Valvular heart disease Flashcards
what are common valve diseases
- Mitral valve prolapses
- Aortic stenosis/regurgitation
- Mitral regurgitation
- Mitral stenosis
- Right sides valve lesions
what is rheumatic fever
- 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
why is rheumatic fever less present down
- Environmental factors
- Decrease in virulence of group A h’lytic strep
- Penicillin
name a virus that can cause rheumatic fever
group A h’lytic strep
define mitral valve prolapse
≥2mm systolic prolapse of 1 or both valve leaflets beyond long-axis annular plane during 2DE
what is the pathology of mitral valve prolapse
histologically normal valves
– myxomatous degeneration
– Marfan, Ehlers danlos
describe the physiology of mitral valve prolapse
• During systole when the valve is close the valve leaflet flops back into the left ventricle
what are the symptoms of mitral valve prolapse
- usually asymptomatic
- associated with chest pain and atrial arrhythmia
name a clinical sign of mitral valve prolapse
• 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
what is aortic stenosis
- narrowing of the aortic valve
what is the causes of aortic stenosis
- Calcific disease
- Congenital bicuspid valve – tends to degenerate an calcific in middle age
- Rheumatic disease
what are the clinical findings of aortic stenosis
- dyspnoea
- angina
- syncope
- left ventricular failure
- sudden death
describe the clinical findings of aortic stenosis
- 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
what are the signs of aortic stenosis
Slow rising carotid pulse
S4 ± ejection click
Ejection systolic murmur
what does an ECG look like for aortic stenosis
exaggerated QRS on the anterior chest lead, thick heart muscle generates a lot of electrical activity
what are the indications of surgery in aortic stenosis
• 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
what are the two causes of aortic regurgitation
- aortic valve leaflet disease
- aortic root dilating disease
describe how aortic valve leaflet disease can cause aortic regurgitation
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
describe how aortic root dilating disease can cause aortic regurgitation
- Ankylosing spondylitis
- Marfan syndrome
- Aortic dissection
what are the clincial symptoms of aortic regurgitation
Dyspnoea - contractile failure as ventricle dilates
• Angina - O2 demand of dilated hypertrophied LV
what are the clinical signs of aortic regurgitation
- 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)
what are the indications of surgery for aortic regurgitation
- Any symptoms of AR
- Echocardiographic evidence of worsening LV dilation
what are the causes of mitral stenosis
- Rheumatic fever
what are the symptoms of mitral stenosis
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
what are the signs of mitral stenosis
Pulse - AF
Auscultation (heart)- loud S1, opening snap, mid-diastolic rumble, ± pre-systolic murmur (SR only)
Volume overload - increased JVP, basal creps, ankle oedema
what are the investigations used for mitral stenosis
ECG
echocardiogram
what do you need to have n order to have a valvuloplasty for mitral stenosis
noncalcified valve, no mitral regurgitation, no LA thrombus
name the 3 causes of mitral regurgitation
- mitral valve leaflet disease
- subvalvar disease
- functional MR
how does mitral leaflet disease cause mitral regurgitation
- Mitral valve prolapse
• Rheumatic disease
• Infective endocarditis
how does subvalvar disease cause mitral regurgitation
- Chordal rupture
• Papillary muscle dysfunction (usually ischaemic)
• Papillary muscle rupture
how does functional MR lead to mitral regurgitation
LV dilation
what are the symptoms of mitral regurgitation
Dyspnoea, orthopnoea - due to increased left atrial pressure
Palpitations- atrial fibrillation
Systemic emboli- static blood within dilated fibrillating left atrium predisposes to thrombosis
what are the signs of mitral regurgitation
Pulse - SR/AF
Auscultation (heart) - Pansystolic murmur S3
Volume overload -increased JVP, basal creps, ankle oedema
what are the indications for surgery on mitral regurgitation
• 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
what is the drug treatment given to patients with valvular heart disease
- 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)
