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Cardiovascular > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

Describe components of the mitral valve?

A

Anterior MVL and Posterior MVL
Annulus
Papillary muscles and chordae tendinae
Opening is 4-6 cm2

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2
Q

Describe the aetiology of Mitral stenosis

A

Rheumatic Heart Disease
Congenital MS
Systemic conditions - SLE and RA

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3
Q

Describe the pathophysiology of mitral stenosis

A

Atria to ventricle pressure gradient increases so LA pressure increases
Pulmonary venous and capillary pressures increase so PVR increases
PaP increases and PHT develops
RH dilatation with TR and PReg

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4
Q

What decides the severity of mitral stenosis?

A

Trans-valvular pressure gradient and trans-valvular flow rate (CO and HR)

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5
Q

What can cause tachycardia?

A

Exercise, acute illness, pregnancy and atrial fibrillation

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6
Q

What are the clinical manifestations of mitral stenosis?

A

Dyspnoea (mild exertional to pulmonary oedema), Haemoptysis, Systemic embolization, IE, Chest pain and hoarseness (compression of L recurrent laryngeal nerve by large LA)

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7
Q

How does systemic embolization occur in MS?

A

LA and LAA enlargement so blood flow becomes stagnant here

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8
Q

What signs can be seen on clinical examination of patient with Mitral stenosis?

A

Mitral facies (purple discolouration), normal pulse, prominent a wave for JVP, tapping apex beat and diastolic thrill, RV heave and heart sound found in diastole (very quiet)

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9
Q

What changes can be seen on an ECG of a patient with mitral stenosis?

A

P> 0.12 secs can show RVH

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10
Q

What investigations are used for mitral stenosis?

A

ECG and Cardiac catheterisation
CXR
Echo and Cardiac magnetic resonance

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11
Q

What changes on CXR can be seen - mitral stenosis?

A

heart border is larger due to LA and LAA enlargement

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12
Q

What can be seen on echo of patient with mitral stenosis?

A

Thickening and scarring of the leaflets
Fusion of the commissures

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13
Q

Describe the medical treatment for a patient with mitral stenosis

A

Diuretics and restriction of Na intake
AF - SR restoration or ventricular rate control
Anticoagulation

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14
Q

What interventional treatment can be used for mitral stenosis?

A

Valvotomy and MVR

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15
Q

Describe the aetiology for mitral regurgitation

A

Rheumatic heart disease, mitral valve prolapse, IE, Degenerative with age, and functional MR due to LV and annular dilatation

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16
Q

Describe the pathophysiology of mitral regurgitation

A

Effective Regurgitant Orifice is not fixed so effects preload, afterload and LV contractibility
LV compensation then acute or chronic MR

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17
Q

Describe pathophysiology of acute mitral regurgitation

A

ESP and ESV decrease which decreases wall tension

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18
Q

Describe the pathophysiology of chronic mitral regurgitation

A

EDV increases and ESV returns to normal
Eccentric LVH develops

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19
Q

What are the clinical manifestations of acute MR?

A

Breathlessness due to pulmonary oedema and cardiogenic shock

20
Q

Describe the clinical manifestations of chronic MR

A

Fatigue, exhaustion due to low CO and right heart failure
Dyspnoea or palpitations due to AF

21
Q

What can be seen on examination of patient with mitral regurgitation?

A

Pulse is normal or reduced in HF, JVP is prominent if right heart failure, brisk and hyperdynamic apex beat, RV heave and S2 is split so early A2 and loud P2

22
Q

Describe the extra heart sound in mitral regurgitation?

A

Holosystolic, blowing, loud at apex, radiating to axilla and no relationship in intensity and severity

23
Q

What are some lab investigations used for mitral regurgitation?

A

ECG - LA enlargement is P>0.12 secs and tall, RVH is prominent R waves
CXR - cardiomegaly, LA enlargement, calcification
Cardiac catheterisation and LV angiography

24
Q

What can be seen on echo of Mitral regurgitation?

