise
During pregnancy
Acute illness
AF

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9
Q

What are some of the clinical presentations of mitral stenosis?

A

Dyspnoea
Haemoptysis
Systemic embolism- LA and left atrium appendage enlargement
Infective endocarditis
Chest pain
Hoarseness

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10
Q

Why might a patient w mitral stenosis present w haemotysis?

A

Due to thin veins rupturing

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11
Q

Why may a patient w mitral stenosis present with hoarseness?

A

Due to compression of the left recurrent laryngeal nerve by the enlarged LA

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12
Q

What could be some of the clinical findings upon examination in those with mitral stenosis?

A

Mitral facies
Pulse – normal
JVP – prominent a wave
Tapping apex beat and diastolic thrill
RV heave

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13
Q

What is mitral facies?

A

Purple discolouration of the nose and cheeks

->idk if this will help but mitral=mitral stenosis, facies= face?

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14
Q

When might you hear a murmur upon auscultation of a patient with mitral stenosis?

A

Between the second and first heart sound

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15
Q

Which two investigations are commonly used in diagnosis of mitral stenosis?

A

ECG
CXR

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16
Q

Which investigation confirms the diagnosis of mitral stenosis?

A

Echocardiography

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17
Q

What would you see on an ECHO which would indicate mitral stenosis?

A

Thickening and scarring of the leaflets
Fusion of the commissures

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18
Q

What are the main treatments for mitral stenosis?

A

Diuretics
Reduced sodium intake

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19
Q

Which treatment should be given to all patients with AF and is safer to give in those w mitral stenosis than not?

A

Anticoagulants

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20
Q

What is the interventional treatment of mitral stenosis?

A

Valvotomy (balloon vs surgical)
MVR- mitral valve repair

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21
Q

What is the most common cause of mitral regurgitation?

A

Like mitral stenosis, rheumatic heart disease

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22
Q

What are some other causes of mitral regurgitation?

A

Mitral valve prolapse
Infective endocarditis

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23
Q

What is the pathophysiological cause of mitral regurgitation?

A

Effective regurgitant orifice of the valve is not fixed.

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24
Q

How does the LV try to compensate in acute mitral regurgitation?

A

End systolic pressure decreases
End systolic pressure decreases
Wall tension decreases

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25
How does the LV try to compensate in chronic mitral regurgitation?
End diastolic volume increases End systolic volume returns to normal Left ventricular hypertrophy develops
26
What are some of the clinical symptoms of acute mitral regurgitation?
Breathlessness Pulmonary oedema Cardiogenic shock
27
What are some of the clinical symptoms of chronic mitral regurgitation?
Fatigue Exhaustion Right heart failure Dyspnoea or palpitations due to AFib
28
Why might a person with chronic mitral regurgitation feel exhaused?
Low cardiac output
29
Discuss the severity of acute vs chronic mitral regurgitation.
Acute- medical emergency, must be dealt with quickly. Chronic- severe but has built up gradually over years
30
Describe what may be seen upon clinical examination in someone with mitral regurgitation (MR).
Pulse – normal or reduced in heart failure JVP – prominent if RH failure present Brisk and hyperdynamic apex beat RV heave
31
Describe what may be heard upon auscultation in patients with MR.
Reduced S1, early A2, loud S2
32
Which investigations may be carried out in those w suspected MR?
ECG CXR
33
What would the ECG show in someone with MR?
Prolonged P wave Prominent R wave in R precordial leads
34
Which investigation could be used for the diagnosis of MR and MS but is pretty much obsolete?
Cardiac catheterisation
35
What has Cardiac catheterisation been replaced by?
Echocardiography
36
What causes of MR can you see when looking at the ECHO?
Leaflet dysfunction, chordae, papillary muscles, annular disease
37
What is the main aim of treatment for acute MR?
Reduce preload and afterload
38
Which drugs can reduce preload and afterload?
-Sodium nitroprusside -Dobutamine -IABP
39
What is the main aim of treatment for chronic MR?
Lack of evidence showing anything helps so main goal is to preserve the LV function
40
What are to options for innervation treatment when it comes to MR?
Mitral valve apparatus repair Mitral valve replacement
41
What is the main cause of aortic valve stenosis?
Degenerative- valve degenerates over time
42
Which valve is most commonly affected by valve disease?
Aortic valve
43
What is the most common congenital valve diseases?
Bicuspid aortic valve abnormality
44
What is the other causes, other than degeneration, of AVS?
Rheumatoid heart disease
45
Describe the pathophysiology of AVS
-Increased LV systolic pressure -Severe concentric hypertrophy and increase in LV Mass -Increased LV end diastolic pressure -Increased myocardial oxygen consumption
46
What can the increased myocardial oxygen demand in AVS lead to?
Myocardial ischaemia Ultimately HF
47
What are the symptoms of AVS?
Usually asymptomatic for long period -Breathlessness on exertion -Chest pain -Dizziness -HF
48
Describe the common clinical examination findings of someone with AVS.
Pulse – small volume and slowly rising JVP – prominent if RH failure present, low BP Vigurous and sustained apex beat RV Heave
49
Describe what may be heard upon auscultation of someone with AVS.
Normal S1 Less audible S2/A2
50
What are the usual investigations for AVS?
ECG CXR ECHO
51
Describe the treatment for AVS
Treatment only offered for those who develop HF
52
hat is the intervention for AVS?
Replacement/repair of the aortic valve
53
What are the two mains groups of causes for aortic regurgitation?
Diseases of the aorta Diseases of the leaflets
54
What are some of the causes of aortic regurgitation relating to the leaflets?
Bicuspid aortic valve Rheumatic heart disease Endocarditis Myxomatous degeneration
55
What are some of the causes of aortic regurgitation relating to the aorta?
Dilated aorta (Marfans, hypertension) Connective tissue disorders
56
Describe the pathophysiology of AR.
-LV accommodates both stroke volume and regurgitant volume -Increased LVEDV and LV systolic pressure -LV hypertrophy and LV dilatation -Increased myocardial oxygen consumption
57
What can happen as a result to the increased myocardial oxygen consumption in AR?
Myocardial ischaemia LV failure
58
Describe the symptoms of chronic AR.
Very long asymptomatic phase Presents w breathlessness
59
Describe the sequence of events of acute AR and treatment.
Medical emergency Often have to be bridged w meds until surgery possible
60
What might you see upon clinical examination in a patient w AR?
Pulse – large volume and collapsing (Corrigan sign) Wide pulse pressure Hyperdynamic, displaced apex beat
61
Upon auscultation, what might you hear in someone w AR?
Normal S1 and S2 S2 followed by very soft murmur
62
What are the investigations for someone with AR?
ECG ECHO CXR
63
What might you see on someone with AR on their ECHO?
Thick cusp Vegetations
64
What therapy helps those w AR?
Vasodilator therapy
65
What would be the intervention for those w AR?
Replacement/repair of aortic valve

Year 1-Cardiovascular System (41 decks)

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