Valvular Heart Disease Flashcards
Cause of mitral stenosis?
Rheumatic Heart Disease
Congenital
Lupus and rheumatoid arthritis
What happens in mitral stenosis?
AV pressure gradient increases
Left atrial pressure increases
Pulmonary venous and capillaries pressures increase
Pulmonary hypertension develops
Leads to right heart dilatation
LV systolic function normal
What are the symptoms/manifestations of mitral stenosis?
SOB (exertional)
Heamoptysis
Systemic embolisation
Palpitations
Hoarseness
Chest pain
Infective endocarditis
Mitral stenosis examination findings?
JVP - prominent a wave
Tapping apex beat
Mitral facies
RV heave
Normal pulse
Diastolic murmur:
Rumbling at apex
Mitral stenosis investigations and ECG findings?
ECG:
Broad notched p wave
RV hypertrophy
CXR:
LA enlargement
Echo cardiac mri may show vegetations
Mitral Stenosis medical treatment?
Diuretics and restricted Na intake
Anticoagulants for those with af
Mitral Regurgitation pathology?
Rheumatic heart disease
Mitral valve prolapse
Infective endocarditis
Degeneration
MR pathophysiology?
LV compensation:
Acute - end systolic pressure and volume decrease, wall tension decreases
Chronic - EDV, ESV return to normal, lvh develops
MR clinical manifestations?
Acute: sob, oedema, cardiogenic shock
Chronic: fatigue, rh failure, dyspnoea or palpitations from afib
MR examination findings?
Normal pulse
JVP is prominent if RH failure present
Brisk apex beat
Heave
Auscultation:
reduced S1
Systolic murmur at apex radiates to axilla, best when patient exhales and rolls to the left
MR treatment?
Acute: na nitroprusside, IABP, dobutamine to reduce preload and afterload
Aortic stenosis causes?
RHD
Degeneration
Bicuspid
AS examination findings?
Pulse - small and slowly rising
JVP prominent if RH failure
Vigorous apex beat
Heave
Ejection systolic murmur transmitted to the carotids
AS ECG findings?
ECG can show evidence of LV hypertrophy
Increased QRS voltage
AS pathophysiology?
Increased LV pressure
Increased LV size
Myocardial ischaemia
AS symptoms?
Long asymptomatic phase
Chest pain
Dizziness
Sob on exertion
Heart failure
As treatment?
Limited to those with heart failure
Causes of aortic regurgitation?
Dilated aorta (marfans, hypertension)
Connective tissue disorders
Bicuspid aortic valve
RHD
Endocarditis
Myxomatous degeneration
AR pathophysiology?
LV hypertrophy and dilatation
Myocardial ischaemia and LV failure
AR symptoms?
Chronic AR: breathlessness
AR examination findings?
Collapsing pulse
Diastolic murmur in aortic area
AR investigations?
ECG
ST changes (LV strain and left anterior descending)
CXR
Cardiomégalie in chronic AR
Echocardiography
AR medical treatment?
Vasodilator de,aus timing for surgical intervention
