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1ST YEAR SYSTEMS: Cardiovascular > Valvular heart disease > Flashcards

Valvular heart disease Flashcards

1
Q

where is the mitral valve in the heart

A

between the L atrium and L ventricle

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2
Q

what can cause mitral stenosis?

A

rheumatic heart disease
congenital mitral stenosis
systemic conditions like rheumatoid arthritis and systemic lupus erythematous (SLE)

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3
Q

what happens to LV pressures and systolic function in mitral stenosis?

A

they remain normal

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4
Q

Clinical signs of mitral stenosis (6)

A

Dyspnoea: mild exertional to pulmonary oedema

Haemoptisis: rupture of thin-walled veins

Systemic embolisation: LA and LAA enlargement

IE - infective endocarditis

Chest pain

Hoarseness (compression of the L recurrent laryngeal nerve)

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5
Q

what is mitral facies?

A

a distinctive facial appearance associated with mitral stenosis. Someone with mitral stenosis may present with rosy cheeks, whilst the rest of the face has a bluish tinge due to cyanosis

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6
Q

what would you find upon examination of stomeone with mitral senosis

A 
Mitral facies
Pulse – normal
JVP – prominent a wave
Tapping apex beat and diastolic thrill
RV heave
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7
Q

what investigations can be done for mitral stenosis

A

ECG
Echo - TOE
CXR - large left atrium
Cardiac catheterisation - dye put through heart - seen on chest x ray and pressure is measured - not used much

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8
Q

what imaging techniques are used for VHD

A

echocardiogram - see thickening and scarring of the leaflets (around valve)

cardiac magnetic resonance (MRI of the heart)

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9
Q

what are the 2 interventional invasive treatment options for mitral stenosis

A

valvotomy - balloon or surgical (cuts into leaflets)

Mitral valve replacement

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10
Q

what change in your diet can be implemented to treat mitral stenosis

A

low Na intake

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11
Q

what treatment options are there for mitral stenosis?

A

diuretics - increase the amount of H20 and Na in urine so more removed from the body

anticoagulants for all with atrial fibrillation

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12
Q

what does treatment for those with atrial fibrillation aim to do?

A

restore sinus rhythm or ventricular rate control

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13
Q

when might you get mitral regurgitation (backward blood flow through MV when left ventricle contracts)

A

rheumatic heart disease
mitral valve prolapse (2 valves don’t close evenly)
Infective endocarditis
degenerative MR - primary
functional MR - secondary - due to LV and annular dilatation

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14
Q

anticoagulation treatment is given to all patients with what condition?

A

atrial fibrillation

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15
Q

what 2 interventional/invasive treatments are used for mitral heart disease

A

Valvotomy - balloon vs surgical - cutting into valve leaflets

MVR - mitral valve replacement

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16
Q

what diseases can cause mitral valve regurgitation?

A

rheumatic heart disease
mitral valve prolapse
infective endocarditis

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17
Q

degenerative MR is primary or secondary?

A

primary

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18
Q

functional MR is primary or secondary

A

secondary - due to LV and annular dilatation. The mitral valve itself is normal in secondary however regurgitation occurs by either myocardial infarction or cardiomyopathy

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19
Q

Define mitral regurgitation

A

abnormal reversal of blood flow from the L ventricle to the L atrium. The volume of both chambers increase

20
Q

How does the LV compensate for MR

A

MR exerts a vol overload on the LV which is then compensated by eccentric hypertrophy (dilatation) in chronic MR

21
Q

What happens to the EDV and regurgitation vol in chronic MR?

A

EDV increases and end- systolic volume

regurgitation volume increases

22
Q

why is systolic pressure lower than normal in MR

A

extra volume is delivered into the LA so there is a smaller end systolic volume - lower systolic pressure

23
Q

What happens to the LV with pattern of overload over time? and what does this allow?

A

LV remodels as a thin-walled enlarged chamber that permits supernormal diastolic function. This allows the LV to deliver an increased total SV and a normal forward SV

24
Q

How does the remodeling of the LV ultimately lead to heart failure?

