Valvular heart disease Flashcards
what is a stenosis?
an abnormal narrowing in a blood vessel or other tubular organ or structure
what is a stenosis sometimes called?
a stritcture
what is tricuspid stenosis?
it is narrowing of the tricuspid valve opening
describe tricuspid stenosis
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
what is pulmonic stenosis?
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
what is a result of pulmonic stenosis
the right ventricle have to pump harder than normal to overcome the obstruction
what is mitral stenosis
it is a valvular heart disease
describe mitral stenosis
it is narrowing of the mitral valve opening that blocks blood flow from the left atrium to the left ventricle
characterise mitral stenosis
mitral stenosis is characterised by the narrowing of the office of the mitral valve of the heart
what does mitral stenosis usually result from?
rheumatic fever, but infants can be born mitral stenosis
what are the symptoms of mitral stenosis?
mitral stenosis does not cause symptoms unless it is severe
what is aortic stenosis
it is one of the most common and most serious valve disease problems
describe aortic stenosis
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
which heart valves can be stenotic
all 4
name the 4 conditions of stenotic heart valves
tricuspid stenosis
pulmonic stenosis
mitral stenosis
aortic stenosis
when does valvular insufficiency occur?
this occurs when a valve does not close tightly
describe valvular insufficiency
this is abnormal closure of a heart valve resulting in failure to prevent regurgitation of blood
what is valvular insufficiency also be classed as?
valvular incompetence
what is valvular heart disease?
it is any disease process involving one or more of the four valves of the heart
where is the aortic valve and the mitral valve
on the left
where is the pulmonary valve and tricuspid valve
on the right
state 8 symptoms of heart valve disease
shortness of breath difficulty catching your breath weakness dizziness discomfort in your chest palpitations swelling of your ankles, feet or abdomen rapid weight gain
what valve failure or dysfunction result in
diminished heart functionality, though the particular consequences are dependent on the type and severity of valvular disease
what else does treatment of damaged valves involve, apart from medication
surgical valve repair - valvuloplasty
or
valve replacement - insertion of an artificial heart valve
what are the right heart valves usually involved in?
congenital conditions
where is the mitral valve situated?
in between the left atrium and the left ventricle
what is the mitral valve made up of?
it is made up of 2 leaflets, it is the only heart valve to made up of only 2 leaflets
what is the most common condition affecting the mitral valve?
mitral stenosis
what does stenosis mean?
narrowing essentially
in reference to the mitral valve, what else can happen/occur very suddenly
leakage or regurgitation
what is the most common reason for mitral stenosis to occur?
due to rheumatic heart disease, mitral stenosis can also occur from systemic conditions like lupus, and it can also be a congenital condition
with regards to mitral stenosis what happens to the pressure in the left atrium and ventricle?
the pressure increases
what is the one thing that affects the mitral stenosis?
the trans-valvular pressure gradient
describe clinical presentations of mitral stenosis
first heart sound - quite loud faint whoosh very faint blowing murmur second heart sound right ventricular heave
state 2 investigations of mitral stenosis
ECG
cardiac catheterisation
CXR - enlargement of the left atrium seen
what is the imaging technique of mitral stenosis
Echocardiography
- thickening and scarring of the leaflets is seen
- fusion of the commissures is seen
what remains the number ones cause across the world for mitral regurgitation?
rheumatic heart disease
is mitral regurgitation more common in men or woman?
men
what are clinical manifestations of acute mitral regurgitation
breathlessness
pulmonary oedema
cardiogenic shock
what are the clinical manifestations of chronic mitral regurgitations?
fatigue exhaustion right heart failure dyspnoea palpitations due to atrial fibrillation
state laboratory investigations of mitral regurgitation
ECG
- left atrium enlargement
CXR
- cardiomegaly
- left atrium enlargement
- calcification of mitral annulus
cardiac catheterisation
- left ventricle angiography
describe investigating mitral regurgitation through imaging
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
describe the medical treatment for acute mitral regurgitation
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
where is the aortic valve?
it is between the left ventricle and the aorta
state one valve that has to put up with the highest velocities of blood at any one time
the aortic valve
what percentage of the population only have a bicuspid aortic valve compared to a tricuspid aortic valve
1-2%
state 4 classical symptoms of heart disease
chest pain
breathlessness
fainting
syncope
describe clinical presentations of aortic stenosis
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
describe the laboratory investigations of aortic stenosis
ECG
- LVH voltage criteria
- ST/T changes
CXR
- calcification of AV
no longer use cardiac catheterisation for diagnosis
describe the imaging of aortic stenosis
echocardiography
- main way for diagnosis
- shows all information in reference to the valve being looked into
- will show what the ventricle is doing
in regards to medical treatment of aortic regurgitation was form of treatment can delay the timing for surgical intervention
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
what is infective endocarditis
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
what form of treatment does infective endocarditis require?
