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Systems: Cardiovascualar AB > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

How are the valves arranged in the heart?

A
  • Valves are situated within a 1cm line

- They sit at the ‘bases’ of the heart

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2
Q

Describe the anatomy of the mitral valve.

A
  • Bicuspid valve with 2 cusps
  • Anterior cusp is larger
  • Posterior is more semi-lunar shaped
  • Separates the left atrium and left ventricle
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3
Q

What is the aetiology of mitral stenosis?

A
  • Rheumatic heart disease
  • Congenital MS
  • Systemic conditions such as lupus and rheumatoid arthritis
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4
Q

What is the most common cause of mitral stenosis?

A

Rheumatic heart disease

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5
Q

What is mitral stenosis?

A

Narrowing of the mitral valve so the orifice is <2cm

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6
Q

What is the pathophysiology of MS?

A
  • Atrioventricular pressure gradient increases
  • Left atrium pressure increases
  • Pulmonary venous and capillary pressure increase
  • Peripheral vascular resistance increases
  • Pulmonary arterial pressure increases and pulmonary hypertension develops
  • Right heart dilation with tricuspid regurgitation and pulmonary regurgitation
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7
Q

In MS what remains normal?

A

Left ventricle pressure and systolic function

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8
Q

What determines the severity of MS?

A
  • Trans-valvular pressure gradient

- Trans-valvular flow rate

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9
Q

What affects trans valvular flow rate?

A
  • CO

- HR

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10
Q

When does MS usually become apparent?

A

With conditions that cause tachycardia

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11
Q

Give examples of conditions which can cause tachycardia.

A
  • Exercise
  • Acute illness
  • Pregnancy
  • Atrial fibrillation
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12
Q

How does MS present?

A
  • Dyspnoea (mild exertional to pulmonary oedema)
  • Haemoptysis ( due to rupture of thin walled veins)
  • Systemic embolization
  • Infective endocarditis
  • Chest pain
  • Hoarseness
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13
Q

What may be found on examination of someone with MS?

A
  • Mitral facies
  • Normal pulse
  • Prominent JVP wave
  • Tapping apex beat and diastolic thrill
  • Right ventricicular heave
  • Diastolic murmur
  • 3rd HS
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14
Q

What are the investigations for MS?

A
  • ECG (RV hypertrophy)
  • Cardiac catheterisation
  • CXR (LA enlargement)
  • ECHO
  • MRI
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15
Q

What is the non-interventional treatment for MS?

A
  • Diuretics and restriction of Na intake
  • If in AF, sinus rhythm restoration or ventricular rate control
  • Anticoagulation of those in AF
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16
Q

What is the interventional treatment for MS?

A
  • Valvotomy (balloon vs surgery)

- Mitral valve replacement

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17
Q

What is mitral regurgitation?

A

Mitral valve becomes leaky/incompetent

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18
Q

What is the aetiology of MR?

A
  • Rheumatic heart disease
  • Mitral valve prolapse
  • Infective endocarditis
  • Degenerative
  • LV and annular dilatation
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19
Q

What is the most common cause for MR in the developed world?

A

Mitral valve prolapse

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20
Q

What is mitral valve prolapse?

A
  • Degenerative condition which occurs mostly in men aged 40-50.
  • The valve is no longer attached to the chordae tendinae
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21
Q

What is the pathophysiology of MR?

A
  • Effective regurgitant orifice not fixed
  • Extremely dependent on preload, afterload and LV contractility
  • Annular enlargement lead to increase in regurgitant volume
  • LV tries to compensate
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22
Q

How does the LV try to compensate in MR?

A
  • In acute end systolic pressure and end systolic volume decrease. Wall tension also decreases
  • In chronic, end diastolic volume increases and end systolic volume returns to normal, eccentric left ventricular hypertrophy develops
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23
Q

How is LA compliance effected in MR?

A

-A combination of increase and decrease

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24
Q

How is LA compliance decreased?

A
  • Marked pressure rise
  • Thickening of atrial myocardium
  • Increase in PVR and remodelling of the pulmonary vasculature with PHT
25
Q

How is LA compliance increased?

A
  • Marked volume enlargement
  • Lesser changes in pulmonary vasculature
  • Development of AF
26
Q

How does acute MR present?

A

Breathlessness due to pulmonary oedema or cardiogenic shock

27
Q

How does chronic MR present?

A
  • Fatigue
  • Exhaustion
  • Right heart failure
  • Dyspnoea or palpitations due to AF
28
Q

What would be found on examination of MR?

A
  • Normal pulse (reduced in HF)
  • JVP prominent if RH failure present
  • Brisk and hyperdynamic apex beat
  • RV heave
  • Reduced S1 and split S2
  • Murmur
29
Q

What investigations should be carried out for MR?

