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Cardiorespiratory 2 > Valvular heart disease > Flashcards

Valvular heart disease Flashcards

1
Q

what are common valve diseases

A
  • Mitral valve prolapses
  • Aortic stenosis/regurgitation
  • Mitral regurgitation
  • Mitral stenosis
  • Right sides valve lesions
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2
Q

what is rheumatic fever

A
  • Inflammatory response that can effect either the mitral or aortic valve
  • Inflammation happens acutely and if it is very severe they could get very sick
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3
Q

why is rheumatic fever less present down

A
  • Environmental factors
  • Decrease in virulence of group A h’lytic strep
  • Penicillin
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4
Q

name a virus that can cause rheumatic fever

A

group A h’lytic strep

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5
Q

define mitral valve prolapse

A

≥2mm systolic prolapse of 1 or both valve leaflets beyond long-axis annular plane during 2DE

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6
Q

what is the pathology of mitral valve prolapse

A

histologically normal valves
– myxomatous degeneration
– Marfan, Ehlers danlos

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7
Q

describe the physiology of mitral valve prolapse

A

• During systole when the valve is close the valve leaflet flops back into the left ventricle

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8
Q

what are the symptoms of mitral valve prolapse

A
  • usually asymptomatic

- associated with chest pain and atrial arrhythmia

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9
Q

name a clinical sign of mitral valve prolapse

A

• If you listen to the patients you can hear the 1st half sound and then there is a click midsystole and at the end of systole when the aortic valve and pulmonary valve closes

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10
Q

what is aortic stenosis

A
  • narrowing of the aortic valve
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11
Q

what is the causes of aortic stenosis

A
  • Calcific disease
  • Congenital bicuspid valve – tends to degenerate an calcific in middle age
  • Rheumatic disease
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12
Q

what are the clinical findings of aortic stenosis

A
  • dyspnoea
  • angina
  • syncope
  • left ventricular failure
  • sudden death
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13
Q

describe the clinical findings of aortic stenosis

A
  • dyspnoea - increase in diastolic pressure in stiff non-compliant LV
  • Angina - increase in O2 demand of hypertrophied LV, thickened aortic valve as the ventricles have to generate more pressure to push blood through the valve thus is hypertrophied and it needs oxygen which the coronary cannot deliver, patietns are often quite old as have coronary disease so reduced oxygen levels
  • Syncope - either paroxysmal ventricular arrhythmias or exertional cerebral hypoperfusion, if you have aortic stenosis and you black out this is a serious sign, due to hypotension heart cannot increase blood around body
  • LVF - contractile failure as ventricle dilates
  • Sudden death - ventricular arrhythmias
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14
Q

what are the signs of aortic stenosis

A

Slow rising carotid pulse
S4 ± ejection click
Ejection systolic murmur

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15
Q

what does an ECG look like for aortic stenosis

A

exaggerated QRS on the anterior chest lead, thick heart muscle generates a lot of electrical activity

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16
Q

what are the indications of surgery in aortic stenosis

A

• Any symptoms of Aortic stenosis
• Echocardiographic evidence of worsening LV dilatation
• Peak systolic pressure gradient >50 mmHg
- TAVI is a new treatment that is being used, it involves putting the valve on the end of a Cather trans vascular aortic valve implantation

17
Q

what are the two causes of aortic regurgitation

A
  • aortic valve leaflet disease

- aortic root dilating disease

18
Q

describe how aortic valve leaflet disease can cause aortic regurgitation

A

Calcific disease
• Congenital bicuspid valve
• Rheumatic disease
• Infective endocarditis – damages the valve progressively therefore you only get regurigtiation in this, in particular effects aortic or mitral, mortality is 100% before antibiotics, effective against strap and strep 33% is dead with in a year now

19
Q

describe how aortic root dilating disease can cause aortic regurgitation

A
  • Ankylosing spondylitis
  • Marfan syndrome
  • Aortic dissection
20
Q

what are the clincial symptoms of aortic regurgitation

A

Dyspnoea - contractile failure as ventricle dilates

• Angina - O2 demand of dilated hypertrophied LV

21
Q

what are the clinical signs of aortic regurgitation

A
  • Rapidly rising carotid pulse - vigorous ejection of volume loaded LV
  • Early diastolic murmur - aortic backflow (left sternal edge)
  • Ejection murmur - turbulent ejection from volume loaded LV (left sternal edge)
22
Q

what are the indications of surgery for aortic regurgitation

A
  • Any symptoms of AR

- Echocardiographic evidence of worsening LV dilation

23
Q

what are the causes of mitral stenosis

A
  • Rheumatic fever
24
Q

what are the symptoms of mitral stenosis

A

Dyspnoea, orthopnoea - increased left atrial pressure

RV failure- passive consequence of increased left atrial pressure and reactive pulmonary vasoconstriction

Palpitations atrial fibrillation

Systemic emboli - static blood within dilated fibrillating left atrium predisposes to thrombosis

25
Q

what are the signs of mitral stenosis

A

Pulse - AF

Auscultation (heart)- loud S1, opening snap, mid-diastolic rumble, ± pre-systolic murmur (SR only)

Volume overload - increased JVP, basal creps, ankle oedema

26
Q

what are the investigations used for mitral stenosis

A

ECG

echocardiogram

27
Q

what do you need to have n order to have a valvuloplasty for mitral stenosis

A

noncalcified valve, no mitral regurgitation, no LA thrombus

28
Q

name the 3 causes of mitral regurgitation

A
  • mitral valve leaflet disease
  • subvalvar disease
  • functional MR
29
Q

how does mitral leaflet disease cause mitral regurgitation

A
  • Mitral valve prolapse
    • Rheumatic disease
    • Infective endocarditis
30
Q

how does subvalvar disease cause mitral regurgitation

A
  • Chordal rupture
    • Papillary muscle dysfunction (usually ischaemic)
    • Papillary muscle rupture
31
Q

how does functional MR lead to mitral regurgitation

A

LV dilation

32
Q

what are the symptoms of mitral regurgitation

A

Dyspnoea, orthopnoea - due to increased left atrial pressure

Palpitations- atrial fibrillation

Systemic emboli- static blood within dilated fibrillating left atrium predisposes to thrombosis

33
Q

what are the signs of mitral regurgitation

A

Pulse - SR/AF

Auscultation (heart) - Pansystolic murmur S3

Volume overload -increased JVP, basal creps, ankle oedema

34
Q

what are the indications for surgery on mitral regurgitation

A

• Symptoms that fail to respond to medical treatment
• Worsening cardiovascular complications
– pulmonary hypertension (MS)
– LV dilatation (MR)

Percutaneous MitraClip for patients too sick for heart surgery

35
Q

what is the drug treatment given to patients with valvular heart disease

A
  • Fluid retention - diuretics
    • Low forward output due to regurgitant valve lesions (AR, MR) - vasodilators
    • AF (MS, MR) - digoxin, beta-blockers, verapamil
    • Anticoagulants to protect against systemic embolisation (AF)

Cardiorespiratory 2 (43 decks)

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