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x1 - Cardiovascular > Valvular heart disease > Flashcards

Valvular heart disease Flashcards

1
Q

Common heart valve lesions

A

Mitral stenosis,
Mitral regurgitation,
Aortic stenosis,
Aortic regurgitation

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2
Q

Symptoms of mitral stenosis

A 
haemoptysis,
Chest pain,
Cough,
Hoarse voice (rare),
Infective endocarditis
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3
Q

Mitral stenosis pathophysiology

A

MV orifice < 2cm^2,
Always chronic,

LA pressure increases,
= Pulmonary hypertension,
= Right heart dilatation

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4
Q

Mitral stenosis signs

A 
Mitral facies (red/purple cheeks),
Normal pulse,
JVP - prominent a-wave,
Tapping apex beat,
Diastolic thrill,
RV heave,
Diastolic murmur,
Pulmonary oedema
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5
Q

Investigations for mitral stenosis

+ findings

A

ECG
CXR
Echo: Thickening and scarring of leaflets Cardiac MRI
Cardiac catheterisation: Large pressure gradient between LA and LV

FINDINGS:
RV Hypertrophy
LA enlargement/dilatation

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6
Q

Mitral stenosis treatment

A

Valvotomy (balloon/surgical),

Mitral valve replacement

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7
Q

Mitral regurgitation symptoms

A

ACUTE: dyspnoea, pulmonary oedema, cardiogenic shock

CHRONIC: Fatigue, right heart failure, dyspnoea/ palpitations (due to AFib)

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8
Q

Mitral regurgitation signs

A

Normal/reduced pulse,
JVP - prominent if RH failure,
Brisk + hyperdynamic apex beat
RV heave,

Systolic “blowing” murmur - loud at apex, radiating to axilla.

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9
Q

Mitral regurgitation investigations

+ likely findings

A

ECG
CXR
Echo: Dysfunction of leaflets, papillary muscles, chordae tendineae etc.

FINDINGS:
LA enlargement
RVH
Calcification of mitral annulus

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10
Q

Mitral regurgitation treatment

A

Mitral valve apparatus repair,

Mitral valve replacement

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11
Q

General symptoms of heart valve disease

A

Fatigue,
Dyspnoea,
Oedema

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12
Q

Mitral regurgitation pathophysiology

A

ACUTE: ↓ End systolic pressure and end systolic volume = ↓ LV wall tension.

CHRONIC: ↓BP = ↑ EDV = normal ESV + LV hypertrophy

Orifice size depends on:
Preload, afterload and LV contractility

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13
Q

Aortic stenosis pathophysiology

A

Aortic valve narrowing

↑LV systolic pressure = LV hypertrophy = ↑ LV myocardial O2 demand = ischaemia

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14
Q

Aortic stenosis symptoms

A

Long asymptomatic phase

Angina,
Syncope,
Exertional dyspnoea,

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15
Q

Aortic stenosis signs

A 
Pulse - small volume and slowly rising,
JVP - prominent if RH failure,
Low BP, 
Vigorous and sustained apex beat, 
RV heave,
Late peaking systolic murmur, radiating to carotids
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16
Q

Aortic stenosis investigations + likely outcomes

A

ECG: ST changes (show LV strain)
CXR: Calcification of aortic valve
Echo: Low AV cusp mobility
Cardiac catheterisation: High pressure gradient btw LV and aorta

FINDINGS:
LV Hypertrophy

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17
Q

Aortic stenosis treatment

A

Medical treatment: Limited to those who develop heart failure,
Interventional treatment: Aortic valve replacement or repair

18
Q

Aortic regurgitation pathophysiology

A

↓diastolic BP = ↑EDV = LV hypertrophy and dilatation

= ↑ LV myocardial O2 demand = ischaemia

19
Q

Aortic regurgitation symptoms

A

CHRONIC:
Long asymptomatic phase,
Exertional dyspnoea

ACUTE:
Poorly tolerated as wall tension cannot acutely adapt

20
Q

Aortic regurgitation signs

A

Pulse - large volume and collapsing
Wide pulse pressure,
Hyperdynamic, misplaced apex beat
Early diastolic, soft murmur

