Valvular Heart disease Flashcards
1
Q
Anatomy of the valves
A
- tricuspid valve - Located between the right atrium and the right ventrile
- Pulmonary valve- Located between the right ventrcile and the pulmonary artery
- Mitral valve- Located bettwen teh LA and LV
- Aortic valve - Located between the LV and the aorta
Atrioventricular (AV) valves - Mitral (biscuspid) and tricuspid calve
Semi-lunar valves - aortic valve and pulmonary valve
Mitral and aortic- left heart
Pulmonary and tricuspid are in the right heart
2
Q
Aortic stenosis definition
A
Narrowing of the aortic valve producing turbulent blood flow. Obstruction of blood flow across the aortic valve.
3
Q
Classfication of aortic stenosis
A
4
Q
Aortic stenosis Clinical features
A
- Patients often asymptomatic
- elderly patient with chest pain
- SAD
- Syncope
- Angina - increased myocardial work
- Dyspnoea
5
Q
Pathophysiology of aortic stenosis
A
- LV outflow obstruction
- results in Increased LV pressure
- LV hypertrophy and more vigorous and prolonged contraction to overcome obstruction and maintain cardiac output
- myocardial oxygen demand is increased
- As systole is prolonged, diastole is shortened and therefore myocardial blood suuply from the coronary arteries is reduced
6
Q
Causes of aortic stenosis
A
- congenital e.g Bicuspid aortic valve (most common in younger patients), Williams sundrome (supravalvular aortic stenosis)
- degenerative calcification (most common in older patients)
- post rhuematic disease
- subvalvular HOCM
7
Q
Features of Aortic stenosis
A
- Low pitched ejection systolic murum best heard in aortic area that radiates to the carotids
- thrills (palpable murmur)
- Narrow pulse pressure
- anacrotic - slow rising pulse
- Heaving non displaced apex beat
8
Q
Investigations of aortic stenosis
A
- ECG:
- LVH,
- LBBB
- Poor wave progression
- Echocardiography: valve area <1.5cm
- diagnostic
- colour doppler signals show high velocity
- CXR:
- LVH
- Aortic valve calcification,
- cathetherism: accurate measure of aortic stenosis
9
Q
Management of aortic stenosis
A
- is asymptomatic then observe patient as a rule
- if symptomatic then surgery (AVR) or TAVI
- is asymptomatic but valvular gradient >50 mmHg and with features such as LV systolic dysfunction then consider surgery
- balloon valvuloplasty is limited to patientd with critical aortic stenosis who are not fit for valve replacement
- medical management is only symptomatic
10
Q
Aortic regurgitation definition
A
Aortic regurgitaition is the diastolic flow of blood from the aorta into the left ventricle
11
Q
Pathophysiology of aortic regurgitation
A
- regurgitation of blood back into the LV after each systole
- results in an increased end-diastolic volume and increased SV
- LV works harder and become hypertrophied
- If AR worsens the LV may not be able to compensate and LVF will result
- situation worses resulting in congestion
- backpressure from the LV may also cause pulmonary hypertension and RVF
12
Q
Causes of Aortic regurgitation
A
- valvular
- rhuematic
- infective endocarditis
- connective tissue disease e.g RA/S:E
- bicuspid aortic valve
- aortic
- aortic dissection
- sponyli-arthropathies
- hypertension
- sphyllis
- marfans
13
Q
Features of AR
A
- early diastolic murmur, best heard in the tricuspid area, with the patient sitting forwards and breath held in expiration
- collpasing pulse (waterhammer) - increased stroke volume and rapid run of blood back into ventricle
- wide pulse pressure
- downward and laterally displaced apex beat which is thrusting in nature
- Mussets - head bobbing with each beat)
- Corrigan (prominent pulsation in neck)
- quincke sign (visible capullary pulsation in the nail bed)
- mid-diastolic austin-flint murmur in severe AR due to partial closure of the anterior mitravl valve cusps caused by regurgitation streams
14
Q
Presentation of AR
A
- acute AR
- sudden, severe shortness of breath, rapidly deveoping heart failure, chest pain
- chronic AR
- long asymptomatic period, palpitations, shortness of rbeath, chest pain, sudden cardiac death
15
Q
Investigations of AR
A
- ECO: AV structure, morphology, regurgitation jet with colour doppler
- CXR:
- acute (minimal cardiac enlargement, normal aortic root/arch, pulmonary venous pattern increases,
- chronic (marked cardiac enlargement, prominent aortic root.arch, normal pulmonary venous pattern)
- ECG: LVH, LAD, LV conduction defects
22
Q
Investigations of AS
A
- Echo - see table
- ecg: AF or LAE
- CXR: LAE
