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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
Q

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

A

End diastolic volume increases
End systolic volume returns to normal
Left ventricular hypertrophy develops

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26
Q

What are some of the clinical symptoms of acute mitral regurgitation?

A

Breathlessness
Pulmonary oedema
Cardiogenic shock

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27
Q

What are some of the clinical symptoms of chronic mitral regurgitation?

A

Fatigue
Exhaustion
Right heart failure
Dyspnoea or palpitations due to AFib

28
Q

Why might a person with chronic mitral regurgitation feel exhaused?

A

Low cardiac output

29
Q

Discuss the severity of acute vs chronic mitral regurgitation.

A

Acute- medical emergency, must be dealt with quickly.
Chronic- severe but has built up gradually over years

30
Q

Describe what may be seen upon clinical examination in someone with mitral regurgitation (MR).

A

Pulse – normal or reduced in heart failure
JVP – prominent if RH failure present
Brisk and hyperdynamic apex beat
RV heave

31
Q

Describe what may be heard upon auscultation in patients with MR.

A

Reduced S1, early A2, loud S2

32
Q

Which investigations may be carried out in those w suspected MR?

A

ECG
CXR

33
Q

What would the ECG show in someone with MR?

A

Prolonged P wave
Prominent R wave in R precordial leads

34
Q

Which investigation could be used for the diagnosis of MR and MS but is pretty much obsolete?

A

Cardiac catheterisation

35
Q

What has Cardiac catheterisation been replaced by?

A

Echocardiography

36
Q

What causes of MR can you see when looking at the ECHO?

A

Leaflet dysfunction, chordae, papillary muscles, annular disease

37
Q

What is the main aim of treatment for acute MR?

A

Reduce preload and afterload

38
Q

Which drugs can reduce preload and afterload?

A

-Sodium nitroprusside
-Dobutamine
-IABP

39
Q

What is the main aim of treatment for chronic MR?

A

Lack of evidence showing anything helps so main goal is to preserve the LV function

40
Q

What are to options for innervation treatment when it comes to MR?

A

Mitral valve apparatus repair
Mitral valve replacement

41
Q

What is the main cause of aortic valve stenosis?

A

Degenerative- valve degenerates over time

42
Q

Which valve is most commonly affected by valve disease?

A

Aortic valve

43
Q

What is the most common congenital valve diseases?

A

Bicuspid aortic valve abnormality

44
Q

What is the other causes, other than degeneration, of AVS?

A

Rheumatoid heart disease

45
Q

Describe the pathophysiology of AVS

A

-Increased LV systolic pressure
-Severe concentric hypertrophy and increase in LV Mass
-Increased LV end diastolic pressure
-Increased myocardial oxygen consumption

46
Q

What can the increased myocardial oxygen demand in AVS lead to?

A

Myocardial ischaemia
Ultimately HF

47
Q

What are the symptoms of AVS?

A

Usually asymptomatic for long period

-Breathlessness on exertion
-Chest pain
-Dizziness
-HF

48
Q

Describe the common clinical examination findings of someone with AVS.

A

Pulse – small volume and slowly rising
JVP – prominent if RH failure present, low BP
Vigurous and sustained apex beat
RV Heave

49
Q

Describe what may be heard upon auscultation of someone with AVS.

A

Normal S1
Less audible S2/A2

50
Q

What are the usual investigations for AVS?

A

ECG
CXR
ECHO

51
Q

Describe the treatment for AVS

A

Treatment only offered for those who develop HF

52
Q

hat is the intervention for AVS?

A

Replacement/repair of the aortic valve

53
Q

What are the two mains groups of causes for aortic regurgitation?

A

Diseases of the aorta
Diseases of the leaflets

54
Q

What are some of the causes of aortic regurgitation relating to the leaflets?

A

Bicuspid aortic valve
Rheumatic heart disease
Endocarditis
Myxomatous degeneration

55
Q

What are some of the causes of aortic regurgitation relating to the aorta?

A

Dilated aorta (Marfans, hypertension)
Connective tissue disorders

56
Q

Describe the pathophysiology of AR.

A

-LV accommodates both stroke volume and regurgitant volume
-Increased LVEDV and LV systolic pressure
-LV hypertrophy and LV dilatation
-Increased myocardial oxygen consumption

57
Q

What can happen as a result to the increased myocardial oxygen consumption in AR?

A

Myocardial ischaemia
LV failure

58
Q

Describe the symptoms of chronic AR.

A

Very long asymptomatic phase
Presents w breathlessness

59
Q

Describe the sequence of events of acute AR and treatment.

A

Medical emergency
Often have to be bridged w meds until surgery possible

60
Q

What might you see upon clinical examination in a patient w AR?

A

Pulse – large volume and collapsing (Corrigan sign)
Wide pulse pressure
Hyperdynamic, displaced apex beat

61
Q

Upon auscultation, what might you hear in someone w AR?

A

Normal S1 and S2
S2 followed by very soft murmur

62
Q

What are the investigations for someone with AR?

A

ECG
ECHO
CXR

63
Q

What might you see on someone with AR on their ECHO?

A

Thick cusp
Vegetations

64
Q

What therapy helps those w AR?

A

Vasodilator therapy

65
Q

What would be the intervention for those w AR?

A

Replacement/repair of aortic valve

Year 1-Cardiovascular System (41 decks)

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