Valvular Heart Disease Flashcards
What is rheumatic heart disease?
inflammatory disease
caused by strep progenies
inflammation and scarring triggered by autoimmune reaction to infection
leads to mitral stenosis/ mitral regurgitation
Define mitral prolapse
> 2mm systolic prop lapse of 1 or both leaflets beyond long axis annular plane during 2DE
Identify the pathology of mitral prolapse
histologically normal valves
myxomatous degeneration
Marfan / Ehlers danlos
What happens in mitral valve prolapse?
valve leaflets are floppy so they bow back into the left atrium during systole
sometimes produces mitral regurgitation
What are the symptoms of mitral prolapse?
asymptomatic
can be associated with chest pains and arythmias
What is the treatment of mitral prolapse?
antibiotic prophylaxis
What are the signs of mitral prolapse?
ejection click
late systolic murmur
What are the causes of aortic stenosis?
calcific disease
congenital bicuspid aortic valve
rheumatic heart disease
What are the symptoms of aortic stenosis?
dyspnea angina syncope left ventricular failure sudden death
How does aortic stenosis lead to dyspnea?
increased diastolic pressure in stiff non compliant left ventricle
What are the signs of aortic stenosis?
slow rising carotid pulse
S4
ejection click
EJECTION SYSTOLIC MURMUR
What are the investigations for aortic stenosis?
ECG
Lateral CXR
Echo
What pressure signals are seen in aortic stenosis?
severe pressure gradient across aortic valve
increased left ventricle pressure than aortic pressure
prominent ‘a’ wave
What are the indications for surgery in aortic stenosis?
any symptoms of aortic stenosis
echo showing evidence of worsening left ventricle dilation
peak systolic pressure gradient > 50mmHg
if patient is too sick do TAVI
What is aortic regurgitation?
blood leaks black into left ventricle from aorta during diastole
pressure in aorta is not maintained
therefore, left ventricular filling has 2 sources: left atrium and aorta
Starling’s Law means that there is an increased systolic pressure but drops quickly when the valve closes
What are the causes of aortic regurgitation?
Aortic valve leaflet disease: calcific disease, rheumatic disease, infective endocarditis, congenital bicuspid valve
Aortic root dilating disease: aortic dissection, ankylosing spondylitis, Marfan’s syndrome
What are the symptoms of aortic regurgitation?
often none
angina - increased O2 demand for hypertrophied left ventricle
dyspnea - contractile failure as ventricle dilates
What are the signs of aortic regurgitation?
rapidly rising pulse - vigorous ejection of volume loaded left ventricle
early diastolic murmur - aortic back flow (left sternal edge)
ejection murmur- turbulent ejection from volume loaded left ventricle (left sternal edge)
What is mitral stenosis?
narrowed mortal valve leads to problems in left ventricular filling
What are the causes of mitral stenosis?
rheumatic disease
What are the symptoms of mitral stenosis?
dyspnoea - increased left atrial pressure leads to increased pressure in pulmonary circulation
RV failure - consequence of increase left atrial pressure and pulmonary vasoconstriction
Palpitations - AF
Systemic emboli - pooling of blood in atria due to AF. static blood within dilated fibrillating left atrium predisposes to thrombosis
What are the signs of mitral stenosis?
irregularly irregular pulse due to AF loud S1 - closure of stenotic mitral valve opening snap of valve MID DIASTOLIC MURMUR elevated JVP basal crepitations ankle oedema
What are the investigations for mitral stenosis?
ECG - huge P waves due to left atrial enlargement
Echo
X ray - blunted left border (left atrial bulge)
Valvuloplasty - fixes pressure gradient in left atria and left ventricle
What are the causes of mitral regurgitation?
mitral valve leaflet disease: mitral valve prolapse, rheumatic heart disease, infective endocarditis
subvalvar disease: chordal rupture, papillary muscle dysfunction, papillary muscle rupture
functional mitral regurgitation - left ventricle dilation
What is mitral regurgitation?
blood leaks back into left atrium during systole
leads to increased pressure in left atrium
What are the symptoms of mitral regurgitation?
dyspnea
orthopnea
palpitations - AF
systemic emboli
What are the signs of mitral regurgitation?
pulse - sinus rhythm, atrial fibrillation
pansystolic murmur
S3 - increased atrial pressure leads to rapid ventricular filling when valve opens
elevated JVP
basal crepitations
ankle oedema
What are the investigations for mitral regurgitation?
echocardiogram
angiogram
What are the indications for surgery of mitral valve disease?
symptoms don’t respond to medical treatment
worsening CVS complications e.g pulmonary hypertension (MS) and LV dilation (MR)
for patients too sick for surgery - mitraclip (percutaneous stitch across valve leaflets and pull them together to get less regurgitation)
What are the medical treatments for valvular heart disease?
Diuretics
Vasodilators -low forward output due to regurgitant valve lesion
Digoxin, beta blockers, verapramil to help treat AF
propyhlaxis - anticoagulants and antibiotics