A

eventually the overload damages the LV

25
Q

what clinical signs are associated with acute and chronic MR?

A

acute - SOB - pulmonary oedema, cardiogenic shock

chronic - fatigue, exhaustion (low cardiac output), right heart failure
dyspnoea or palpitations due to atrial fibrillation

26
Q

What would you find on clinical examination of someone with MR?

A 
Normal pulse or reduced in heart failure
JVP prominent if RH failure 
Brisk or hyperdynamic apex beat - radiates to axilla
RV heave
Reduced S1 sound
split S2
27
Q

Lab investigations

A

ECG
CXR
Cardiac catheterisation - LV angiography, obsolete

28
Q

Imaging for MR

A

echocardiography

helps see severity of MR

29
Q

Treatment for acute and chronic MR

A

Acute preload and afterload reduction may be life-saving
sodium nitroprusside

chronic - lack of evidence that therapy works for haemodynamic improvement
MVR

30
Q

how wide is a normal aortic valve

A

3-4 cm2

31
Q

3 causes of aortic stenosis

A

degenerative
rheumatic
bicuspid - if valve is bicuspid and not tricuspid it may cause the aortic valve to narrow

32
Q

Describe what happens to the aortic valve in rheumatic aortic stenosis

A
  • adhesion, fusion of the commissures (location at which 2 valve leaflets touch at the edges) and retraction and stiffening of the free cusp margins

so basically can get fusion of commissures like as if someone has sown the valve leaflets together so they open up less
or
calcification of the valve - stiffer - can’t open much

33
Q

Describe what happens to the aortic valve in degenerative aortic stenosis

A

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

34
Q

Describe pathophysiology of aortic stenosis

A

increase in LV systolic pressure
severe concentric hypertrophy and LV mass
increased LV EDP LA pressure increases and you get pulmonary hypertension
increased myocardial O2 consumption
myocardial ischaemia (can’t meet demand)
LV failure

35
Q

define concentric hypertrophy

A

hypertrophic growth of a hollow organ without overall enlargement, in which the walls of the organ are thickened and its capacity or volume is diminished.

36
Q

Symptoms of aortic stenosis

A 
long asymptomatic phase 
chest pain (angina)
syncope/dizziness (exertional pre-syncope)
breathlessness on exertion
heart failure
37
Q

what would you find on clinical examination of patient with aortic stenosis

A

small pulse volume
slowly rising
JVP - prominent if RH failure present, low BP
vigorous and sustained apex beat
RV heave
normal S1 sound
S2 : less audible A2 (closure of aortic valve)

38
Q

investigations for aortic stenosis and regurgitation?

A

ECG
CXR
cardiac catheterisation

39
Q

Imaging for Aortic stenosis

A

echocardiography

CMR - MRI

40
Q

Causes for aortic regurgitation in relation to aorta (2)

A

dilated due to Marfan’s (an abnormality in connective tissue) or hypertension

41
Q

Causes for aortic regurgitation in relation to leaflets (4)

A

Bicuspid aortic valve
rheumatic heart disease
endocarditis
myxomatous degeneration - Connective tissue disorder

42
Q

pathophysiology of aortic regurgitation

A

LV accommodates both SV and regurgitant volume
increased LVEDV and LV systolic pressure
LV hypertrophy and LV dilatation
increased MVO2 (myocardial O2 consumption)
Myocardial ischaemia
LV failure

43
Q

Symptoms of chronic aortic regurgitation

A

long asymptomatic phase

exertional breathlessness

44
Q

Symptoms of acute aortic regurgitation

A

poorly tolerated as LV wall tension cannot acutely adapt

45
Q

What would you find on examination of patient with aortic regurgitation

A

pulse - large volume and collapsing
wide pulse pressure
hyperdynamic, displaced apex beat
normal S1 and S2 sounds, soft murmur, early diastolic

46
Q

treatment for aortic regurgitation (2)

A

vasodilator therapy shown to delay the timing for surgical intervention

AVR

1ST YEAR SYSTEMS: Cardiovascular (39 decks)

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