Valvular heart disease Flashcards
What causes Rheumatic heart disease?
- immune response to M protein of S.pyogenes 2-3 weeks post-infection (Scarlet fever, pharyngitis)
Which group of people is rheumatic heart disease most common?
- children (6-15 yrs) of developing countries and NT
What are the clinical features of rheumatic heart disease?
Hint: major and minor criteria
Major criteria: “CASES”
- Carditis: tachy, murmur, pericardial rub, CCF, cardiomegaly, conduction defects
- Arthritis: migratory polyarthritis which affects larger joints
- Subcutaneous nodules
- Erythema marginatum
- Sydenham’s chorea
Minor criteria:
- fever
- raised ESR/CRP
- arthralgia
- prolonged PR interval
- previous rheumatic fever
What is the management for RHD?
- bed rest until CRP normal for 2 weeks
- benzyl penicillin IV then PO for 10 days
- analgesia for carditis and arthritis
What are the cardiac sequelae for RHD?
- mitral (70%)
- aortic (40%)
- tricuspid (10%)
- pulmonary (2%)
- incompetent lesions develop during the attack and stenotic lesions develop years later
Do incompetent lesions develop during the attack or years later in RHD?
- During the attack
- stenotic lesions develop years later
How long does an attack of rheumatic fever last?
- 3 months on average
In aortic regurgitation:
which chamber is affected?
what kind of load?
what is the effect?
- left ventricle
- volume
- eccentric hypertrophy
In mitral regurgitation:
which chamber is affected?
what kind of load?
what is the effect?
- left ventricle
- volume
- eccentric hypertrophy
In aortic stenosis:
which chamber is affected?
what kind of load?
what is the effect?
- left ventricle
- pressure
- concentric hypertrophy
In mitral stenosis:
which chamber is affected?
what kind of load?
what is the effect?
- left atrium
- pressure
- left atrial dilatation
With stenotic valve lesions when is it best to operate?
When symptoms appear, the hypertrophy will regress after surgery
With incompetent valve lesions when is it best to operate?
Before symptoms, as they coincide with irreversible changes in the left ventricle
What are some causes of aortic stenosis?
- calcific change
- congenital aortic stenosis/ born with bicuspid aortic valve (predisposes to stenosis)
- rheumatic fever
What are some symptoms of AS?
- asymptomatic while compensated
- SOB on exertion, angina and syncope
What are the signs of AS?
- murmur: ejection systolic crescendo-decrescendo murmur best heard over the upper right sternal edge
- may radiate to carotids
- carotid pulse has a slow upstroke (plateau)
- thrill over upper right sternal edge
- heaving apex