A
  • ECG
  • CXR
  • Cardiac catheterisation
  • ECHO
30
Q

What would be seen on MR ECG?

A
  • LA enlargement(p>0.12s, tall)

- RVH (prominent R wave in R precordial leads)

31
Q

What would be seen on MR CXR?

A
  • Cardiomegaly
  • LA enlargement
  • Calcification of mitral annulus
32
Q

What should be looked at on ECHO for MR?

A
  • LV dimensions
  • Cause of MR (leafelt dysfunction, chordae, papillary muscles, annular disease)
  • Severity of MR and Pap
33
Q

What is the non-interventional treatment for MR?

A
  • Acute: preload and afterload reduction (sodium nitroprusside, dobutamine, IABP)
  • Chronic:watchful waiting
34
Q

What is the interventional treatment for MR?

A
  • Mitral valve apparatus repair

- Mitral valve replacement

35
Q

What is the anatomy of the aortic valve?

A
  • Tricuspid valve with 3 cusps

- Located between aorta and left ventricle

36
Q

What is aortic stenosis?

A

Narrowing of the aortic valve orifice <1.5-2cm

37
Q

What is the aetiology of aortic stenosis?

A
  • Degenerative
  • Rheumatic
  • Bicupsid
38
Q

What is the pathology of rheumatic aortic stenosis?

A
  • Adhesion
  • Fusion of the commissures and retraction
  • Stiffening of the free cusp margins
39
Q

What is the pathology of degenerative aortic stenosis?

A
  • Linked to atherosclerosis

- A slow inflammatory process resulting in thickening and calcification of the cusps from base to free margins

40
Q

What is the pathophysiology of AS?

A
  • Increased LV systolic pressure
  • Severe concentric hypertrophy and LVM
  • Increased LVEDP (LA pressure increases)
  • PHT
  • Increased MVO2
  • Myocardial ischaemia
  • LV failure
41
Q

What are the symptoms of AS?

A
  • Long asymptomatic period
  • Chest pain
  • Syncope/dizziness
  • Dyspnoea on exertion
  • Heart failure
42
Q

What would be found on clinical examination of AS?

A
  • Small volume and slow rising pulse
  • JVP prominent if RH failure present, low BP
  • Vigorous and sustained apex beat
  • RV heave
  • Normal S1 with less audible ST
  • Systolic ejection murmur
43
Q

What are the investigations for AS?

A
  • ECG
  • CXR
  • Cardiac catheterisation
  • ECHO
44
Q

What would be seen on AS ECG?

A
  • LVH voltage criteria
  • ST/T changes (LV strain
  • Taller R waves
45
Q

What would be seen on AS CXR?

A

Calcification of AV

46
Q

What would be seen on AS ECHO?

A
  • Demonstrates the AV cusp mobility
  • LV function and hypertrophy
  • Doppler haemodynamic assessment of pressure gradient and AVA
47
Q

Who is medical treatment limited to for AS?

A

Those who develop heart failure

48
Q

What is the interventional treatment available for AS?

A

Aortic valve repair or replacement

49
Q

What is the aetiology of aortic regurgitation?

A 
Aorta
-Dilated aorta (hypertension, Marfans)
-Connective tissue disorders
Leaflets
-Bicuspid aortic valve
-Rheumatic heart disease
-Endocarditis
-Myxomatous degeneration
50
Q

What is the pathophysiology of AR?

A
  • LV accommodates both SV and RegVol
  • Increased LVEDV and LV systolic pressure
  • LV hypertrophy and LV dilatation
  • Increased MVO2
  • Myocardial ischaemia
  • LV failure
51
Q

What are the symptoms of chronic AR?

A
  • Long asymptomatic phase

- Exertional dyspnoea

52
Q

What are the symptoms of acute AR?

A

-Poorly tolerated as wall tension cannot adapt

53
Q

What would be found on clinical examination of AR?

A
  • Large volume and collapsing pulse
  • Wide pulse pressure
  • Hyperdynamic, displace apex beat
  • Early diastolic murmur
54
Q

What investigations should be carried out for AR?

A
  • ECG
  • CXR
  • ECHO
55
Q

What would be seen on ECG of AR?

A
  • ST/T changes (LV strain)

- LAD

56
Q

What would be seen on CXR of AR?

A

-Cardiomegaly in chronic AR

57
Q

What would be seen on ECHO of AR?

A
  • Demonstrates the AV cusp anatomy (thickening, prolapsing, number of cusps, vegetations)
  • LV function, dilatation and hypertrophy
  • Doppler haemodynamic assessment of regurgitant flow
58
Q

What is the medical treatment for AR?

A

-Vasodolator therapy shown to delay the timing for surgical intervention

59
Q

What is the interventional treatment for AR?

A

Aortic valve repair or replacement

Systems: Cardiovascualar AB (42 decks)

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