Valvular heart disease Flashcards
Describe the anatomy of the mitral valve
Mitral- Located between the left atrium and left ventricle. It has two leaflets, anterior & posterior leaflets, chord tendineae attached to leaflets. Annulus (incomplete ring of tissue) holds the valve in place and enable valve movement during systole, anterolateral & posterior medial papillary muscles attach to chord tendineae. When the pressure drops in the LV within pressure of LA the valve is opened, (passive ventricular filling), blood is pushed in LV from LA, pushes leaflets causing closing of the valve as the blood enters. 4-6cm squared in size
Describe the anatomy of the tricuspid valve
Located between the right atrium and right ventricle. It has three leaflets, anterior, septal (small) & posterior leaflet, has a smaller Valsalva of 3.5cm2. it also has an annulus to support valve. Right side runs on lower pressure (pulmonary circulation)
Describe the anatomy of the aortic valve
Located between the left ventricle and the aorta. It has three cusps (semilunar leaflets). It’s got nodules of around on the free margins, normal valve area about 2.5 to 3.5 centimetres. Where the valve closes and touches its free margins is known as a commissure, mechanical closure of AV valve determines diastole.
Describe the anatomy of the pulmonary valve
Located between the right ventricle and the pulmonary artery. It also has three crescent shaped cusps.
Define the annulus
An incomplete ring of tissue that holds the valve in place
Define the sinus of valsalva
The sinus of Valsalva refers to the dilated portion of the aortic root located just above the aortic valve. These sinuses are small, pocket-like expansions in the aorta, which play a role in the normal functioning of the aortic valve and the overall dynamics of the heart
Define the Doppler flow
Doppler flow refers to the use of Doppler ultrasound to measure and assess the flow of blood within the blood vessels or heart. The technique is based on the Doppler effect.
If the blood is moving toward the ultrasound probe, the frequency of the reflected sound increases (positive shift), and if the blood is moving away from the probe, the frequency decreases (negative shift). Doppler flow is frequently used to assess heart valves (e.g., detecting mitral regurgitation, aortic stenosis), measure pulmonary artery pressure, and examine shunts or vascular diseases.
Define regurgitation, it’s causes and effects
Definition: occurs when a valve does not close properly so blood leaks backwards into prior chamber, backflow can happen in any valve.
Cause: It can result in valve prolapse or structural damage to the valve
Effect: It can lead to volume overload in affected chamber, increases afterload resulting in SOB, fatigue & oedema
Define stenosis, it’s causes and effects
Definitions: narrowing or stiffening of a valve which restricts blood flow. It can any of the 4 valves, MV & AV most affected.
Cause: stenosis is caused by thickening or calcification of valve leaflets, occurs due to ageing, congenital defects or inflammatory diseases
Effects: Narrowed valve requires the heart to work harder, leading to an increased afterload, it can cause angina, SOB & fatigue
Define Atresia , it’s causes and effects
Definitions: a congenital defect that results in an absence or malformation of a heart valve, normally affects PV or AV. Results in blood not being able to flow at all
Cause: Present at birth, The development of the heart valve is abnormal during fetal growth, leading to complete or near-complete blockage of the valve.
Effects: leads to impaired circulation, it needs other pathways to maintain blood flow e.g., abnormal shunts.
This condition often needs surgery to correct blood flow
What are the etiology (origins) of valvular disease
Degenerative
Infective endocarditis
Rheumatic fever
Secondary causes e.g., MI
Name congenital conditions
- aortic stenosis
- pulmonary stenosis
- tricuspid atresia
- ebsteins
- tetralogy of fallot
Define aortic stenosis, it’s causes & symptoms
AV valve becomes narrowed or stiffens, restricting blood flow from LV to A. this leads to an increase in LV pressure and afterload, this can result in LV hypertrophy. If left untreated increased workload can result in heart failure
Symptoms: angina, SOB, synocope, heart murmur & palpitations, it can also be mild and present no noticeable symptoms.
Cause: It can be caused by congenital heart defect, age-related degeneration & rheumatic fever.
Define pulmonary stenosis, it’s causes & symptoms
A congenital heart defect in which PV stiffens & narrows which restricts the blood flow to the lungs. This results in an increased afterload & RV hypertrophy which can lead to right-sided heart failure
Symptoms: mild PS indicates no symptoms, moderate-severe shows SOB, fatigue, angina, syncope & murmur
Cause: congenital, rheumatic fever or carcinoid syndrome,
Define tricuspid atresia, it’s causes and symptoms
A congenital defect in which the tricuspid valve is either absent or malformed, this causes backflow, RV tends to be underdeveloped and blood must find a different route to the lungs.
It normally bypasses the RV through the ventricular septal defect or atrial septal defect.
Symptoms: Cyanosis, SOB, fatigue, poor feeding in infants, slow growth & heart murmur
Causes: congenital or genetic causes e.g., downs syndrome
Define tetralogy of Fallot, it’s causes and symptoms
A congenital heart defect that consists of 4 heart related abnormalities that occur together, leads to less oxygen being pumped in systemic circulation.
he four components are pulmonary stenosis, ventricular septal defect, overriding aorta & right ventricular hypertrophy.
causes: congenital
Symptoms: SOB, cyanosis, finger clubbing, murmur & fainting
Define ebsteins, it’s causes and symptoms
A rare congenital defect that affects right-side of the heart. RV may also be undeveloped making it less effective at pumping blood that can lead to a decrease in blood flow to the lungs and cause low oxygen levels in the body.
The tricuspid valve is displaced downward into the right ventricle, a condition referred to as “apical displacement”. This means the valve is positioned lower than usual. The valve leaflets may be malformed or have defects, leading to improper closure. This causes tricuspid regurgitation, blood leaks backwards towards RA
causes: can be genetic e.g., Wolf-Hirschhorn syndrome or trisomy 21 (Down syndrome).
Symptoms: SOB, Fatigue, cyanosis, oedema in limbs& palpitations
Describe the use of a P.E in diagnosing valvular disease
can identify heart murmurs & indications of heart failure. Hearing a mumur using the auscultation method can help identify a valvular issue.
Describe the use of a TTE in diagnosing valvular disease
Non-invasive imaging uses sound waves to create real-time images of the heart, used to evaluate valvular function & structure, It Measures the size of the heart chambers, blood flow across valves, and estimates the severity of the valve disorder.
Describe the use of a TEE in diagnosing valvular disease
Involves a probe in the oesophagus to obtain high quality images of the heart valves, It’s used for assessing valvular stenosis, regurgitation, and endocarditis. TEE provides a closer view of the mitral and aortic valves.
Describe the use of a chest x-ray in diagnosing valvular disease
Helps assess the size & shape of the heart, it can identify valvular disease & enlargement of the heart & other signs of valvular dysfunction
Describe the use of a doppler echo in diagnosing valvular disease
A special ultrasound used to measure the velocity of blood flow across heart valves, helps to assess severity of stenosis & regurgitation
Describe the signs (see, hear, touch) associated with valvular disease
Mumur
Clubbing of nails/fingers
Peripheral Cyanosis
Splinter hemorrhages
ECG-hypertrophy
Raised JVP
Heart failure
oedema
Describe the symptoms associated with valvular disease
SOB
Fatigue
Reduced exercise capacity
Syncope
Chest pain & arrythmias
Thromboembolism
Fever
