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1st year systems > valvular heart disease > Flashcards

valvular heart disease Flashcards

1
Q

what is mitral stenosis?

A

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

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2
Q

what changes happen to the chambers with mitral stenosis?

A 
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
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3
Q

what happens to the left ventricular pressures and systolic function with mitral stenosis?

A

its just normal

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4
Q

what are clinical manifestations of mitral stenosis?

A

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)

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5
Q

what would you see on a clilnical examination for mitral stenosis?

A 
Mitral facies
Pulse – normal
JVP – prominent a wave
Tapping apex beat and diastolic thrill
RV heave
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6
Q

how would you investigate mitral stenosis?

A

ECG
cardiac catheterisation
cxr

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7
Q

what is the imaging that you would use ofr mitral stenosis?

A

echocardiography

cardiac magnetic resonance

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8
Q

what medical treatment would you suggest for mitral stenosis?

A

Diuretics and restriction of Na intake
AF: SR restoration or ventricular rate control
Anticoagulation: all those with AF, debatable in SR

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9
Q

what is interventional treatment for mitral stenosis?

A

Valvotomy (balloon vs surgical)

MVR

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10
Q

what is aetiology and pathology of mitral regurgitation?

A 
Rheumatic Heart Disease
Mitral valve prolapse (MVP)
IE
Degenerative
Functional MR due to LV and annular dilatation
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11
Q

whats the path-physiology of mitral regurgitation?

A

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

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12
Q

what are clinical manifestations of mitral regurgitation?

A 
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

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13
Q

what would you see examining a patient with mitral regurgitation?

A

Pulse – normal or reduced in heart failure
JVP – prominent if RH failure present
Brisk and hyperdynamic apex beat
RV heave

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14
Q

what are laboratry investigations for mitral regurgitation?

A

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

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15
Q

what imaging would you use for mitral regurgitation?

A

echocardiography

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16
Q

what would you see from an echocardioggraph with someone that has mitral regurgitation?

A

LV dimensions
Cause of MR: leaflet dysfunction, chordae, pap muscles, annular disease
Severity of MR and Pap

17
Q

what is medical treatment of mitral regurgitation?

A

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

18
Q

what would interventional mitral regurgitation treatment be?

A

Mitral valve apparatus repair or

Mitral valve replacement

19
Q

what is the aetiology of aortic stenosis?

A

Degenerative
Rheumatic

Bicuspid

20
Q

whats the path-physiology of aortic stenosis?

A

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

21
Q

what chamber is most affected with aortic stenosis?

A

left ventricle

22
Q

what are aortic stenosis symptoms?

A 
Long asymptomatic phase
Cardinal Symptoms
Chest pain (angina)
Syncope/Dizziness (exertional pre-syncope)
Breathlessness on exertion
Heart failure
23
Q

what would you see with a patient with aortic stenosis when examining them?

A

Pulse – small volume and slowly rising
JVP – prominent if RH failure present, low BP
Vigurous and sustained apex beat
RV heave

24
Q

what are laboratory investigations for aortic stenosis?

A

ECG: LVH voltage criteria, ST/T changes (LV strain)

CXR: calcification of AV

Cardiac catheterisation: Peak LV-peak aortic gradient- obsolete

25
Q

whats the imaging you would use for aortic stenosis?

A

Echocardiography

CMR

26
Q

what would you see on an echocardiogram with a patient wiht aortic stenosis?

A

Demonstrates the AV cusp mobility
LV function and hypertrophy
Doppler haemodynamic assessment of pressure gradient and AVA

27
Q

how goos is treatment for aortic stenosis?

A

Limited to those who develop heart failure

but can do the interventional treatment which is aortic valve replacement or repair

28
Q

whats the aetiology of aortic regurgitation?

A

Aorta
Dilated aorta (Marfans, hypertension)
Connective tissue disorders

Leaflets
Bicuspid aortic valve
Rheumatic heart disease
Endocarditis
Myxomatous degeneration
29
Q

whats the path-physiology of aortic regurgitation

A 
LV accommodates both SV and RegVol
Increased LVEDV and LV systolic pressure
LV hypertrophy and LV dilatation
Increased MVO2
Myocardial ischaemia
LV failure
30
Q

whats the symptoms of aortic regurgitations?

A

Chronic AR:
Long asymptomatic phase
Exertional breathlesness

Acute AR:
Poorly tolerated as wall tension cannot acutely adapt
(LV pressure x LV radius /wall thickness)

31
Q

what would ou see on examination with a patient with aortic regurgitation?

A

Pulse – large volume and collapsing (Corrigan sign)
Wide pulse pressure
Hyperdynamic, displaced apex beat

32
Q

whats the laboratory investiagtion in aortic regurgitation?

A

ECG: ST/T changes (LV strain), LAD

CXR: cardiomegaly in chronic AR

Cardiac catheterisation: obsolete, previously aortogram performed

33
Q

what imaging would you use for aortic regurgitation?

A

Echocardiography

34
Q

what would you see on an echocardiogram with a patient with aortic regurgitation?

A

Demonstrates the AV cusp anatomy (thickening, prolapsing, number of cusps, vegetations)
LV function, dilatation and hypertrophy
Doppler haemodynamic assessment of regurgitant flow

35
Q

what is the medical treatment for aortic regurgitation?

A

Vasodilator therapy shown to delay the timing for surgical intervention

36
Q

what is the interventional treatment of aortic regurgitation?

A

Aortic valve replacement or repair

1st year systems (74 decks)

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