21
Q

Aortic regurgitation investigations + likely findings

A

ECG: ST changes (LV strain)
CXR
Echo: Regurgitant flow, Thickening/prolapsing/no. of AV cusps
Cardiac MRI

FINDINGS
LV Hypertrophy/ dilatation
Cardiomegaly (chronic)

22
Q

Aortic regurgitation treatment

A

Only valve disease that can use drug therapy:
Vasodilator therapy

Interventional treatment: Aortic valve replacement or repair

23
Q

potential sternotomy complications

A 
Wire infection,
Painful wires,
Sternal dehiscence (splitting open),
Sternal malunion (fails to heal),
Cardiac tamponade (fluid in pericardial sac),
Stroke,
Death
24
Q

Common valve problems requiring cardiac surgery

A

Senile tricuspid aortic stenosis,
Bicuspid aortic stenosis

Degenerative mitral regurgitation

25
Q

Indications for valve replacement

A

AS: severe
AR: severe, especially with LV dilatation

MS: orifice <1.5cm2 (audible murmur)
MR: severe = systolic blood flow reversal in pulmonary veins.

26
Q

Types of prosthetic valves

+ results

A

Biological (e.g. pig) - wears out after 15 years

Mechanical (plastic) - lasts > 40 years, warfarin required for life

27
Q

Treatment of infective endocarditis of valves

A

Medical = antibiotics (much more successful if native valve compared to prosthetic)

Surgery of severe or persistent

28
Q

Use and results of mitral valve repair

A

Used in degenerative MR,

complete valve competence can be restored = better than valve replacement

29
Q

Symptoms of infective endocarditis

A 
Fever/ Chills
Night sweats, fatigue,  malaise, weight loss
Weakness
Arthralgia (joint pain)
Headache
Dyspnoea
30
Q

Signs of infective endocarditis

A 
Cardiac murmur
Janeway lesions
Osler nodes
Splinter haemorrhages
Petechial haemorrhage
Roth spots
vasculitic rash
31
Q

Investigation of infective endocarditis

A

Blood culture: Identify causative bacteria
FBC: Elevated acute inflammatory markers (ESR/ CRP)
ECG: Prolonged PR interval
Echocardiogram: Shows vegetations, damaged valves, turbulent flow etc.
Urinalysis: Haematuria (blood in urine)

32
Q

Treatment of infective endocarditis

A

Prolonged antibiotics

Surgery (if severe regurgitation, large vegetations, persistent pyrexia or progressive renal failure)

33
Q

Rheumatic heart disease symptoms

A

Symptoms of heart valve disease/ IE

34
Q

Signs of rheumatic heart disease

A

Pericardial friction rub
Murmurs
Pancarditis

35
Q

Rheumatic heart disease investigations

A

Blood culture: show previous strep infection
FBC: Increased inflammatory markers
Erythrocyte Sedimentation Rate (ESR): Shows clotting if increased
ECG: features of heart block

36
Q

Treatment of rheumatic heart disease

A

Anti-inflammatories
Antibiotics
Treatment of heart valve disease/ IE
Surgery if unresolved by medical treatment

Prevention = Prolonged antibiotics to prevent recurrent streptococcal infections

37
Q

Sternotomy

A

Most common thoracic incision

Used for:

  • heart valve replacements
  • cardiac transplant
  • CABG
38
Q

Prevention of IE for high risk groups

A

E.g. previous IE, prosthetic valve, congenital heart disease

Prophylactic antibiotics before dental procedures
Strict dental and cutaneous hygiene
Disinfection of wounds
Discourage piercing/ tattooing
Limit invasive procedure
39
Q

Contraction of endocarditis

A

Mitral valve prolapse
Congenital heart disease (e.g. bicuspid aortic valve)
Prosthetic valves
Rheumatic heart disease

^ Damaged/diseased valves cause turbulent blood flow leading to endothelial damage

  • -> formation of NBTE
  • -> bacteria in bloodstream (due to infected needle, open wound etc.) adhere to NBTE
  • -> vegetation
40
Q

Rheumatic heart disease pathophysiology

A

Strep infection causes immune system to make Abs that attack the endocardium (type II hypersensitivity reaction)

= repeated inflammation of heart valves with fibrinous repair

x1 - Cardiovascular (8 decks)

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