valvular heart disease Flashcards
mitral stenosis aetiology
calcification of the valves
rheumatic heart disease
congenital conditions
what is mitral stenosis
partial opening of the valves during diastole
is left ventricular function affected with mitral stenosis ?
LV pressures and systolic function normal
clinical manifestations of mitral stenosis
breathlessness from the pulmonary oedema
haemoptisis from the rupture of the tin walled veins.
embolisation from left atrium enlargement which results in stasis of blood which can lead to thrombus formation.
chest pain
hoarseness if there is compression of the l recurrent laryngeal nerve.
clinical examination of mitral stenosis
there is diastolic thrill
there is a right ventricular heave
tapping apex beat and a diastolic thrill
normal pulse
major cause of mitral stenosis
rheumatic fever
mitral regurgitation cause
dilated left ventricle with systolic heart failure
dilated cardiomyopathy)
mitral valve damage
infective endocarditis especially in drug users
mitral valve prolapse ( connective tissue disorder eg marfan`s syndrome )
rheumatic fever
aortic stenosis
partial opening of the aortic valve during systole
cause s of aortic stenosis
<70 years bicuspid aortic valve ( congenital)
>70 years calcification
aortic regurgitation
increase in blood flow from aorta to ventricle during diastole
aortic regurgitation aetiology
-anything that causes the dilatation of the aorta that is
1. aortic aneurysm
2.hypertension
3.connective tissue disorders
4.dilated aorta(Marfan`s syndrome)
5.tear of the aorta
-anything that causes damage of the leaflets
1.rheumatic disease ‘
2.endocarditis
3.bicuspid aortic valve
-anything that causes inflammation of the aorta
1.syphilis
2.takasubos myopathy
rheumatic fever
bacteria that causes strep throat there is release of plasma cells to counter these bacteria and the plasma cells destroy the valves that is mitral and aortic valves
what is are the effects of mitral stenosis
pulmonary oedema
dilatation of the left atria will cause atrial fibrillation
thrombus formation which leads to stroke etc .
what are the of mitral regurgitation
pulmonary oedema
with acute mitral regurgitation there is decreased cardiac output which can lead to cardiogenic shock
effects of aortic stenosis
reduced cardiac output and reduced systemic perfusion
cause syncope
may lead for myocardial ischemia
left ventricle pressure increase
left atrium enlargement
left ventricular hypertrophy
effects of aortic regurgitation
reduction of cardiac output , low bp , cardiogenic shock
pulmonary oedema
increased preload and increased pulses
clinical examinations of mitral stenosis
crepitations
normal pulse
jvp
thrills
rv heave
investigations for mitral stenosis
ecg
cardiac catheterisation
chest x.ray
cardiac mri
treatment for mitral stenosis
Diuretics and restriction of Na intake
AF: SR restoration or ventricular rate control
Anticoagulation: all those with AF, debatable in SR
mitral regurgitation clinical manifestations
pulmonary oedema
cardiogenic shock
breathlessness
can cause atrial fibrillation which is presented as palpitations
fatigue
exhaustion
right heart failure
clinical examination of mitral regurgitation
jvp increase
rv heave
crepitations on auscultations of the chest
there is a shifted apex beat .
mitral regurgitation sound
holosystolic sound that is loud at the apex
and radiates to the axilla
reduced s1 and split s2 early A2 and loud p2
mitral regurgitation investigations
ECG
CXR
cardiac catheterisation
echocardiography
cardiac mri
treatment of mitral regurgitation
Acute MR: preload and afterload reduction may be life-saving (sodium nitroprusside, dobutamine, IABP)
Chronic MR: lack of evidence that any therapy is beneficial for haemodynamic improvement, LV function preservation
