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Cardiovascular System > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

Aetiology

A
  • Rheumatic Heart Disease
  • Congenital MS
  • Systemic conditions SLE, RA
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2
Q

Pathophysiology

A

LA pressure increases
Pulmonary venous and capillary pressure increases
Pulmonary vascular resistance increases
Pulmonary arterial pressure increases and pulmonary hypertension develops

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3
Q

How is the left ventricle and systolic function in mitral stenosis

A

Normal

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4
Q

Clinical Manifestation of Mitral stenosis (6)

A 
Dyspnoea
Haemoptysis
Systemic embolisation
Infective endocarditis
Chest pain
Hoarseness
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5
Q

Clinical Examination of Mitral Stenosis (6)

A 
Mitral facies
Normal pulse
JVP-prominen wave
Tapping apex beat
Diastolic thrill
RV heave
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6
Q

Investigations for Mitral Stenosis

A

ECG P> 0.12 sec
CXR0 LA enlargement
ECHO- thickening and scarring of leaflets and fusion of commissures
Imaging- cardiac magnetic resonance

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7
Q

Medical Treatment (4)

A

• Diuretics and restriction of Na intake (reduce blood pressure)
• Atrial Fibrillation: Sinus rhythm restoration or ventricular rate control
Valvotomy
Mitral valve replacement

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8
Q

Acute Mitral Regurgitation

A

decrease in EDP and decrease in wall tension

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9
Q

Chronic Mitral Regugitation

A

Increase in EDP and ESP returns to normalEccentic LVH develops

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10
Q

Normal size of ope aorta

A

3-4 cm (2)

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11
Q

Aetiology of stenosis

A
  • Degenerative
  • Rheumatic
  • Bicuspid
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12
Q

Stenosed Aortic valve

A

<1.5 cm (2)

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13
Q

Rheumatic pathophysiology of aortic stenosis

A

adhesion, fusion of the commissures and retraction and stiffening of the free cusp margins

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14
Q

Degenerative pathophysiology of aortic stenosis

A

linked to atherosclerosis, a slow inflammatory process resulting in thickening and calcification of the cusps from base to free margin

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15
Q

Stages of development of aortic stenosis (7)

A
  1. Increased LV systolic pressure
  2. Severe concentric hypertrophy and
  3. Left ventricular pressure increases
  4. Pulmonary Hypertension
  5. Myocardial ischaemia
  6. LV failure
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16
Q

Symptoms of aortic stenosis (4)

A

Angina
Syncope/Dizziness
Breathlessness on exertion
Heart failure

17
Q

Clinical Examination of aortic stenosis (6)

A 
Pulse- small volume and slowly rising
JVP- prominent
Low BP
RV heave
Normal S1
S2 less audible
18
Q

Laboratory investigations of aortic stenosis (6)

A 
ECG
CXR
Cardiac catheterisation
ECHO
CMR
19
Q

What does an ECG demonstrate in aortic stenosis

A

LVH- ST/T changes

20
Q

What does a CXR demonstrate in aortic stenosis

A

Calcification of AV

21
Q

What does an ECHO demonstrate in aortic stenosis

A
  • Demonstrate the AV cusp mobility
  • LV function and hypertrophy
  • Doppler haemodynamic assessment of pressure gradient and AVA
22
Q

Treatment of aortic stenosis

A

Aortic valve repair or replacement

23
Q

Aetiology of Aortic regurgitation (2)

A
  1. Dilated aorta (Marfans, hypertension)

2. CT disorder

24
Q

What problems arise in the valves with aortic regurgitation (4)

A

Bicuspid aortic valve
Rheumatic heart disease
Endocarditis
Myxomatous degeneration

25
Q

Pathophysiology of aortic regurgitation

A
  • 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
26
Q

Symptoms in chronic AR (2)

A
  • Long asymptomatic phase

* Exertional breathlessness

27
Q

Symptoms on acute AR

A
  • Poorly tolerated as wall tension cannot acutely adapt

* (LV pressure x LV radius /wall thickness)

28
Q

Clinical examination of AR

A
  • Pulse- large volume and collapsing (Corrigan sign)
  • Wide pulse pressure
  • Hyperdynamic, displaced apex beat
  • Early diastolic, decrescendo, soft murmur
29
Q

Investigations for AR (5)

A

ECG
CXR
Cardiac Catheterisation
ECH/CMR

30
Q

With imagine what are you looking for

A

 AV cusps anatomy (Thickening, prolapsing, number of cusps, vegetations)
 LV function, dilatation and hypertrophy
 Doppler haemodynamic, assessment of regurgitant flow

31
Q

Medical treatment for AR (2)

A
  • Vasodilator therapy shown to delay the timing for surgical intervention
  • Aortic valve replacement or repair

Cardiovascular System (42 decks)

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