Valvular heart disease Flashcards
What are some valvular heart diseases
Aortic stenosis
Aortic regurgutation
Mitral regurgitation
Mitral stenosis
What is normal aortic valve area
3-4cm^2
I hen do symptoms of aortic stenosis develop
When valve is 1/4th normal valve area of normal
How would you investigate Aortic stenosis
echo
* looking for LV size and function, dilation and EF (determines severity of disease)
* Doppler derived gradient and valve area
how is aortic stenosis graded
- Based on normal aortic valve area (3-4cm squared)
- Mild: >1.5
- moderate: 1-1.5
- severe: 1
How do you manaage Aortic stenosis
General
* fastigious dental care
* consider infective endocarditis prophylaxis in dental procedures
Medical
* AV replacement, surgical/TAVI (TRANSCATHETER av IMPANTATION)
In aortic stenosis when would intervention be requires
- Any symotomsatic patienta with severe AS
- Any patient with decreasing EF
- Any patients undergoing CABG with mod-sev AS
Define Mitral regurgutation
Bsckflow of blood from left ventricle to left atrium during systole
what causes primary mitral regurgitation
FINNISH
what causes secondary mitral regurgiation
normal vavce architecture but impaire
FINNISH
what are the physical sign and symptoms of Mitral regurg
Ascultation: pansystolic murmur at apex radiativ to axila
breathlessness
How is Mitral regurgitation medicated
- Rate control for afib : B blockers, digoxin
- Anticoagulation in atrial fibrillation and flutter
- Nitrates / Diuretics in acute MR
- Chronic HF Rx if chronic MR with CCF
What interventions can be done in mitral regurg
- Surgical replcements and repairs
- Transcatheter edge to edge repair (TEER)
Define Aortic regurgutatoin
lelakature of blood in LV during diastole due to ineffective coaptation of the aortic cusps
Etiology of chronic aortic regurg
- Bicuspid aortic valve
- Rheumatic
- Infective endocarditis
What would you find on physical examination of aortic regurg
**wide pulse pressure **
hyperdynamic and displaced apical impulse
Ascultation: Diastolic blowing murmur - left sternal border
Systolic ejection murur - increased flow across aortic valce
what are the typical presentations of Aortic regurg
- Dyspnoea
- Palpitations: due to increased force of contraction and ectopics
how do you diagnose Aortic regurg
- Echo - Evaluation of the AV and aortic root with measurements of LV dimensions and function
- CXR (chest x ray) enlarged cardiac silhouette and aortic root enlargement
How do you manage aortic regurg
Define mitral stenosis
Obstruction of LV inflow that prevents proper filling during diastole
what is a normal mitral valve area
4-6cm squared
Discuss pathophysiology of Mitral stenosis
Progressive dyspnea
increase transmitral pressure