A

LV dimensions
Cause of MR - leaflet dysfunction, papillary muscles or annular disease
Severity of MR and Pap (pulmonary arterial pressure)

25
Q

What can be measured on CMR imaging?

A

Accurate cardiac volumes and volumetric determination of Reg vol.

26
Q

What is the medical treatment for mitral regurgitation?

A

Acute - preload and afterload reduction
Chronic - Haemodynamic improvement and LV function preservation

27
Q

What is the interventional treatment for MR?

A

Mitral valve apparatus repair and mitral valve replacement

28
Q

Describe the aortic stenosis aetiology

A

Degenerative, rheumatic heart disease and bicuspid (congenital)
AVA < 1.5-2 cm2 instead of normal 3-4cm2

29
Q

Describe the rheumatic pathophysiology of aortic stenosis

A

Adhesion, fusion of the commissures and retraction and stiffening of the free cusp margins

30
Q

Describe the degenerative pathophysiology of aortic stenosis

A

Linked to atherosclerosis, is a slow inflammatory process resulting in thickening and calcification of the cusps from base to free margins

31
Q

Describe aortic stenosis pathophysiology

A

Increased LV systolic pressure - severe concentric hypertrophy and Increased LV mass - increases LVEDP (end diastolic pressure) - increased MVO2 - myocardial ischaemia - LV failure

32
Q

What are the symptoms of aortic stenosis?

A

Long asymptomatic phase, life expectancy decreases when symptoms appear
Chest pain, syncope, dizziness, breathlessness on exertion and HF

33
Q

What can be seen on examination of patient with aortic stenosis?

A

Small volume pulse which is slow rising, JVP prominent if RH failure and low BP, vigorous and sustained apex beat, RV heave and less audible S2

34
Q

Describe the heart sound heard in aortic stenosis

A

S2 - less audible A2
Late peaking, loud at base, harsh and radiating to carotids

35
Q

What lab investigations are used in aortic stenosis?

A

ECG - LVH voltage criteria, ST/T changes showing LV strain
CXR - calcification
Cardiac catheterisation - peak LV aortic gradient

36
Q

What can be measured and seen on echo for aortic stenosis?

A

Demonstrates AV cusp mobility
LV function and hypertrophy
Doppler haemodynamic assessment of pressure gradient and aortic valve area

37
Q

Describe the medical and interventional treatment of aortic stenosis

A

Medical - if develop heart failure
Interventional - aortic valve replacement or repair

38
Q

Describe the aetiology of aortic regurgitation - aorta

A

Dilated aorta - Marfan’s, hypertension
Connective tissue disorder

39
Q

Describe the aetiology of aortic regurgitation - leaflets

A

Bicuspid aortic valve, rheumatic heart disease, endocarditis and myxomatous degeneration

40
Q

Describe the pathophysiology of aortic regurgitation

A

LV accommodates both SV and RegVol - increased LVEDV and LV systolic pressure - LV hypertrophy and LV dilatation
Causes increased MVO2 - myocardial ischaemia - LV failure

41
Q

What are the symptoms of chronic AR?

A

Long asymptomatic phase then exertional breathlessness

42
Q

What are the symptoms of acute AR?

A

Poorly tolerated as wall tension so cannot acutely adapt

43
Q

What can be seen on clinical examination of aortic regurgitation?

A

Pulse is large volume and collapsing, wide pulse pressure, hyperdynamic and displaced apex beat

44
Q

Describe the heart sound in aortic regurgitation

A

Normal S1 and S2
Early diastolic, decrescendo, soft murmur
Very quiet

45
Q

What are the lab investigations for AR?

A

ECG - ST/T changes for LV strain and LAD
CXR - cardiomegaly in chronic AR
Cardiac catheterisation

46
Q

What does Echo demonstrate in AR?

A

Demonstrates AV cusp anatomy (thickening, no of cusps and vegetations)
LV function, dilatation and hypertrophy
Doppler haemodynamic assessment of regurgitant flow

47
Q

What is the medical treatment and interventional treatment for AR?

A

Vasodilator therapy will delay timing for surgical intervention
Aortic valve replacement

Cardiovascular (33 decks)

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