valvular heart disease Flashcards
what is mitral stenosis?
its a rheumatic heart disease
Mitral stenosis is a narrowing of the mitral valve opening that blocks (obstructs) blood flow from the left atrium to the left ventricle
what changes happen to the chambers with mitral stenosis?
A-V p gradient increases LA pressure increases Pulmonary venous and capillary pressures increase PVR increases PaP increases and PHT develops RH dilatation with TR and PReg
what happens to the left ventricular pressures and systolic function with mitral stenosis?
its just normal
what are clinical manifestations of mitral stenosis?
Dyspnoea: mild exertional to pulmonary oedema
Haemoptisis: rupture of thin-walled veins
Systemic embolisation: LA and LAA enlargement
IE
Chest pain
Hoarseness (compression of the L recurrent laryngeal nerve)
what would you see on a clilnical examination for mitral stenosis?
Mitral facies Pulse – normal JVP – prominent a wave Tapping apex beat and diastolic thrill RV heave
how would you investigate mitral stenosis?
ECG
cardiac catheterisation
cxr
what is the imaging that you would use ofr mitral stenosis?
echocardiography
cardiac magnetic resonance
what medical treatment would you suggest for mitral stenosis?
Diuretics and restriction of Na intake
AF: SR restoration or ventricular rate control
Anticoagulation: all those with AF, debatable in SR
what is interventional treatment for mitral stenosis?
Valvotomy (balloon vs surgical)
MVR
what is aetiology and pathology of mitral regurgitation?
Rheumatic Heart Disease Mitral valve prolapse (MVP) IE Degenerative Functional MR due to LV and annular dilatation
whats the path-physiology of mitral regurgitation?
ERO – not fixed
Preload
Afterload
LV contractility
LV compensation
Acute: ESP and ESV , Wall tension
Chronic: EDV and ESV returns to normal, eccentric LVH develops
LA compliance
Reduced – marked pressure rise, thickening of atrial myocardium, increase in PVR and remodelling of the pulmonary vasculature with PHT
Increased – marked volume enlargement, lesser changes in pulmonary vasculature, but develop AF
A combination of the two
what are clinical manifestations of mitral regurgitation?
Acute MR (valve perforation, chordal/pap muscle) Breathlessness: pulm oedema, cardiogenick shock
Chronic MR:
Fatigue, exhaustion (low CO), Right heart failure
Dyspnoea or palpitations due to AFib
what would you see examining a patient with mitral regurgitation?
Pulse – normal or reduced in heart failure
JVP – prominent if RH failure present
Brisk and hyperdynamic apex beat
RV heave
what are laboratry investigations for mitral regurgitation?
ECG: LA enlargement (P>0.12 sec, tall), RVH (prominent R wave in R precordial leads)
CXR: cardiomegaly, LA enlargement, calcification of mitral annulus
Cardiac catheterisation: LV angiography - obsolete
what imaging would you use for mitral regurgitation?
echocardiography
what would you see from an echocardioggraph with someone that has mitral regurgitation?
LV dimensions
Cause of MR: leaflet dysfunction, chordae, pap muscles, annular disease
Severity of MR and Pap
what is medical treatment of mitral regurgitation?
Acute MR: preload and afterload reduction may be life-saving (sodium nitroprusside, dobutamine, IABP)
Chronic MR: lack of evidence that any therapy is beneficial for haemodynamic improvement, LV function preservation
what would interventional mitral regurgitation treatment be?
Mitral valve apparatus repair or
Mitral valve replacement
what is the aetiology of aortic stenosis?
Degenerative
Rheumatic
Bicuspid
whats the path-physiology of aortic stenosis?
Rheumatic: Adhesion, fusion of the commissures and retraction and stiffening of the free cusp margins
Degenerative: linked to atherosclerosis, a slow inflammatory process resulting in thickening and calcification of the cusps from base to free margins
what chamber is most affected with aortic stenosis?
left ventricle
what are aortic stenosis symptoms?
Long asymptomatic phase Cardinal Symptoms Chest pain (angina) Syncope/Dizziness (exertional pre-syncope) Breathlessness on exertion Heart failure
what would you see with a patient with aortic stenosis when examining them?
Pulse – small volume and slowly rising
JVP – prominent if RH failure present, low BP
Vigurous and sustained apex beat
RV heave
what are laboratory investigations for aortic stenosis?
ECG: LVH voltage criteria, ST/T changes (LV strain)
CXR: calcification of AV
Cardiac catheterisation: Peak LV-peak aortic gradient- obsolete
whats the imaging you would use for aortic stenosis?
Echocardiography
CMR
what would you see on an echocardiogram with a patient wiht aortic stenosis?
Demonstrates the AV cusp mobility
LV function and hypertrophy
Doppler haemodynamic assessment of pressure gradient and AVA
how goos is treatment for aortic stenosis?
Limited to those who develop heart failure
but can do the interventional treatment which is aortic valve replacement or repair
whats the aetiology of aortic regurgitation?
Aorta
Dilated aorta (Marfans, hypertension)
Connective tissue disorders
Leaflets Bicuspid aortic valve Rheumatic heart disease Endocarditis Myxomatous degeneration
whats the path-physiology of aortic regurgitation
LV accommodates both SV and RegVol Increased LVEDV and LV systolic pressure LV hypertrophy and LV dilatation Increased MVO2 Myocardial ischaemia LV failure
whats the symptoms of aortic regurgitations?
Chronic AR:
Long asymptomatic phase
Exertional breathlesness
Acute AR:
Poorly tolerated as wall tension cannot acutely adapt
(LV pressure x LV radius /wall thickness)
what would ou see on examination with a patient with aortic regurgitation?
Pulse – large volume and collapsing (Corrigan sign)
Wide pulse pressure
Hyperdynamic, displaced apex beat
whats the laboratory investiagtion in aortic regurgitation?
ECG: ST/T changes (LV strain), LAD
CXR: cardiomegaly in chronic AR
Cardiac catheterisation: obsolete, previously aortogram performed
what imaging would you use for aortic regurgitation?
Echocardiography
what would you see on an echocardiogram with a patient with aortic regurgitation?
Demonstrates the AV cusp anatomy (thickening, prolapsing, number of cusps, vegetations)
LV function, dilatation and hypertrophy
Doppler haemodynamic assessment of regurgitant flow
what is the medical treatment for aortic regurgitation?
Vasodilator therapy shown to delay the timing for surgical intervention
what is the interventional treatment of aortic regurgitation?
Aortic valve replacement or repair