prompt medical treatment, if left untreated, the infection can damage your heart valves
what is the first indication for cardiac surgery in infective endocarditis?
heart failure
when is emergency surgery required in regards to infective endocarditis?
in cases of refractory heart failure due to valvular lesions, intra-cardiac fistulas and high grade cardiac conduction abnormalities caused by septal abscesses
what is the surgical treatment of infective endocarditis?
mitral valve repair
aortic valve replacement
what is cardiac ischaemia?
it is the name for the decreased blood flow and oxygen to the heart muscle
what is coronary thrombosis?
it is a blockage of the flow of blood to the heart
what is coronary thrombosis caused by?
it is caused by a blood clot in a coronary artery
what are 6 causes of cardiac ischaemia?
atherosclerosis embolism coronary thrombosis aortic dissection arteritides congenital
what are symptomatic indications for coronary artery bypass grafting
any for of coronary artery disease pattern
what does CABG stand for?
coronary artery bypass graft
describe the selection of patients for CABG
adequate lung, mental and hepatic function
and that the ascending aorta and distal coronary targets are ok
state the 3 conduits for CABG
reversed saphenous vein
internal mammary arteries
radial arteries
what is median sternotomy?
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
what is median sternotomy often mistakenly referred to as?
open heart surgery
what is coronary artery bypass grafting?
it is a type of surgery that improves blood flow to the heart
when do surgeons use CABG?
to treat people who have severe coronary heart disease
what is coronary heart disease?
it is a disease in which a waxy substance called plaque builds up inside the coronary arteries
where can the bypass graft for a CABG be?
it can be a vein from the leg or an inner chest-wall artery
what does bypass grafting involve?
it involves sewing the graft vessels to the coronary arteries beyond the narrowing or blockage
state 4 sternotomy related problems
wire infection
painful wires
sternal dehiscence
sternal malunion
state 3 post-op problems in cardiac surgery
cardiac tamponade
death
stroke
what is cardiac tamponade
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
describe basically cardiac tamponade
compression of the heart by an accumulation of fluid in the pericardial sac
what can the condition cardiac tamponade be described as
a medical emergency
what is the effect on the heart in relation to the condition cardiac tamponade
the condition cardiac tamponade places extreme pressure on your heart
state 3 primary features of cardiac tamponade following cardiac surgery
raised CVP
raised heart rate
low blood pressure
state 3 secondary features of cardiac tamponade following cardiac surgery
oliguria
increased oxygen requirements
metabolic acidosis
what is the treatment for cardiac tamponade following cardiac surgery
chest re-opening
what is the long term outcomes post CABG
50% of patients have no further cardiac problems 10 years later
what is the percentage of patients who may require a repeat CABG
5%
what is valvular heart disease characterised by?
damage or a defect in one of the four heart valves
state the four heart valves?
the mitral, aortic, tricuspid and pulmonary
what is the main surgery in terms of adult cardiac surgery?
aortic and mitral valve surgery
what is the main surgery in terms of paediatric cardiac surgery?
all four heart valves are operated with roughly equal frequency
describe mitral valve repair
it is a cardiac surgery procedure performed by cardiac surgeons to treat stenosis or regurgitation of the mitral valve
what is the mitral valve described as
the inflow valve for the left side of the heart
what are causes of valvular heart disease in the adult
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
what are the 3 commonest valve problems requiring cardiac surgery in Aberdeen
senile tricuspid aortic stenosis
bicuspid aortic stenosis
degenerative mitral valve regurgitation
what is rheumatic fever
it is a non-congenitive acute fever marked by inflammation and pain in the joints
who does rheumatic fever mainly affect
young people
what is rheumatic fever caused by?
a streptococcal infection
what does rheumatic heart disease discribe
a group of acute chronic heart disorders that can occur as a result of rheumatic fever
what is one common result of rheumatic fever
heart valve damage, this damage to the heart valves may lead to a valve disorder
what is endocarditis?
it is inflammation of the endocardium
state 4 indications for surgery in endocarditis
severe valvular regurgitation
large vegetations
persistent pyrexia
progressive renal failure
state one of the most common and most serious valve disease problems
aortic stenosis
what is aortic stenosis
narrowing of the aortic valve opening
what does aortic stenosis restrict?
the blood flow from the left ventricle to the aorta and it may also affect the pressure in the left atrium
what does aortic stenosis typically present as?
heart failure, angina, syncopal episode or as an asymptomatic incidental finding
what is aortic regurgitation?
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
what is mitral regurgitation defined as?
an abnormal reversal of blood flow from the left ventricle to the left atrium
what is mitral regurgitation caused by?
disruption in any part of the mitral valve apparatus
what is cardiopulmonary bypass?
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
what are the 2 basic types of valves that can be used for valve replacement
mechanical valves
tissue valves
