Valvular heart disease Flashcards
Myxomatous
Glycosaminoglycan accumulation
What is the aetiology of MDVD?
Idiopathic (possibly collagen abnormalities, seratonin signalling and mechanical stress)
What common signalment is associated with MDVD?
CKCS, age
Describe the pathological changes seen here.
- Nodular thickening of the leaflets of the mitral valves
- Would also se LA/LV dilatation
- Jet lesions
- Elongated chordae tendinae
What causes eccentric hypertrophy of muscle?
Volume overload caused by increased backflow of blood due to valvular incompetence.
How is blood pressure maintained during MDVD by the body?
- Remember, MDVD causes poor systolic function of the heart!*
1. SNS - Tachycardia, positive inotropym vasoconstriction
2. RAAS - Na+ and fluid retention, increased circulating volume, vasoconstriction
3. Remodelling of heart muscle
What sequelae are associated with MDVD?
- SNS - myocyte toxicity due to Ca overload, increased oxygen demand and cell death
- RAAS - increased circulatory volume and congestion
- Remodelling - fibrosis, increased wall stress, mitral regurgitation
- Thrombosis - blood stasis
What clinical signs are associated with MDVD?
- Increased respiratory rate and effort
- Cachexia
- Pale mm and CRT prolonged
- Tachy/ dyspnoea
- Weak femoral pulses
- Pleural effusion
- Jugular distension
- Ascites
- Positive hepatojugular reflex
- Increased respiratory noise
Which is NOT a sign of forwards heart failure?
A) Pale mucous membranes
B) Cold Extremities
C) Dyspnoea
D) Quiet heart sounds on ausculation
Dyspnoea
Which of these is NOT a negative prognostic indicator for degenerative valve disease?
A) BNP detection
B) LA enlargement
C) Being a CKCS
D) Chordae tendinae rupture
Why?
Being a CKCS - they are usually diagnosed earlier!
What type of murmur is usually associated with MDVD?
Left apical murmur - loud depending on disease severity
Describe this ECG.
No P waves at the complexes - supraventricular premature complex
Describe this ECG
Tachycardia - ventricular
Describe this ECG
An irregular baseline with lots of small p waves - atrial fibrillation
Describe what can be seen in this radiograph.
Cardiomegaly - increased vertrbral heart score
Particularly left auricular/ atrial bulging
Describe the changes that would be seen on echo with MDVD.
Enlarged LA, mitral regurgitation, dilated and rounded ventricle, hyperdynamic, regurgitation
What does NT-proBNP measure?
Biomarker of cardiac muscle damage
Loop diuretic MOA
Na+ Cl- inhibitor - prevents RAAS H2O and Na+ in the kidney
PDEi MOA
Positive inotrope - improves myocardial contractility
ACEi MOA
RAAS inhibition
Potassium-sparing diuretic MOA
Aldosterone antagonist - negates K+ excretion due to Na+ and H2O retention
