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Cardiovascular system > Valvular heart disease > Flashcards

Valvular heart disease Flashcards

1
Q

what is a stenosis?

A

an abnormal narrowing in a blood vessel or other tubular organ or structure

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2
Q

what is a stenosis sometimes called?

A

a stritcture

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3
Q

what is tricuspid stenosis?

A

it is narrowing of the tricuspid valve opening

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4
Q

describe tricuspid stenosis

A

the narrowing of the tricuspid valve opening restricts blood flow between the upper and lower part of the right side of the heart, or from the right atrium to the right ventricle

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5
Q

what is pulmonic stenosis?

A

it is a condition in which the pulmonary valve is too tight, so that the flow of blood from the right ventricle of the heart into the pulmonary artery is impeded

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6
Q

what is a result of pulmonic stenosis

A

the right ventricle have to pump harder than normal to overcome the obstruction

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7
Q

what is mitral stenosis

A

it is a valvular heart disease

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8
Q

describe mitral stenosis

A

it is narrowing of the mitral valve opening that blocks blood flow from the left atrium to the left ventricle

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9
Q

characterise mitral stenosis

A

mitral stenosis is characterised by the narrowing of the office of the mitral valve of the heart

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10
Q

what does mitral stenosis usually result from?

A

rheumatic fever, but infants can be born mitral stenosis

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11
Q

what are the symptoms of mitral stenosis?

A

mitral stenosis does not cause symptoms unless it is severe

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12
Q

what is aortic stenosis

A

it is one of the most common and most serious valve disease problems

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13
Q

describe aortic stenosis

A

it is the narrowing of the aortic valve opening, restricting the blood flow from the left ventricle to the aorta and the pressure in the left atrium may also be affected

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14
Q

which heart valves can be stenotic

A

all 4

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15
Q

name the 4 conditions of stenotic heart valves

A

tricuspid stenosis
pulmonic stenosis
mitral stenosis
aortic stenosis

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16
Q

when does valvular insufficiency occur?

A

this occurs when a valve does not close tightly

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17
Q

describe valvular insufficiency

A

this is abnormal closure of a heart valve resulting in failure to prevent regurgitation of blood

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18
Q

what is valvular insufficiency also be classed as?

A

valvular incompetence

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19
Q

what is valvular heart disease?

A

it is any disease process involving one or more of the four valves of the heart

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20
Q

where is the aortic valve and the mitral valve

A

on the left

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21
Q

where is the pulmonary valve and tricuspid valve

A

on the right

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22
Q

state 8 symptoms of heart valve disease

A 
shortness of breath
difficulty catching your breath
weakness
dizziness
discomfort in your chest
palpitations
swelling of your ankles, feet or abdomen
rapid weight gain
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23
Q

what valve failure or dysfunction result in

A

diminished heart functionality, though the particular consequences are dependent on the type and severity of valvular disease

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24
Q

what else does treatment of damaged valves involve, apart from medication

A

surgical valve repair - valvuloplasty
or
valve replacement - insertion of an artificial heart valve

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25
Q

what are the right heart valves usually involved in?

A

congenital conditions

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26
Q

where is the mitral valve situated?

A

in between the left atrium and the left ventricle

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27
Q

what is the mitral valve made up of?

A

it is made up of 2 leaflets, it is the only heart valve to made up of only 2 leaflets

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28
Q

what is the most common condition affecting the mitral valve?

A

mitral stenosis

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29
Q

what does stenosis mean?

A

narrowing essentially

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30
Q

in reference to the mitral valve, what else can happen/occur very suddenly

A

leakage or regurgitation

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31
Q

what is the most common reason for mitral stenosis to occur?

A

due to rheumatic heart disease, mitral stenosis can also occur from systemic conditions like lupus, and it can also be a congenital condition

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32
Q

with regards to mitral stenosis what happens to the pressure in the left atrium and ventricle?

A

the pressure increases

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33
Q

what is the one thing that affects the mitral stenosis?

A

the trans-valvular pressure gradient

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34
Q

describe clinical presentations of mitral stenosis

A 
first heart sound - quite loud
faint whoosh
very faint blowing murmur
second heart sound
right ventricular heave
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35
Q

state 2 investigations of mitral stenosis

A

ECG
cardiac catheterisation
CXR - enlargement of the left atrium seen

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36
Q

what is the imaging technique of mitral stenosis

A

Echocardiography

  • thickening and scarring of the leaflets is seen
  • fusion of the commissures is seen
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37
Q

what remains the number ones cause across the world for mitral regurgitation?

