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cardiovascular phase2a > Valvular heart disease > Flashcards

Valvular heart disease Flashcards

1
Q

Name the types of aortic stenosis

A

Supravalvular, subvalvular, valvular

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2
Q

What happens to the valve in degenerative aortic stenosis?

A

Thickened valve with reduced orifice

Calcification restricts opening of valve

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3
Q

What is the pathophysiology of aortic stenosis?

A

Pressure gradient develops between LV and the aorta > LV function initially maintained by compensatory pressure hypertrophy > compensatory mechanisms exhausted > LV function declines

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4
Q

How does aortic stenosis present?

A

Syncope
Angina
Dyspnoea on exertion (due to HF)
Sudden death (

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5
Q

What are the physical signs of aortic stenosis?

A

Slow rising carotid pulse (pulsus tardus) and decreased pulse amplitude (pulsus parvus)
Heart sounds - soft or absent second heart sound, S4 gallop due to LVH
Ejection systolic murmur

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6
Q

What investigations would be carried out for aortic stenosis?

A

Echocardiography - assess severity

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7
Q

What management is used for aortic stenosis?

A

Fastidious dental hygiene/care
Consider IE prophylaxis in dental procedures
Surgical replacement - transcutaneous aortic valve implantation

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8
Q

What are the indications for surgery in aortic stenosis?

A

Any symptomatic patient with severe AS
Any patient with decreasing EF
Any patient undergoing CABG with moderate or severe AS

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9
Q

What is the definition of mitral regurgitation?

A

Back-flow of blood from LV to LA during systole

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10
Q

What are the aetiologies of mitral regurgitation?

A

Myxomatous degeneration
Ischaemic MR
Rheumatic heart disease
Infective endocarditis

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11
Q

What is the pathophysiology of mitral regurgitation?

A

Pure volume overload

Compensatory mechanisms > LA enlargement, LVH and increased contractility

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12
Q

What are the physical signs and symptoms of mitral regurgitation?

A

Auscultation - soft S1 and pan systolic murmur at apex radiating to axilla
Exertional dyspnoea
HF: may coincide with increased haemodynamic burden

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13
Q

What imaging studies would be carried out for mitral regurgitation and what would they show?

A

ECG - LA enlargement, AF, and LVH with severe MR
CXR - LA enlargement, central pulmonary artery enlargement
Echocardiography - estimation of LA, LV size and function

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14
Q

What medication management would be used for mitral regurgitation?

A 
Vasodilator - ACE-I, hydralazine
Rate control for AF with beta-blockers, CCB, digoxin
Anticoagulation in AF and flutter
Diuretics for fluid overload
IE prophylaxis
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15
Q

What would be the indications for surgery?

A

Any symptoms at rest or exercise

Asymptomatic - if EF

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16
Q

What is the definition of aortic regurgitation?

A

Leakage of blood into LV during diastole due to ineffective coaptation of the aortic cusps

17
Q

What is the aetiology of aortic regurgitation?

A

Bicuspid aortic valve
Rheumatic
Infective endocarditis

18
Q

What is the pathophysiology of aortic regurgitation?

A

Combined pressure and volume overload
Compensatory mechanisms > LV dilatation, LVH
Progressive dilation > HF

19
Q

What would be the physical exam findings in aortic regurgitation?

A

Wide pule pressure
Hyperdynamic and displaced apical impulse
Auscultation - diastolic blowing murmur at left sternal border; austin flint murmur; systolic ejection murmur

20
Q

What imaging would be done in aortic regurgitation and what would it show?

A

CXR - enlarged cardiac silhouette and aortic root enlargement
Echo - evaluation of AV and aortic root with measurements of LV dimensions and function

21
Q

What are the progressive symptoms of aortic regurgitation?

A

Dyspnoea - exertional, orthopnoea, and paroxysmal nocturnal dyspnoea
Palpitations - due to increased force of contraction and ectopics

22
Q

What management is used for aortic regurgitation?

A

IE prophylaxis
Medical - vasodilators
Serial echo to monitor progression

23
Q

What are the indications for surgery in aortic regurgitation?

A

Any symptoms at rest or exercise

Asymptomatic treatment if EF drops below 50% or LV becomes dilated

24
Q

What is the definition of mitral stenosis?

A

Obstruction of LV inflow that prevents proper filling during diastole

25
Q

What is the predominant cause of mitral stenosis?

A

Rheumatic carditis

26
Q

What are some other rarer causes of mitral stenosis?

A

Infective endocarditis

Mitral annular calcification

27
Q

What is the pathophysiology of mitral stenosis?

A

LA dilation > pulmonary congestion (reduced emptying) > progressive dyspnoea (worse with exercise, fever, tachycardia and pregnancy)
Increased transmitral pressures > LA enlargement and AF
Haemoptysis due to rupture of bronchial vessels due to elevated pulmonary pressure

28
Q

What causes mortality in mitral stenosis?

A

Progressive pulmonary congestion, infection and thromboembolism

29
Q

What are the physical signs of mitral stenosis?

A

Prominent ‘A’ wave in jugular venous pulsations - due to pulmonary hypertension and RVH
Signs of right-sided HF in advanced disease
Redness on face

30
Q

What heart sounds would be heart in mitral stenosis?

A

Diastolic murmur

Loud opening S1 snap

31
Q

What evaluations are done in mitral stenosis and what would be seen?

A

ECG - AF and LA enlargement
CXR - LA enlargement and pulmonary congestion; occasionally calcified MV
Echo - gold standard for diagnosis; assess mitral valve mobility, gradient and mitral valve area

32
Q

What medical management is used for mitral stenosis?

A

Beta-blockers, CCBs and digoxin prolong diastole for improved diastolic filling
Diuretics for fluid overload
IE prophylaxis

33
Q

What surgical treatment can be carried out for mitral stenosis?

A

Percutaneous mitral balloon valvotomy

34
Q

What are the indications for valve replacement in mitral stenosis?

A

Any symptomatic patient

Asymptomatic moderate or severe MS with pliable valve suitable for PMBV

cardiovascular phase2a (14 decks)

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