Valvular heart disease Flashcards
Which are the 4 types?
Aortic stenosis
Aortic regurgitation
Mitral stenosis
Mitral regurgitation
Which are the 2 most common types?
aortic stenosis and mitral regurgitation
What is rheumatic fever?
an inflammatory disease that can involve the heart, joints, skin and brain
(its an autoimmune reaction - not an infection)
What causes rheumatic fever?
Pharyngeal infection with streptococcus progenies
group A beta-haemolytic streptococcus
Causes of aortic stenosis
Congenital - bicuspid aortic valve: presents later in life
Acquired:
- degenerative: calcific valve disease
- Rheumatic fever
Pathophysiology of aortic stenosis
Reduced CO
LV hypertrophy
Which valves in the heart have how many cusps?
All have 3 (tricuspid, aortic, pulmonary) except the mitral valve has 2
Which side of the heart is the mitral valve?
left
Symptoms of severe aortic stenosis
ABS
Angina - from LV hypertrophy
Breathlessness - due to HF
Syncope - exercise induced
Signs of aortic stenosis
Ejection systolic murmur radiating to the carotids
Slow-rising pulse (weak and late)
LV heave
Systolic thrill over aortic area
Causes of aortic regurgitation
- Rheumatic fever
2. Infective endocarditis (likes to sit on previously damaged valves)
Pathophysiology of AR?
LV failure as LV has to work harder & harder to pump sufficient blood
Symptoms of AR?
Asymptomatic until LV failure occurs
- exertion dyspnoea
- orthopnoea (SOB when lying flat)
- paroxysmal nocturnal dyspnoea
- fatigue
How would you hear an early diastolic murmur in AR?
left sternal edge, high pitch
Signs of AR
- Collapsing or water-hammer pulse
- Deviated apex beat
- Other signs e.g. Corrigan’ sign: carotid pulsation, de Musset’s sign: head nodding with each heart beat
Cause of mitral stenosis
Secondary to previous rheumatic fever
Pathophysiology of mitral stenosis
inflammation –> over time: valve thickening, calcium deposition, cusp fusion –> stenotic orifice, immobility of cusps
back pressure + reduced CO
Symptoms of mitral stenosis
Pulmonary hypertension:
- dyspnoea
- cough - frothy blood tinged sputum
AF - palpitations
Signs of mitral stenosis
mid-diastolic murmur tapping apex beat pink cheeks - malar flush (low CO) AF distension of jugular veins RV heave (from pulm HTN - RHF)
Mitral regurgitation - causes
- Rheumatic fever (50%)
- Mitral valve prolapse
- Others: IHD, cardiomyopathies, IE
Mitral regurgitation pathophysiology
LV failure
Mitral regurgitation signs and symptoms
- *Pansystolic murmur** - heard best at apex (pan systolic = persisting throughout systole)
2. deviated apex beat
3. LV failure symptoms
4. Soft S1, loud S2 (pulm hypertension)
Treatment of valvular heart disease
Medical - treat HF if they have it Surgical - valvoplasty: dilate the valve with a balloon for stenotic valves - **valve replacement**
What valve issue is atrial fibrillation associated with
mitral stenosis as the enlarged atrium disrupts the normal electrical pathways
What are the earlier signs of pulm oedema?
upper lobe blood diversion
kerley B lines
as fluid infiltrates the interstitial
bibasal crepitations
if backlog from pulmonary oedema continues back into the right heart, what signs of right sided HF will be evident?
raised JVP
bilateral pedal oedema (foot)
How is rheumatic fever diagnosed?
Jones Criteria
- either 2 major criteria
- or 1 major and 2 minor
What are the major diagnostic criteria for rheumatic fever?
- carditis
- polyarthritis
- chorea (jerky involuntary movements)
- erythema marginatum (v. specific rash)
- subcut nodules
What are the minor diagnostic criteria for rheumatic fever?
fever arthralgia previous r. fever or rheumatic heart disease ESR/CRP/leukocytosis prolonged PR interval
what are s1 and what is s2 heart sounds?
s1 - due to AV valvue closure (mitral & tricuspid)
s2 - due to semilunar valve closure (aortic & pulmonary)
When would you get systolic murmurs?
(during systole)
- aortic/pulmonary valve stenosis
- mitral/tricuspid regurgitation
When would you get diastolic murmurs?
(during diastole)
- aortic/pulmonary regurgitation
- mitral/tricuspid stenosis
Pt has had rheumatic fever and now a rumbling mid-diastolic murmur, whats Dx?
Mitral stenosis
Pt has fluid on lungs, a pan-systolic murmur and a deviated apex beat, what’s Dx?
Mitral regurgitation
Pt is old, has an ejection systolic murmur, slow-rising carotid pulse, what’s the Dx?
aortic stenosis
Pt has had IE, and has an early diastolic murmur, as well as a collapsing/water hammer pulse, whats the Dx?
aortic regurgitation
