Valvular Heart Disease Flashcards
What causes Mitral stenosis?
- Rheumatic Heart Disease
- Congenital MS
- Systemic conditions (Lupus-Rheumatic arthritis)
How is stenosed mitral orifice?
<2cm3
How big should mitral orifice usually be?
4-6cm3
What ultimately happens with mitral stenosis?
Right heart dilation with tricuspid regurgitation
What happens to the rest of the body?
LV Pressure and systolic function normal
When can mitral stenosis cause tachycardia?
- Exercise
- Acute
- Pregnancy
- Atrial Fibrilation
What can mitral stenosis cause?
- Dysponoea
- Haemoptisis
- Systemic embolisation
- Chest pain
- Hoarseness
What does mitral stenosis cause haemoptisis?
-Rupture of thin walled veins
Why does Mitral Stenosis cause haorseness?
-Compression of the L recurrent laryngeal nerve
What can you find on examination with someone with Mitral Stenosis?
- Mitral Facies
- Pulse=Normal
- JVP=Prominent a wave
- Tapping apex beat and diastolic thrill
- RV heave
- Auscultation
What do you find on an CXR with some one who has mitral stenosis?
LA enlargement
What is the medical treatment of mitral stenosis?
- Diuretics and restriction of NA intake
- Anticoagulants
What is the interventional treatment
Valvotomy (balloon vs Surgical)
Mitral valve replacement
What causes mitral regurgtitation?
- Rheumatic heart disease
- Mitral valve prolapse
What causes Functional Mitral regurgitation?
Left ventricular annular dilatation
What does ERO mean?
effective regurgitant orifices
How does the left ventricle compensate in acute MR?
Decreases end systolic pressure and volume
Decreases in wall tension
How does left ventricel compensate in chronic cases of MR?
Increases End diastolic volume and End systolic volume returns to normal
What does increaseing EDV do to the left ventricle?
makes it eccentric
What happens to the compliance of the LA?
Both increased and reduced?
Why is LA compliance reduced?
Marked pressure rise causing thickening of atrial myocardium
increase in pulmonary vascular resistance and remodelling of the pulmonary vasculature
Why is LA compliance increased?
Marked volume enlargement , lesser changes in pulmonary asculature but develop AF
What can be seen with acute Mitral regurgitation?
Breathlessness
pulm oedema
cardiogenic shock
What can be seen with chronic MR?
Fatigue exhausion (low CO) Right heart failure Dyspnoea or palpitations due to Atrial fibrillation
What can cause valve perforation?
Infection
What is pulse rate like in MR?
normal or reduced in heart failure
What JVP like in MR?
Prominent in RH failure present
What is the apex beat like in MR?
Brisk and Hyperdynamic
What is shown in an ECG with MR?
LA enlargement
Prominent R wave in Right precordial leads
What can be seen in a CXR of someone with MR?
Cardiomegaly, LA enlargement or calcification of mitral mitral annulus
What causes MR?
Leaflet dysfunction
Chordae
pap muscle
Annular disease
What is the medical treatment for mitral stenosis?
- Acute= Preload and afterload reduction may be life saving
- Chronic : not a whole pile mostly for LV function presentation
What is the interventional treatment for MR?
Mitral valve repair
Mitral valve replacement
What can cause aortic stenoisis?
Rheumatic and Degenrative conditions
How does rhuuematic disease cause aortic stenosis?
Adhesion, fusion of the commissures and retraction and stiffening of the free cusp margins
How does degenerative disease cause aortic stenosis?
Linked atherosclerosis, a slow inflammatory process resulting in thickening and calcification of the cusps from base to free margins
What does Aortic stenosis ultimately cause?
concentric hypertrophy Left atrial p increases Increases 02 demand Myocardial ischaemia LV failure
What are the cardinal symptoms of aortic stenosis?
-Chest pain
_syncope
-Breathlessness on exertion
-Heart failure
What does the pulse look like for aortic stenosis?
Small volume and slowly rising
What does the JVP look like with some who has aortic stenosis?
Prominent if RH failure present, low BP
What is the apex beat like in Aortic stenosis?
Vigurous and sustained
Also RV heave
How do you treat aortic stenosis?
Aortic vlave replacement
What can cause aortic regurgitation?
Dilated arota
Or dysfunctional leaflets
What causes the aorta itself to cause aortic regurgitation?
Dilated aorta
Connective tissue disorders
What causes dysfunction in the leaflets which in turn causes aortic regurgitation
- Rheumatic heart disease
- Endocarditis
- Myxomatous degeneration
What does aortic regurgitation?
Increased LV systolic pressure
LV hypertrophy and Lv dilatation
-Myocardial ischaemia
What are the symptoms of chronic AR?
- Long asymptomatic phase
- Exertional breathlesness
What are the symptoms of Acute AR?
Poorly tolerated as wall tension cannot acutely adopt
What is pulse rate like with AR?
Large volume and collapsing (corrigan sign)
What is the apex beat like for someone with AR?
Hyperdynamic displaced apex
What can be seen on an ECG of someone with AR?
ST/T changes
What can be seen in CXR for someone with AR?
If chronic cardiomegaly
