Valvular Heart Disease Flashcards
Aetiology
- Rheumatic Heart Disease
- Congenital MS
- Systemic conditions SLE, RA
Pathophysiology
LA pressure increases
Pulmonary venous and capillary pressure increases
Pulmonary vascular resistance increases
Pulmonary arterial pressure increases and pulmonary hypertension develops
How is the left ventricle and systolic function in mitral stenosis
Normal
Clinical Manifestation of Mitral stenosis (6)
Dyspnoea Haemoptysis Systemic embolisation Infective endocarditis Chest pain Hoarseness
Clinical Examination of Mitral Stenosis (6)
Mitral facies Normal pulse JVP-prominen wave Tapping apex beat Diastolic thrill RV heave
Investigations for Mitral Stenosis
ECG P> 0.12 sec
CXR0 LA enlargement
ECHO- thickening and scarring of leaflets and fusion of commissures
Imaging- cardiac magnetic resonance
Medical Treatment (4)
• Diuretics and restriction of Na intake (reduce blood pressure)
• Atrial Fibrillation: Sinus rhythm restoration or ventricular rate control
Valvotomy
Mitral valve replacement
Acute Mitral Regurgitation
decrease in EDP and decrease in wall tension
Chronic Mitral Regugitation
Increase in EDP and ESP returns to normalEccentic LVH develops
Normal size of ope aorta
3-4 cm (2)
Aetiology of stenosis
- Degenerative
- Rheumatic
- Bicuspid
Stenosed Aortic valve
<1.5 cm (2)
Rheumatic pathophysiology of aortic stenosis
adhesion, fusion of the commissures and retraction and stiffening of the free cusp margins
Degenerative pathophysiology of aortic stenosis
linked to atherosclerosis, a slow inflammatory process resulting in thickening and calcification of the cusps from base to free margin
Stages of development of aortic stenosis (7)
- Increased LV systolic pressure
- Severe concentric hypertrophy and
- Left ventricular pressure increases
- Pulmonary Hypertension
- Myocardial ischaemia
- LV failure
Symptoms of aortic stenosis (4)
Angina
Syncope/Dizziness
Breathlessness on exertion
Heart failure
Clinical Examination of aortic stenosis (6)
Pulse- small volume and slowly rising JVP- prominent Low BP RV heave Normal S1 S2 less audible
Laboratory investigations of aortic stenosis (6)
ECG CXR Cardiac catheterisation ECHO CMR
What does an ECG demonstrate in aortic stenosis
LVH- ST/T changes
What does a CXR demonstrate in aortic stenosis
Calcification of AV
What does an ECHO demonstrate in aortic stenosis
- Demonstrate the AV cusp mobility
- LV function and hypertrophy
- Doppler haemodynamic assessment of pressure gradient and AVA
Treatment of aortic stenosis
Aortic valve repair or replacement
Aetiology of Aortic regurgitation (2)
- Dilated aorta (Marfans, hypertension)
2. CT disorder
What problems arise in the valves with aortic regurgitation (4)
Bicuspid aortic valve
Rheumatic heart disease
Endocarditis
Myxomatous degeneration
Pathophysiology of aortic regurgitation
- LV accommodates both stroke volume and regurgitant volume
- Increased left ventricular end-diastolic volume and LV systolic pressure
- LV hypertrophy and LV dilatation
- Increased MVO2
- Myocardial Ischaemia
- LV failure
Symptoms in chronic AR (2)
- Long asymptomatic phase
* Exertional breathlessness
Symptoms on acute AR
- Poorly tolerated as wall tension cannot acutely adapt
* (LV pressure x LV radius /wall thickness)
Clinical examination of AR
- Pulse- large volume and collapsing (Corrigan sign)
- Wide pulse pressure
- Hyperdynamic, displaced apex beat
- Early diastolic, decrescendo, soft murmur
Investigations for AR (5)
ECG
CXR
Cardiac Catheterisation
ECH/CMR
With imagine what are you looking for
AV cusps anatomy (Thickening, prolapsing, number of cusps, vegetations)
LV function, dilatation and hypertrophy
Doppler haemodynamic, assessment of regurgitant flow
Medical treatment for AR (2)
- Vasodilator therapy shown to delay the timing for surgical intervention
- Aortic valve replacement or repair
