Valvular heart disease Flashcards by Faith Taws

What structures are we looking for in the AV?

-3 semilunar crescent shaped cusps
-endothelium covering
-Nodules of arantius
-2.5-3.5 cm2 in area

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What does coaptation of valves mean?

-closure of valves

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When does the AV open?

-pressure in LV is higher than the aorta, valve opens, cusps are forced open and they run parallel to the sinus of Valsalva

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What determines the start of diastole?

-The mechanical closure of the AV

-Diastole is when blood is running into the coronary artery

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What is the annulus?

-incomplete ring of tissue that holds the valve in place
-allows movement of the valve during systole

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Describe chordae tendinae and papillary muscles in the MV

-CT are rope like structures connected to papillary muscles which are like lumps of myocardium, they contract to put tension on CT and they crossover so they aren’t only attached to the anterior or posterior leaflet.

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How many times does the MV open during diastole?

twice in one cardiac cycle

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Describe the E wave seen on the m mode during MV diastole

passive ventricular filling

-valve opens, blood in LA is sucked into LV and is pushing on the ventricular aspect of the leaflets, which pushes them up causing them to close

-blood pours in and shuts the valve

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Describe the A wave seen on the m mode during MV diastole

active ventricular filling

-atria are contracting

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What is the MV area?

4-6 cm2

-largest orifice in the heart

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What is the TV area?

21/2 -3 cm2

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What structure are we looking for in the PV?

-3 semi lunar crescent shaped cusps
-endothelial tissue covering the endocardium
-free end strengthened bi tendinous fibres with a nodule in the middle (cant always see the nodules)

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What does a doppler allow us to see?

-blood flow direction and velocity
-normal valve flow- 1m/s

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What are the types of valvular disease?

-stenosis
-regurgitation
-atresia/malformation

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What is atresia malformation?

-incorrect valve structure that has not formed properly during embryology- congenital defect

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What are some acquired aetiologies of valvular heart disease?

-degenerative
-infective endocarditis
-rheumatic fever
-secondary causes-MI,DCM,PPM

What is infective endocarditis?

-caused by staphylocorous bug that has invaded the valve and eats the valve destroying it

leads to a haemodynamically unstable patient

Name some congenital aetiology that can cause valvular heart disease

-Ebsteins
-TOF
-aortic stenosis
-pulmonary stenosis
-tricuspid atresia

What is Ebsteins?

TV is displaced closer to the apex and part of the RV forms part of the RA

What is TV atresia?

underdeveloped TV that results in hypoplastic right ventricle

What happens when a valve is stenosed?

-narrowing of the orifice
-increased velocity to try maintain a normal cardiac output

Describe some atresia’s of AS

normal

RF- stenosis at the commissures lead to less valve mobility as the valve is being restricted, increased velocity

Calcific- degenerative, thickening within the cusps restricting mobility

bicuspid-more oval shape during diastole, two cusps have become one- called a raphe

What happens to the afterload with AS?

-increases
-heart has to work harder to open the valve to maintain the cardiac output
-myocytes in the heart get bigger, they don’t proliferate

What is the normal SV when the heart contracts?

70 mils

What is voltage criteria for LVH?

3.5mV add the s wave in v1 and r wave in v5- over 3.5mV indicates LVH

What is the haemodynamic waveform?

-LV contacts forcing valve open -cusps are aligned with the aorta root -so the pressure in LV should be the same as the aorta because they are at one -shows us pressure gradient changes

Why do patients with MV stenosis get SOB?

-pressure increase travels down pulmonary veins and then pulmonary capillaries and gets to the lungs. Fluid is forced out into alveoli, they become waterlogged so they become stiff and non compliant

What is the prime site for a thrombus if it occurs due to MV stenosis?

left atrial appendage

What is a MV prolapse (MVP) ?

-leaflets should buldge into the LA and coap but in MVP the chordinae tendinae have been damaged and stretched so when the heart contracts the posterior leaflet is going into the LA where it should stay level with the annulus

What is functional MV regurgitation?

-LV become dilated, pulls the valve apart so it fails to coapt -caused by structural problems

What is a cardiomegaly heart?

-big heart -big shape on chest x-ray and they measure cardiac silhouette against thoracic silhouette and if its over 50% your patient is cardiomegalic

What are some clinical manifestation symptoms of Valvular heart disease that a patient may present with?

-SOB -fatigue -reduced exercise capacity -syncope -chest pain and arrhythmias -thromboembolism -fever

What are some clinical manifestation signs of Valvular heart disease that a patient may present with?

-murmur -clubbing -splinter haemorrhages -peripheral cyanosis -ECG hypertrophy -cardiomegaly/heart failure -raised JVP -oedema (pitting, or in sacral regions in immobile patients)

What is a patent ductus arteriosus murmur?

a machinery murmur that occurs throughout the whole cardiac cycle - its the only murmur that does this

How can you treat valvular heart disease?

-replace the valve (prosthetic valves, tissue valves, mechanical valves) -bileaflet valve/bidisk valve needs anticoagulants, there is a risk of thrombus formation where the hinges are opening and closing. They have washing jets now to deliberately make the valves leak at the hinges -repair- valvuloplasty, innoui balloon, forcing leaflets open TAVI-transaortic valve implant or insertion, the old valve isn't removed, the TAVI is placed over the top of the old valve

What does CABG stand for?

Coronary artery bypass graphing