A

rheumatic heart disease

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38
Q

is mitral regurgitation more common in men or woman?

A

men

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39
Q

what are clinical manifestations of acute mitral regurgitation

A

breathlessness
pulmonary oedema
cardiogenic shock

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40
Q

what are the clinical manifestations of chronic mitral regurgitations?

A 
fatigue
exhaustion
right heart failure
dyspnoea
palpitations due to atrial fibrillation
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41
Q

state laboratory investigations of mitral regurgitation

A

ECG
- left atrium enlargement

CXR

  • cardiomegaly
  • left atrium enlargement
  • calcification of mitral annulus

cardiac catheterisation
- left ventricle angiography

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42
Q

describe investigating mitral regurgitation through imaging

A 
echocardiography
- left ventricle dimensions
- the cause of mitral regurgitation can be seen,
e.g. 
- leaflet dysfunction
- chordae disease
- papillary muscle disease
- annular disease
the severity of mitral regurgitation can be seen
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43
Q

describe the medical treatment for acute mitral regurgitation

A

acute mitral regurgitation is an absolute emergency and has to be treated straight away

preload and after-load reduction may be life-saving

surgery is required

44
Q

where is the aortic valve?

A

it is between the left ventricle and the aorta

45
Q

state one valve that has to put up with the highest velocities of blood at any one time

A

the aortic valve

46
Q

what percentage of the population only have a bicuspid aortic valve compared to a tricuspid aortic valve

A

1-2%

47
Q

state 4 classical symptoms of heart disease

A

chest pain
breathlessness
fainting
syncope

48
Q

describe clinical presentations of aortic stenosis

A

pulse is usually quite small, the cardiac output is smaller that what it is usually
auscultation going to hear something that is quite normal

loud, harsh, crescendo-decrescendo, sound radiates to the neck even, very loud

49
Q

describe the laboratory investigations of aortic stenosis

A

ECG

  • LVH voltage criteria
  • ST/T changes

CXR
- calcification of AV

no longer use cardiac catheterisation for diagnosis

50
Q

describe the imaging of aortic stenosis

A

echocardiography

  • main way for diagnosis
  • shows all information in reference to the valve being looked into
  • will show what the ventricle is doing
51
Q

in regards to medical treatment of aortic regurgitation was form of treatment can delay the timing for surgical intervention

A

vasodilator therapy, some medication may actually help aortic regurgitations and deny the timing before the need for valve surgery, aortic regurgitation is the only valve condition that is able to accept seem form of vasodilation therapy

52
Q

what is infective endocarditis

A

it is a serious condition, it is an infection of the endocardial surface of the heart, which may include one or more heart valves, the mural endocardium, or a septal defect

53
Q

what form of treatment does infective endocarditis require?

A

prompt medical treatment, if left untreated, the infection can damage your heart valves

54
Q

what is the first indication for cardiac surgery in infective endocarditis?

A

heart failure

55
Q

when is emergency surgery required in regards to infective endocarditis?

A

in cases of refractory heart failure due to valvular lesions, intra-cardiac fistulas and high grade cardiac conduction abnormalities caused by septal abscesses

56
Q

what is the surgical treatment of infective endocarditis?

A

mitral valve repair

aortic valve replacement

57
Q

what is cardiac ischaemia?

A

it is the name for the decreased blood flow and oxygen to the heart muscle

58
Q

what is coronary thrombosis?

A

it is a blockage of the flow of blood to the heart

59
Q

what is coronary thrombosis caused by?

A

it is caused by a blood clot in a coronary artery

60
Q

what are 6 causes of cardiac ischaemia?

A 
atherosclerosis
embolism
coronary thrombosis
aortic dissection
arteritides
congenital
61
Q

what are symptomatic indications for coronary artery bypass grafting

A

any for of coronary artery disease pattern

62
Q

what does CABG stand for?

A

coronary artery bypass graft

63
Q

describe the selection of patients for CABG

A

adequate lung, mental and hepatic function

and that the ascending aorta and distal coronary targets are ok

64
Q

state the 3 conduits for CABG

A

reversed saphenous vein
internal mammary arteries
radial arteries

65
Q

what is median sternotomy?

A

it is a type of surgical procedure in which a vertical inline incision is made along the sternum, after which the sternum itself is divided

66
Q

what is median sternotomy often mistakenly referred to as?

A

open heart surgery

67
Q

what is coronary artery bypass grafting?

A

it is a type of surgery that improves blood flow to the heart

68
Q

when do surgeons use CABG?

