Valvular Heart Disease Flashcards
describe the cardiac valves
AV valves allow blood to flow from atria to ventricles -
tricuspid (right)
mitral (left)
pulmonary valve allows blood into pulmonary artery
aortic valve allows blood into aorta
what is cardiac valvular disease ?
functional deficiency of the valves
what are the 2 main types of valvular heart disease ?
valvular stenosis
valvular incompetence
what is valvular stenosis ?
narrowing of the valve orifice limits the quantity of blood passing through the valve
what is valvular incompetence ?
failure of the non-return function of the valve leads to valvular regurgitation
what are the consequences of valvular heart disease ?
reduction in cardiac output
infection
what results form a reduction in cardiac output ?
poor function, exercise intolerance, left ventricular hypertrophy, left ventricular failure, sudden death
what can result from infection ?
infective endocarditis
what is involved in left heart valvular disease ?
mitral stenosis,
mitral regurgitation,
aortic stenosis,
aortic regurgitation
what is mitral stenosis ?
thickening of the valve leaflets with calcification and closure of the commisures
what is mitral regurgitation ?
mitral valve prolapse –> bacterial endocarditis, rheumatic heart disease, IHD resulting in rupture of papillary muscle/chordae tendinae, cardiomyopathy
what is aortic stenosis ?
obstruction to the left ventricular flow,
degenerative calcification,
rheumatic heart disease
what is aortic regurgitation ?
arises from valve dysfunction or incompetence or dilation of the aortic root
what are the causes of aortic regurgitation ?
rheumatic heart disease, hypertension, syphilis, marfan's syndrome, ehler's danlos syndrome, osteogenesis imperfecta, idiopathic aortic root dilation, endocarditis
what are the complications of left heart valvular disease ?
heart failure,
atrial fibrillation,
endocarditis
what is involved in right heart valvular disease ?
tricuspid stenosis,
tricuspid regurgitation
what causes tricuspid stenosis ?
rheumatic heart disease
what causes tricuspid regurgitation ?
right ventricular enlargement caused by RHD, congenital HD or endocarditis secondary to IV drug use
what causes rheumatic heart disease ?
acute rheumatic fever from group A streptococcal infection
what are the complications associated with rheumatic heart disease related to ?
antibody cross reactivity
what are the general complications of rheumatic heart disease ?
heart - pericarditis, myocarditis, endocarditis
joints - fitting polyarthritis
skin - subcutaneous nodules and skin rashes
arteries - arteritis
what is the histological hallmark of rheumatic fever ?
The Aschoff Body -
swollen eosinophilic collagen
macrophages
lymphocytes
what are the outcomes of rheumatic fever ?
most children never recover fully
scarring process thickens the valve cusps and fuses the commisures leading to stenosis of the valve
what is infective endocarditis ?
acute/chronic disease resulting from infection of a focal area of the endocardium
heart valve usually involved but may involve the mural endocardium of the atrium or ventricle or a congenital defect
what is infective endocarditis classified into ?
acute - destructive, previously normal heart valve with highly virulent organism (S. aureus)
subacute - infection of previously abnormal valve with organisms of low virulence (S. viridians)
what are the sources of organisms for infective endocarditis ?
oropharynx - streptococci
respiratory tract
skin - staphylococci, yeasts
GI an urinary tract
what is the clinical presentation of infective endocarditis ?
cardiac disease
infection
embolism
immunological phenomena
where do most cases of infective endocarditis occur ?
left sided valves mitral and aortic
what is the pathogenesis of infective endocarditis ?
endocardial injury
adherence of platelets and fibrin
vegetation formation
secondary infection by microorganisms circulating the blood
what medications might patients be taking for valvular heart disease and what are their relevance to dentistry ?
anticoagulants - bleeding risk
calcium channel blockers - gingival hyperplasia
beta blockers, ACE inhibitors, diuretics - oral drug reactions
