Valvular Heart Disease Flashcards
Ventricular anatomy and hemodynamic response to aortic stenosis
- Ventricular anatomy: aortic valve becomes fused, narrow and unable to open under normal pressures.
- Hemodynamic response: ↑end diastolic pressure ↑systolic pressure, ↓aortic diastolic pressure.
Ventricular anatomy and hemodynamic response to aortic regurgitation (insufficiency)
- Ventricular anatomy: aortic valve can not close properly to allow the build up of pressure during diastole. Vegetation may be present and causing the destruction of the valve.
- Hemodynamic response: ↑stroke volume, ↑pulse pressure,↓ aortic diastolic pressure (blood leaks back)
Causes, signs, symptoms of aortic stenosis
- Causes: bicuspid aortic valve (most common congenital heart disease), senile aortic stenosis, rheumatic heart disease
- Symptoms
- Dyspnea on exertion
- Syncope
- Angina (hypertrophy, ↑systolic pressure, ↓aortic diastolic pressure, ↑end diastolic pressure)
- Signs:
- systolic ejection murmur
- abnormal heart sounds
- Possible LV and RV failure
Qualities of heart murmur associated w/aortic stenosis
- Ejection + thrill (diamond or crescendo-decrescendo)
- Peaks later as stenosis becomes more severe.
- Radiates to neck.
Abnormal heart sounds in aortic stenosis
- S2: becomes softer as valve becomes more immobile and if myocardium deteriorates.
- Opening: sudden forceful valve opening or high pressure jet hitting aorta
- S4: LVH
- S3: if ventricle fails.
Signs/symptoms of L/R HF w/aortic stenosis
- If LV fails: narrow pulse pressure, peripheral vasoconstriction, rales, S3
- If RV fails too: ↑JVP, peripheral edema.
Cause, hemodynamic effects, signs/symptoms of aortic regurgitation
- Cause:
- Aortic leaflet disease: bicuspid valve disease, rheumatic heart disease, endocarditis.
- Aortic root disease: aortic aneurysm/dissection, marfan’s syndrome, syphilis.
- Hemodynamic effects: low aortic diastolic pressure, large stroke volume, high pulse pressure.
- Symptoms: well tolerated, symptoms of heart failure only after years.
- Signs: wide pulse pressure bounding (waterhammer) pulses, capillary pulses (quinke), diastolic decrescendo murmur (turbulence), displaced vigorous LV apex impulse.
Cause, hemodynamic effects, signs/symptoms of mitral stenosis
- Cause: rheumatic heart disease (4:1 in females)
- Hemodynamic effects: obstruction of flow from left atrium to left ventricle→↑LA pressure↑PA and RV pressure.
- Symptoms:
-
↑ Left atrial and pulmonary capillary pressures: dyspnea, cough, pulmonary edema - RV failure: ↑elevated jugular venous pressure, edema.
-
- Signs:
- Diastolic murmur: heard best in left lateral decubitus, soft, accentuated when flow is greatest; loud S1; opening snap (as mitral valve gets more severe).
- CXR: signs of ↑LA pressure→LA enlargement, Kerley B-lines and heart failure, pulmonary artery enlargement.
Characteristics of bicuspid valve disease
- common congenital heart defect
- increased risk for aortic stenosis, aortic insufficiency, endocarditis, and vascular complications
- should be monitored routinely via echo
Signs of aortic regurgitation
CXR findings in aortic stenosis, mitral stenosis
- Aortic stenosis: post-stenotic dilation of aorta, enlarged LA and LV if failure occurs.
- Aortic regurgitation: LV enlargement, dilated aorta.
- Mitral stenosis: signs of elevated LA pressure—LA enlargement, Kerley B-lines and heart failure, pulmonary artery enlargement.
ECG findings in aortic stenosis, mitral stenosis
- Aortic stenosis: LVH, occasionally L or R Bundle Branch Block.
- Aortic regurgitation: LV enlargement, dilated aorta
- Mitral stenosis: left atrial enlargment, RVH
Echo findings in aortic stenosis, aortic regurgitation, mitral stenosis
- Aortic stenosis: abnormal valve structure, ventricular hypertrophy, dilated aorta, pressure gradient, aortic valve area.
- Aortic regurgitation: valve or root pathology, ventricular enlargement, amount of aortic insuffiency.
- Mitral stenosis: abnormal valve, pulmonary pressures, mitral valve area.
General course of aortic stenosis
- can occur early in life due to a congenital malformation (bicuspid aortic valve) or late in life (senilar aortic stenosis, or somewhere in between (rheumatic heart disease).
- Good health and youth can mask the symptoms making younger people more at risk for sudden death.
- After the onset of symptoms however, there is a sharp decrease in survival, thus, treatment and therapeutic interventions should take place right away
General course of aortic regurgitation
- generally well tolerated until symptoms of heart failure appear (generally takes years).
- quick response to treat the ventricular hypertrophy associated with aortic insufficiency via replacement of the valve can result in the ventricle returning back to its near normal state.
Characteristics of tricuspid valve disease
Tricuspid Regurgitation is almost always secondary to Right heart failure or
pulmonary Hypertension
Primary Tricuspid Valve disease is rare
– Congenital heart disease
– Endocarditis
– Carcinoid
– Rheumatic (less common than mitral valve)
