Valvular Heart Disease Flashcards
Name some of the pathological mechanisms that can affect the apparatus/annulus of the valves
Annular dilatation,
Annular calcification,
Apparatus thickening, tethering or rupture,
Regional wall motion abnormality
What can occur as a result of aortic stenosis/regurgitation
Stenosis - Increased left ventricular cavity pressure, and pressure overload leading to left ventricular hypertrophy.
Regurgitation - Volume overload leading to left ventricular dilitation.
What are the causes of aortic stenosis?
- Degenerative calcification,
- Bicuspid aortic valve,
- William’s syndrome (supravalvular aortic stenosis)
- Post-rheumatic disease
- Subvalvular - HOCM
What are the symptoms of aortic stenosis?
SAD
- Syncope,
- Angina,
- Dyspnoea,
- Palpitations,
- Pre-syncope,
- LV heart failure symptom’s
- Ejection systolic mumur which radiates to carotids and decreases following valsalva.
What are features of severe aortic stenosis?
- Narrow pulse pressure,
- Slow rising pulse,
- Delayed ejection systolic murmur,
- Soft or abscent S2.
- S4,
- Thril
- Left ventricular hypertophy
- Duration of murmur
What are the investigations for aortic stenosis?
- ECG (LVH)
- ECHO (definitive diagnosis)
- Exercise testing,
- Cardiac MRI
what is the conservative management for aortic stenosis?
If patient is asymptomatic. Should receive regular ECHOs
WHat is the medical management of aortic stenosis?
- Management of left venticular heart failure with diuretics and heart failure meds.
When is surgical management indicated for aortic stenosis?
- All symptomatic patients.
- Asymptomatic patients with LVEJ < 50%
- Asymptomatic but valvular gradient > 40mmHg with features of dysfunction
What are the surgical options for aortic stenosis?
- Surgical replacement of valve (for young/low risk patients)
- Transcatheter AVR (TAVR) for high risk patients
- Balloon valvuloplasty (children with no calcification or adults who are not fir for replacement)
What is aortic sclerosis?
Asymptomatic condition caused by age related degeneration of the valve.
Has ejection systolic murmur which does NOT radiate to carotids
What are the acute causes of aortic regurgitation?
- Infective endocarditis (most common)
- Aortic dissection,
- Traumatic rupture of valve leaflets,
- Iatrogenic
What are the causes of chronic aortic regurgitation?
- Rheumatic heart disease
- Age related calcification
- Congenital bicuspid aortic valve,
- Connective tissue disorders (marfan’s or Ehler’s danlos)
- IE
- Rheumatological conditions: rheumatic heart disease, ankolysing spondylitis, APLS, giant cell arteritis
What are the symptoms of acute and chronic aortic regurgitation?
Acute - Sudden cardiovascular collapse with acute pulmonary oedema
Chronic - Slower onset of exertional dyspnoea, orthopnea and PND and stable angina
What are the features of aortic reguritation?
- Early diastolic murmur.
- Soft S1
- Collapsing pulse,
- Wide pulse pressure,
- Quinkie’s sign (nail bed pulsation)
- Demusset’s sign (head bobbing)
- corrigan’s - Carotid pulsation
- Muller’s sign (Uvula pulsation)
What are the investigations for aortic regurg?
- ECG,
- Inflammatory markers and blood cultures (IE)
- TTE for definitive diagnosis. Can also use cardiac MRI
What is the medical management of aortic regurgitation?
- Mild can be monitored.
- Medical management is used to slow rate of aortic root dilation in high risk patients. This involves using beta blockers +/- losartan to lower BP
What are the indications for surgical management of aortic regurg?
- Symptomatic AR,
- Asymptomatic AR with poor LVEF, LV diastolic diameter >70mm or end-systolic dimeter >50mm
- Infective endocarditis refractory to medical treatment
- Significant enlargement of ascending aorta
symptomatic or asymptomatic with LVSD
What are the causes of acute mitral regurgitation?
- Ischaemic MR caused by papillary muscle rupture
- Ruptured chorae tendinae due to mitral prolapse, IE, rheumatic HD, trauma, spontaneous rupture
- Prosthetic valves
What are the causes of chronic MR?
- Mitral valve prolapse,
- Degenerative changes,
- Rheumatic fever,
- Connective tissue disorders,
- Systemic inflammatory disorders
- Hypertrophic or dilated cardiomyopathy
What are the symptoms of acute and chronic MR?
Sudden onset of:
- SOB,
- Exertional dyspnoea,
- Fatigue,
- Weakness,
- Pulmonary oedema
Chronic - fatigue and exertional dyspnoea
What are the signs of MR?
- Blowing pansystolic murmur,
- S1 may be quiet or abscent
What is the management of MR?
Definitive management - surgery. Either Mitral valve repair (preferred method) or mechanical valve
What can occur due to mitral regurgitation
Volume overload which can lead to left atrial and ventricular dilitation. This can can lead to atrial fibrillation, pulmonary hypertension and secondary right heart failure
