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valvular heart disease Flashcards

1
Q

why is rheumatic fever less common?

A
  • Environmental factors
  • Decreased virulence of group A h’lytic strep
  • Penicillin
  • Surgical treatment saving more lives
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2
Q

name common valve lesions from most to least common

A
  • Mitral valve prolapse
  • Aortic stenosis / regurgitation
  • Mitral regurgitation
  • Mitral stenosis
  • Right sided valve lesions
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3
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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4
Q

what is the prevalence of mitral valve prolapse?

A

2-3% affecting men and women equally

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5
Q

what is the pathology of mitral valve prolapse

A

o histologically normal valves
o myxomatous degeneration
o Marfan, Ehlers danlos

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6
Q

what is the physiology of mitral valve prolapse?

A

valve leaflet(s) prolapses back into LA during systole, sometimes producing MR (variable severity - usually trivial)

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7
Q

what are the symptoms of mitral valve prolapse?

A

usually asymptomatic, questionable association with chest pain and atrial arrhythmias

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8
Q

what are the signs of mitral valve prolapse?

A

ejection click ± late systolic murmur

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9
Q

what is the treatment for mitral valve prolapse?

A

usually none necessary

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10
Q

what are the causes of aortic stenosis?

A
  • Calcific disease
  • Congenital bicuspid valve
  • Rheumatic disease
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11
Q

what are the symptoms of aortic stenosis and what causes them?

A
  • Dyspnoea - diastolic pressure in stiff non-compliant LV
  • Angina - O2 demand of hypertrophied LV
  • Syncope - either paroxysmal ventricular arrhythmias or exertional cerebral hypoperfusion
  • LVF - contractile failure as ventricle dilates
  • Sudden death - ventricular arrhythmias
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12
Q

what are the signs of aortic stenosis?

A
  • Slow rising carotid pulse
  • S4 ± ejection click
  • Ejection systolic murmur
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13
Q

what do the pressure signals look like in aortic stenosis?

A
  • Severe pressure gradient across aortic valve

* Prominent ‘a’ wave (arrowed)

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14
Q

what are indications for surgery in aortic stenosis?

A
  • Any symptoms of AS
  • Echocardiographic evidence of worsening LV dilatation
  • Peak systolic pressure gradient >50 mmHg
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15
Q

what do you do for aortic stenosis patients too sick for heart surgery?

A

• TAVI for patients too sick for heart surgery

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16
Q

what are the 2 main causes of aortic regurgitation?

A

aortic valve leaflet disease

aortic root dilating disease

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17
Q

what are the causes of aortic valve leaflet disease?

A

o Calcific disease
o Congenital bicuspid valve
o Rheumatic disease
o Infective endocarditis

18
Q

what are the causes of aortic root dilating disease?

A

o Ankylosing spondylitis
o Marfan syndrome
o Aortic dissection

19
Q

what are the symptoms of aortic regurgitation and what causes them?

A

often none
o Dyspnoea - contractile failure as ventricle dilates
o Angina - O2 demand of dilated hypertrophied LV

20
Q

what are the signs of aortic regurgitation?

A

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

21
Q

what investigations do you do for aortic regurgitation?

A

aortic root angiogram and 2D Echo-Doppler

22
Q

what are the indications for surgery in aortic regurg?

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 and what causes them?

A
  • Dyspnoea, orthopnoea - left atrial pressure
  • RV failure - passive consequence of 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 signs of mitral stenosis?

A
  • Pulse – AF
  • Ascultation (heart) – loud S1, opening snap mid-diastolic rumble + pre-systolic murmur (SR only)
  • Volume overload - JVP, basal creps, ankle oedema
26
Q

what investigations are needed for mitral stenosis?

A

just need an echo

27
Q

how is mitral stenosis treated?

A

valvuloplasty

28
Q

what are the requirements for valvuloplasty?

A

Noncalcified valve, no mitral regurgitation, no LA thrombus

29
Q

what are the 3 main causes of mitral regurg?

A

mitral valve leaflet disease
subvalvular disease
functional MR

30
Q

what causes mitral valve leaflet disease?

A

Mitral valve prolapse
• Rheumatic disease
• Infective endocarditis

31
Q

what causes subvalvular disease?

A

Chordal rupture
• Papillary muscle dysfunction (usually ischaemic)
• Papillary muscle rupture

32
Q

what causes functional MR?

A

LV dilation

33
Q

what are the symptoms of mitral regurg and what causes them?

A
  • Dyspnoea, orthopnoea - left atrial pressure
  • Palpitations - atrial fibrillation
  • Systemic emboli - static blood within dilated fibrillating left atrium predisposes to thrombosis
34
Q

what are the signs of mitral regurg?

A
  • Pulse - SR/AF
  • Auscultation (heart) - Pansystolic murmur - S3
  • Volume overload - JVP, basal creps, ankle oedema
35
Q

what investigations are done to detect mitral regurg?

A
  • M-mode echo/phono/Doppler

* LV angiogram

36
Q

what are indications for surgery in patients with mitral regurg?

A

• Symptoms that fail to respond to medical treatment
• Worsening cardiovascular complications
o pulmonary hypertension (MS)
o LV dilatation (MR)
• Percutaneous MitraClip for patients too sick for heart surgery

37
Q

what is the medical treatment for 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)
38
Q

how do you treat fluid retention?

A

diuretics

39
Q

how do you treat Low forward output due to regurgitant valve lesions (AR, MR)?

A

vasodilators

40
Q

how do you treat AF?

A

digoxin, beta-blockers, verapamil

41
Q

how do you protect against systemic embolisation?

A

anticoagulants

c2 (37 decks)

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