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Phase 4 - Cardiology > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

Name some of the pathological mechanisms that can affect the apparatus/annulus of the valves

A

Annular dilatation,
Annular calcification,
Apparatus thickening, tethering or rupture,
Regional wall motion abnormality

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2
Q

What can occur as a result of aortic stenosis/regurgitation

A

Stenosis - Increased left ventricular cavity pressure, and pressure overload leading to left ventricular hypertrophy.
Regurgitation - Volume overload leading to left ventricular dilitation.

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3
Q

What are the causes of aortic stenosis?

A
  • Degenerative calcification,
  • Bicuspid aortic valve,
  • William’s syndrome (supravalvular aortic stenosis)
  • Post-rheumatic disease
  • Subvalvular - HOCM
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4
Q

What are the symptoms of aortic stenosis?

A

SAD
- Syncope,
- Angina,
- Dyspnoea,
- Palpitations,
- Pre-syncope,
- LV heart failure symptom’s
- Ejection systolic mumur which radiates to carotids and decreases following valsalva.

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5
Q

What are features of severe aortic stenosis?

A
  • Narrow pulse pressure,
  • Slow rising pulse,
  • Delayed ejection systolic murmur,
  • Soft or abscent S2.
  • S4,
  • Thril
  • Left ventricular hypertophy
  • Duration of murmur
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6
Q

What are the investigations for aortic stenosis?

A
  • ECG (LVH)
  • ECHO (definitive diagnosis)
  • Exercise testing,
  • Cardiac MRI
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7
Q

what is the conservative management for aortic stenosis?

A

If patient is asymptomatic. Should receive regular ECHOs

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8
Q

WHat is the medical management of aortic stenosis?

A
  • Management of left venticular heart failure with diuretics and heart failure meds.
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9
Q

When is surgical management indicated for aortic stenosis?

A
  • All symptomatic patients.
  • Asymptomatic patients with LVEJ < 50%
  • Asymptomatic but valvular gradient > 40mmHg with features of dysfunction
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10
Q

What are the surgical options for aortic stenosis?

A
  • 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)
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11
Q

What is aortic sclerosis?

A

Asymptomatic condition caused by age related degeneration of the valve.
Has ejection systolic murmur which does NOT radiate to carotids

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12
Q

What are the acute causes of aortic regurgitation?

A
  • Infective endocarditis (most common)
  • Aortic dissection,
  • Traumatic rupture of valve leaflets,
  • Iatrogenic
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13
Q

What are the causes of chronic aortic regurgitation?

A
  • 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
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14
Q

What are the symptoms of acute and chronic aortic regurgitation?

A

Acute - Sudden cardiovascular collapse with acute pulmonary oedema
Chronic - Slower onset of exertional dyspnoea, orthopnea and PND and stable angina

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15
Q

What are the features of aortic reguritation?

A
  • 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)
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16
Q

What are the investigations for aortic regurg?

A
  • ECG,
  • Inflammatory markers and blood cultures (IE)
  • TTE for definitive diagnosis. Can also use cardiac MRI
17
Q

What is the medical management of aortic regurgitation?

A
  • 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
18
Q

What are the indications for surgical management of aortic regurg?

A
  • 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

19
Q

What are the causes of acute mitral regurgitation?

A
  • Ischaemic MR caused by papillary muscle rupture
  • Ruptured chorae tendinae due to mitral prolapse, IE, rheumatic HD, trauma, spontaneous rupture
  • Prosthetic valves
20
Q

What are the causes of chronic MR?

A
  • Mitral valve prolapse,
  • Degenerative changes,
  • Rheumatic fever,
  • Connective tissue disorders,
  • Systemic inflammatory disorders
  • Hypertrophic or dilated cardiomyopathy
21
Q

What are the symptoms of acute and chronic MR?

A

Sudden onset of:
- SOB,
- Exertional dyspnoea,
- Fatigue,
- Weakness,
- Pulmonary oedema
Chronic - fatigue and exertional dyspnoea

22
Q

What are the signs of MR?

A
  • Blowing pansystolic murmur,
  • S1 may be quiet or abscent
23
Q

What is the management of MR?

A

Definitive management - surgery. Either Mitral valve repair (preferred method) or mechanical valve

24
Q

What can occur due to mitral regurgitation

A

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

25
Q

What are the causes of mitral stenosis?

A

RHEUMATIC HEART DISEASE.
Or Infective Endocarditis

26
Q

What are the symptoms of MS?

A
  • Dyspnoea (increase in left atrial pressure can cause pulmonary venous hypertension)
  • Haemoptysis (range from pink frothy sputum to sudden haemorrhage)
  • Malar flush,
  • Atrial fibrillation
27
Q

What are the signs of MS?

A
  • Mid-diastolic murmur,
  • LOUD s1
  • Opening snap (indicates valves are still mobile)
  • In severe MS the length of murmur increases and opening snap becomes closer to S”
28
Q

What are the investigations for MS?

A
  • ECHO which can show reduced cross-sectional area of mitral valve <4 sq cm.
  • Chest x ray may show left atrial enlargement
29
Q

What is the management of mitral stenosis?

A

Asymptomatic - monitor
Symptomatic - Percutaneous mitral balloon valvulotomy or mitral valve surgery
AF - Warfarin

30
Q

When is anticoagulants required in patients with bioprosthetic valves and metal vavles?

A

Aortic bioprosthetic valve in sinus rhythm - None required
Aortic bioprosthetic valve in AF - Give anticoagulation
Mitral bioprosthetic valve - INR of 2.5 for first 3 months
Aortic metalic valve - INR of 3.0
Mitral metalic valve - INR of 3.5

31
Q

What is mitral valve prolapse?

A

When mitral valve leaflets bulge into left atrium. Can be caused by primary degeneration or secondary to a connective tissue disorder.
Monitor for MR

Phase 4 - Cardiology (15 decks)

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