A

to treat people who have severe coronary heart disease

69
Q

what is coronary heart disease?

A

it is a disease in which a waxy substance called plaque builds up inside the coronary arteries

70
Q

where can the bypass graft for a CABG be?

A

it can be a vein from the leg or an inner chest-wall artery

71
Q

what does bypass grafting involve?

A

it involves sewing the graft vessels to the coronary arteries beyond the narrowing or blockage

72
Q

state 4 sternotomy related problems

A

wire infection
painful wires
sternal dehiscence
sternal malunion

73
Q

state 3 post-op problems in cardiac surgery

A

cardiac tamponade
death
stroke

74
Q

what is cardiac tamponade

A

it is a serious medical condition in which blood or fluids fill the space between between the sac that encases the heart and the heart muscle

75
Q

describe basically cardiac tamponade

A

compression of the heart by an accumulation of fluid in the pericardial sac

76
Q

what can the condition cardiac tamponade be described as

A

a medical emergency

77
Q

what is the effect on the heart in relation to the condition cardiac tamponade

A

the condition cardiac tamponade places extreme pressure on your heart

78
Q

state 3 primary features of cardiac tamponade following cardiac surgery

A

raised CVP
raised heart rate
low blood pressure

79
Q

state 3 secondary features of cardiac tamponade following cardiac surgery

A

oliguria
increased oxygen requirements
metabolic acidosis

80
Q

what is the treatment for cardiac tamponade following cardiac surgery

A

chest re-opening

81
Q

what is the long term outcomes post CABG

A

50% of patients have no further cardiac problems 10 years later

82
Q

what is the percentage of patients who may require a repeat CABG

A

5%

83
Q

what is valvular heart disease characterised by?

A

damage or a defect in one of the four heart valves

84
Q

state the four heart valves?

A

the mitral, aortic, tricuspid and pulmonary

85
Q

what is the main surgery in terms of adult cardiac surgery?

A

aortic and mitral valve surgery

86
Q

what is the main surgery in terms of paediatric cardiac surgery?

A

all four heart valves are operated with roughly equal frequency

87
Q

describe mitral valve repair

A

it is a cardiac surgery procedure performed by cardiac surgeons to treat stenosis or regurgitation of the mitral valve

88
Q

what is the mitral valve described as

A

the inflow valve for the left side of the heart

89
Q

what are causes of valvular heart disease in the adult

A 
degenerative
congenital
left ventricle or right ventricle dilation
trauma
neoplastic
paraneoplastic
infective
inflammatory
having had rheumatic fever
MI damage to heart
cardiomyopathy
previously has endocarditis
90
Q

what are the 3 commonest valve problems requiring cardiac surgery in Aberdeen

A

senile tricuspid aortic stenosis
bicuspid aortic stenosis
degenerative mitral valve regurgitation

91
Q

what is rheumatic fever

A

it is a non-congenitive acute fever marked by inflammation and pain in the joints

92
Q

who does rheumatic fever mainly affect

A

young people

93
Q

what is rheumatic fever caused by?

A

a streptococcal infection

94
Q

what does rheumatic heart disease discribe

A

a group of acute chronic heart disorders that can occur as a result of rheumatic fever

95
Q

what is one common result of rheumatic fever

A

heart valve damage, this damage to the heart valves may lead to a valve disorder

96
Q

what is endocarditis?

A

it is inflammation of the endocardium

97
Q

state 4 indications for surgery in endocarditis

A

severe valvular regurgitation
large vegetations
persistent pyrexia
progressive renal failure

98
Q

state one of the most common and most serious valve disease problems

A

aortic stenosis

99
Q

what is aortic stenosis

A

narrowing of the aortic valve opening

100
Q

what does aortic stenosis restrict?

A

the blood flow from the left ventricle to the aorta and it may also affect the pressure in the left atrium

101
Q

what does aortic stenosis typically present as?

A

heart failure, angina, syncopal episode or as an asymptomatic incidental finding

102
Q

what is aortic regurgitation?

A

it is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle

103
Q

what is mitral regurgitation defined as?

A

an abnormal reversal of blood flow from the left ventricle to the left atrium

104
Q

what is mitral regurgitation caused by?

A

disruption in any part of the mitral valve apparatus

105
Q

what is cardiopulmonary bypass?

A

it is a technique that temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the body

106
Q

what are the 2 basic types of valves that can be used for valve replacement

A

mechanical valves

tissue valves

Cardiovascular system (34 decks)

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