Valvular Heart Disease Flashcards
What can cause mitral stenosis?
Rheumatic heart disease
Congenital mitral stenosis
Systemic conditions such as systemic lupus erythematosus or
What is mitral stenosis?
When the mitral valve orifice is smaller than 2cm squared
What effect does mitral stenosis have on the heart and blood vessels?
Increases pressure in the left atrium
Pulmonary venous and capillary pressure increases
Pulmonary vascular resistance increases
Pulmonary arterial pressure increases
Pulmonary hypertension develops
Right heart dilatation with tricuspid regurgitation and pulmonary regurgitation
How is mitral stenosis usually picked up?
During tachycardia, so any condition that causes tachycardia will make it clear that there is mitral stenosis
What is used to estimate the severity of mitral stenosis?
Trans-valvular pressure gradient
Trans-valvular flow rate
What is the clinical manifestation of mitral stenosis?
Dyspnoea Haemoptisis Systemic embolisation Chest pain Hoarseness Infective endocarditis
What should you be looking for during a clinical examination for mitral stenosis?
Mitral facies Normal pulse Prominent a wave in the JVP Tapping apex beat Diastolic thrill Right ventricular heave Diastole murmur
What is the sign of mitral stenosis on a chest x-ray?
Left atrium enlargement
What imaging is used to identify and assess mitral stenosis?
Echocardiography
Cardiac magnetic resonance
Chest radiograph
What are the features of mitral stenosis on an echocardiograph?
Thickening and scarring of leaflets
Fusion of the commissures
Mitral valve not opening completely
What is the medical treatment of mitral stenosis?
Diuretics and restriction of sodium intake
Arterial fibrillation restoration or ventricular rate control
Anticoagulation
What can cause mitral regurgitation?
Rheumatic heart disease Mitral valve prolapse Degeneration Functional so to left ventricular and annular dilatation Infective endocarditis
What factors effect mitral regurgitation?
Preload
Afterload
Left ventricular contractility
What happens as a result of reduced left atrial compliance during mitral regurgitation?
Marked pressure rise
Thickening of atrial myocardium
Increase in pulmonary vascular resistance
Remodelling of the pulmonary vasculature with pulmonary hypertension
What happens as a result of increased left atrial compliance during mitral regurgitation?
Marked volume enlargement
Less changes in pulmonary vasculature
Development of atrial fibrillation
What is the effect of acute mitral regurgitation?
Breathlessness
Pulmonary oedema
Cardiogenick shock
What is the effect of chronic mitral regurgitation?
Fatigue Low cardiac output Right heart failure Dyspnoea Palpitation due to arterial fibrillation
What are you looking for in a clinical examination when examining for mitral regurgitation?
Normal or reduced pulse
Prominent jugular venous pulse if RH failure
Brisk and hyper dynamic apex beat
Right ventricular heave
What are you looking for on auscultation for mitral regurgitation?
Reduced S1 Split S2 Early a2 Loud P2 Holosystolic Loud at the apex Radiating to the axial
What are you looking for on an ECG for mitral regurgitation?
Prominent R wave in R precordial leads
What are you looking for on a chest X-ray for mitral regurgitation?
Cardiomegaly
Left atrium enlargement
Calcification of mitral annulus
What is the medical treatment of acute mitral regurgitation?
Preload and after load reduction
Diuretics
What is the medical treatment of chronic mitral regurgitation?
Left ventricular function preservation
What are the two main causes of aortic stenosis?
Rheumatic
Degenerative
What are the rheumatic causes of aortic stenosis?
Adhesion
Fusion of commissures
Retraction and stiffening of the free cusp margins
What are the degenerative causes of aortic stenosis?
Atherosclerosis
What happens as a result of aortic stenosis?
Increased left ventricular systolic pressure
Severe concentric hypertrophy and left ventricular mass
Increased left ventricular end diastolic pressure
Increased myocardial oxygen consumption
Myocardial ischaemia
Left ventricular failure
What are th cardinal symptoms of aortic stenosis?
Chest pain (angina)
Syncope on exertion
Breathlessness on exertion
Heart failure
How much time once symptoms show of aortic stenosis is there to get an operation done?
One month
What are you looking for on clinical examination for aortic stenosis?
Slow rising pulse
Prominent JVP in RH failure
Vigorous and sustained apex beat
Right ventricular heave
What can cause aortic regurgitation?
Dilated aorta Connective tissue disorders Bicuspid aortic valve Rheumatic heat disease Endocarditis Myxomatous degeneration
What happens as a result of aortic regurgitation?
Left ventricle accommodates with stroke volume and regurgitation volume
Increased left ventricular end diastolic volume
Left ventricular systolic pressure increases
Left ventricular hypertrophy
Left ventricular dilation
Increased myocardial oxygen consumption
Myocardial ischaemia
Left ventricular failure
What are you looking for in a clinical examination of aortic regurgitation?
Large volume and collapsing pulse
Wide pulse pressure
Hyperdynamic, displaced apex beat
What is the medical treatment of aortic regurgitation?
Vasodilators delay the timing for surgical intervention
