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Cardiovascular > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What can cause mitral stenosis?

A

Rheumatic heart disease
Congenital mitral stenosis
Systemic conditions such as systemic lupus erythematosus or

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2
Q

What is mitral stenosis?

A

When the mitral valve orifice is smaller than 2cm squared

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3
Q

What effect does mitral stenosis have on the heart and blood vessels?

A

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

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4
Q

How is mitral stenosis usually picked up?

A

During tachycardia, so any condition that causes tachycardia will make it clear that there is mitral stenosis

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5
Q

What is used to estimate the severity of mitral stenosis?

A

Trans-valvular pressure gradient

Trans-valvular flow rate

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6
Q

What is the clinical manifestation of mitral stenosis?

A 
Dyspnoea 
Haemoptisis 
Systemic embolisation 
Chest pain 
Hoarseness
Infective endocarditis
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7
Q

What should you be looking for during a clinical examination for mitral stenosis?

A 
Mitral facies 
Normal pulse 
Prominent a wave in the JVP 
Tapping apex beat 
Diastolic thrill 
Right ventricular heave 
Diastole murmur
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8
Q

What is the sign of mitral stenosis on a chest x-ray?

A

Left atrium enlargement

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9
Q

What imaging is used to identify and assess mitral stenosis?

A

Echocardiography
Cardiac magnetic resonance
Chest radiograph

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10
Q

What are the features of mitral stenosis on an echocardiograph?

A

Thickening and scarring of leaflets
Fusion of the commissures
Mitral valve not opening completely

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11
Q

What is the medical treatment of mitral stenosis?

A

Diuretics and restriction of sodium intake
Arterial fibrillation restoration or ventricular rate control
Anticoagulation

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12
Q

What can cause mitral regurgitation?

A 
Rheumatic heart disease 
Mitral valve prolapse 
Degeneration 
Functional so to left ventricular and annular dilatation 
Infective endocarditis
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13
Q

What factors effect mitral regurgitation?

A

Preload
Afterload
Left ventricular contractility

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14
Q

What happens as a result of reduced left atrial compliance during mitral regurgitation?

A

Marked pressure rise
Thickening of atrial myocardium
Increase in pulmonary vascular resistance
Remodelling of the pulmonary vasculature with pulmonary hypertension

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15
Q

What happens as a result of increased left atrial compliance during mitral regurgitation?

A

Marked volume enlargement
Less changes in pulmonary vasculature
Development of atrial fibrillation

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16
Q

What is the effect of acute mitral regurgitation?

A

Breathlessness
Pulmonary oedema
Cardiogenick shock

17
Q

What is the effect of chronic mitral regurgitation?

A 
Fatigue 
Low cardiac output 
Right heart failure 
Dyspnoea 
Palpitation due to arterial fibrillation
18
Q

What are you looking for in a clinical examination when examining for mitral regurgitation?

A

Normal or reduced pulse
Prominent jugular venous pulse if RH failure
Brisk and hyper dynamic apex beat
Right ventricular heave

19
Q

What are you looking for on auscultation for mitral regurgitation?

A 
Reduced S1 
Split S2
Early a2
Loud P2 
Holosystolic 
Loud at the apex 
Radiating to the axial
20
Q

What are you looking for on an ECG for mitral regurgitation?

A

Prominent R wave in R precordial leads

21
Q

What are you looking for on a chest X-ray for mitral regurgitation?

A

Cardiomegaly
Left atrium enlargement
Calcification of mitral annulus

22
Q

What is the medical treatment of acute mitral regurgitation?

A

Preload and after load reduction

Diuretics

23
Q

What is the medical treatment of chronic mitral regurgitation?

A

Left ventricular function preservation

24
Q

What are the two main causes of aortic stenosis?

A

Rheumatic

Degenerative

25
Q

What are the rheumatic causes of aortic stenosis?

A

Adhesion
Fusion of commissures
Retraction and stiffening of the free cusp margins

26
Q

What are the degenerative causes of aortic stenosis?

A

Atherosclerosis

27
Q

What happens as a result of aortic stenosis?

A

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

28
Q

What are th cardinal symptoms of aortic stenosis?

A

Chest pain (angina)
Syncope on exertion
Breathlessness on exertion
Heart failure

29
Q

How much time once symptoms show of aortic stenosis is there to get an operation done?

A

One month

30
Q

What are you looking for on clinical examination for aortic stenosis?

A

Slow rising pulse
Prominent JVP in RH failure
Vigorous and sustained apex beat
Right ventricular heave

31
Q

What can cause aortic regurgitation?

A 
Dilated aorta 
Connective tissue disorders 
Bicuspid aortic valve 
Rheumatic heat disease 
Endocarditis 
Myxomatous degeneration
32
Q

What happens as a result of aortic regurgitation?

A

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

33
Q

What are you looking for in a clinical examination of aortic regurgitation?

A

Large volume and collapsing pulse
Wide pulse pressure
Hyperdynamic, displaced apex beat

34
Q

What is the medical treatment of aortic regurgitation?

A

Vasodilators delay the timing for surgical intervention

Cardiovascular (34 decks)

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