Valvular heart disease Flashcards
Name the heart valves and describe where they are.
Tricuspid valves: between RA and RV
Mitral (bicuspid): between LA and LV
Pulmonary valves: between RV and pulmonary artery
Aortic valve: between LV and aorta
Which heart valves are semi-lunar?
Pulmonary
Aortic
Which heart valves are atrioventricular?
Mitral (bicuspid)
Tricuspid
Which of the heart valves have 2 cusps?
Mitral
Which of the heart valves have 3 cusps?
Tricuspid
Pulmonary
Aortic
Which valves create the S1 heart sound?
What does the S1 sound like?
S1 = atrioventricular valves
‘lub’
Which valves create the S2 heart sound?
What does the S2 sound like?
S2 = semilunar valves
‘dub’
What is the purpose of the heart valves?
To prevent backflow
What is meant by valve stenosis?
Narrowing of the valve
The valve doesn’t open properly
What is meant by valve regurgitation?
A leaky heart valve
Blood leaks back to where it was just pumped from
Or blood leaks through when the valves are supposed to be shut
What is meant by an incompetent valve?
A regurgitant one
What is aortic stenosis?
Stenosis, narrowing, inability to shut properly
of the aortic valve
What problems occur as a result of aortic stenosis?
Not all the blood in the LV can leave and enter the aorta at each ventricular contraction
The body becomes starved of oxygenated blood
LV must generate higher pressure to get the blood through the valve to the aorta
This leads to LV hypertrophy
You also get ventricular arrythmias
What causes aortic valve stenosis?
Congenital:
- aortic stenosis
- having a bicuspid valve when it should be tricuspid
Aging:
- degenerative calcification
- rheumatic heart disease
How do patients with aortic stenosis present?
Syncope and dyspnoea on exertion
Angina
Sudden death due to V arrhythmias
What are the signs of aortic stenosis?
Slow rising carotid pulse (pulsus tardus)
Decreased pulse amplitude (pulsus parvus)
Systolic ejection murmur
Soft or absent 2nd heart secong
What is the prognosis like for people with aortic stenosis?
Not great at all!
Investigation of aortic stenosis.
Echo:
See LV hypertrophy & dilation
See a reduced ejection fraction
ECG:
Evidence of LV hypertrophy
Depressed ST segment
CXR:
Prominence of ascending aorta
Management of aortic stenosis.
GENERAL
Reduce risk of infective endocarditis: prophylaxis & good dental hygiene
SURGICAL
Valve replacement essential for survival
What is aortic regurgitation?
Leakage of blood from the aorta to the LV during diastole (after the blood has been pumped from the LV to the aorta
Backflow
What problems occur as a result of aortic regurgitation?
Backflow of blood into the LV causes excess loading in the LV
This leads to LV hypertrophy & dilation
This eventually leads to heart failure
What causes aortic regurgitation?
Infective endocarditis Arthritides Severe hypertension Rheumatic heart disease Marfan's
How do patients with aortic regurgitation present?
Asymptomatic until they get LV failure:
Dyspnoea
Orthopnoea (SOB lying flat)
Fatigue
Often asymptomatic until 40s-50s
What are the signs of aortic regurgitation?
Wide pulse pressure: large difference between diastolic and systolic BP
Collapsing pulse
Diastolic blowing murmur
Head bobbing
Investigations of aortic regurgitation.
CXR:
cardiomegaly and aortic root enlargement
Echo:
Look at aortic valve, see LV hypertrophy & dilation
ECG: evidence of LV hypertrophy
Management of aortic regurgitation.
GENERAL
Infective endocarditis prophylaxis
MEDICAL
Vasodilators, ACE inhibitors
MONITORING
Regular Echos
SURGICAL
valve replacement
What is mitral stenosis?
Stenosis, narrowing of the mitral valve
Which restricts blood flow from LA to LV
What problems result from mitral stenosis?
Reduced flow from LA to LV means pressure builds up in the LA
LA hypertrophy
This can also cause a backlog of blood into the lungs: pulmonary hypertension
Atrial fibrilliation due to dilatation of LA walls
Thrombus formation in LA
What complications arise from pulmonary hypertension?
Pulmonary oedema
Increased pulmonary vascular resistance, which puts strain on the right heart
What causes mitral stenosis?
Most often rheumatic fever
It is rare b/c incidence of rheumatic fever is low
How do patients with mitral valve stenosis present?
Progressively worsening exertional dyspnoea
Haemoptysis
Atrial fibrillation
Right heart failure
What are the signs of mitral stenosis?
Mitral facies: cyanotic, dusky pink flushing of upper cheeks
Irregular pulse due to AF
Tapping apex beat
Diastolic murmur
Investigations of mitral stenosis?
ECG: signs of AF
Also LA enlargement
CXR:
Pulmonary congestion
LA enlargement
Calcified mitral valve
ECHO:
assess mitral valve
Management of mitral stenosis.
GENERAL
IE prophylaxis
MONITOR
Regular Echo
MEDICAL
B-blockers, Ca channel blockers, digoxin
Diuretics for fluid overload
SURGICAL
Percutaneous mitral balloon valvotomy (balloon to open out valve)
Replacement
What purpose do drugs like B-blockers & digoxin serve in valve stenosis?
They control heart rate prolonging diastole for improved diastolic filling
What is mitral regurgitation?
Backflow of blood from the LV back into the LA during diastole
What problems occur as a result of mitral regurgitation?
Over time, you get an increase in pressure in the LA
Which is accommodated by LA enlargement
If severe it can lead to backlog of blood into lungs - pulmonary hypertension & pulmonary oedema
What are the causes of mitral regurgitation?
Rheumatic heart disease
Mitral valve prolapse
IE
How do patients with mitral regurgitation present?
Acute vs chronic
Acute MR: pulmonary oedema
Chronic MR:
progressive exertional dyspnoea
fatigue
symptoms of R heart failure
Why do disorders of the mitral valve cause lethargy?
Because they cause a reduced cardiac output
The body receives less blood, and thus oxygen
What are the signs of mitral regurgitation?
Laterally displaced apex beat
Soft S1 sound
3rd heart sound: lub-dub-ta
Pansytolic murmur
Investigations of mitral regurgitation.
ECG:
signs of LA enlargement
AF
LV hypertrophy
CXR:
LA enlargement
ECHO:
Trans-oesophageal echo
LA and LV size & function
Management of mitral regurgitation.
MEDICAL
vasodilators
rate control: B-blockers, digoxin, Ca channel blockers
Anti-coagulants (due to AF)
Diuretics
MONITOR
Regular Echos
GENERAL
IE prophylaxis
SURGERY
Replacement
What is prolapsing mitral valve?
When one or both of the mitral valve leaflets prolapse back into the LA during ventricular systole
It can lead to mitral regurgitation in some cases
What is rheumatic fever?
An inflammatory disease that occurs in young people
A complication of an infection with a group A streptococci
It develops because of an autoimmune reaction triggered by the bacteria
What does rheumatic fever do to the body?
Damages heart valves
Polyarthritis
Skin problems: erythema marginatum (pink rings on the trunk), non-tender subcutaneous nodules over tendons, joints & bony prominences
CNS problems
What is the progression of rheumatic fever?
You get attacks now and then.
Once you have had one you are very likely to get attacks in the future
