Valvular Heart Disease Flashcards
Name the 4 heart valves [4]
- aortic valve
- mitral valve
- pulmonary valve
- tricuspid valve
What are the features of the aortic valve? [3]
- semilunar valve
- lies between left ventricle and aorta
- has 3 cusps (tri-leaflet)
What are the features of the mitral valve? [3]
- bicuspid valve
- lies between the left atrium and left ventricle
- has 2 leaflets (anterior and posterior)
What are the features of the pulmonary valve? [3]
- 3 leaflets
- semilunar valve
- lies between right ventricle and pulmonary artery
What are the features of the tricuspid valve? [2]
- 3 leaflets
- lies between right atrium and right ventricle
Define the valve annulus [1]
the base of the heart valve that supports the leaflets
What structural defects can occur with the valve leaflets? [5]
- calcification
- thickening
- degeneration
- infection
- prolapse
What structural defects can occur with valve apparatus/annulus? [4]
- annular dilatation
- annular calcification
- apparatus tethering/thickening/rupture
- regional wall motion abnormality
Name the functional defects that can affect valves [2]
- stenosis
- regurgitation
Define stenosis [2]
abnormal narrowing of opening of heart valve resulting in pressure overload
Define regurgitation [2]
blood surging back through a defective valve in the heart after the heart has contracting resulting in volume overload
What is the cause of rheumatic valve disease? [1]
acute rheumatic fever
What is the cause of acute rheumatic fever and how does it progress? [2]
- disease caused by strep. pyrogenes infection
- may progress to chronic rheumatic valve disease, with cardiac injruy generated by recurrent inflammation, fibrinous repair and scarring
What are the typical symptoms of acute rheumatic fever? [3]
- painful joints (arthritis)
- fever
- rashes on skin
Which valve is most commonly affected by rheumatic valve disease? [1]
mitral valve
Define aortic stenosis [2]
narrowing of the opening of the aortic valve due to thickening or fusion of the cusps that comprise the valve
- results in an obstruction of the flow of blood from the left ventricle to the aorta during systole
What are the main causes of aortic stenosis? [3]
- rheumatic valve disease
- calcification
- may be congenital
What are the complications of aortic stenosis? [2]
- Increased left ventricular cavity pressure
- Pressure overload leading left ventricular hypertrophy
What are the typical symptoms of aortic stenosis? [5]
- Shortness of breath
- Presyncope
- Syncope
- Chest pain
- Reduced exercise capacity
What are the typical signs of aortic stenosis? [5]
- Ejection systolic murmur
- Soft/quiet second heart sound
- Narrowed pulse pressure
- Heaving apex beat (due to left ventricular hypertrophy)
- Signs of heart failure
Define aortic regurgitation [1]
A leak of the aortic valve resulting in reflux of blood from the aorta into the left ventricle during diastole
What are the causes of aortic regurgitation? [8]
- Degenerative “wear and tear” of the aortic valve
- Rheumatic valve disease
- Aortic root dilatation
- Systemic disease
- Marfan’s syndrome
- Ehlers Danlos syndrome
- Ankylosing spondylitis
- Systemic lupus erythematosus (SLE)
- Endocarditis
What are the complications of aortic regurgitation? [2]
- Volume overload
- Left ventricular dilatation
What are the typical symptoms of aortic regurgitation? [2]
- Shortness of breath
- Reduced exercise capacity
What are the typical signs of aortic regurgitation? [4]
- Early diastolic murmur
- Increased pulse pressure
- Collapsing pulse
- Signs of heart failure
Define a bicuspid aortic valve abnormality [1]
Aortic valve that has 2 leaflets instead of the normal tricuspid leaflets (1-2%)
What are the complications of a bicuspid aortic valve? [2]
- Prone to premature dysfunction
- Associated with aortic abnormalities
Define mitral stenosis [1]
narrowing of the opening of the mitral valve
What are the causes of mitral stenosis? [6]
- Rheumatic valve disease (most common cause)
- Pressure overload
- Dilated left atrium
- Atrial fibrillation
- Pulmonary hypertension
- Secondary right heart dilatation
What are the typical symptoms of mitral stenosis? [5]
- Shortness of breath
- Palpitation
- Chest pain
- Haemoptysis - unique to mitral stenosis
- Right heart failure symptoms
Define mitral regurgitation [1]
Failure of the mitral valve to close, allowing a reflux of blood from the left ventricle of the heart to the left atrium
What are the causes of mitral regurgitation? [5]
- Multifactorial
- Leaflets
- Annulus
- Apparatus
- Volume overload - left atrium/left ventricle
- LV and LA dilatation
- Secondary right heart dilatation
- Atrial fibrillation
What are the typical symptoms of mitral regurgitation? [3]
- Shortness of breath
- Palpitation
- Right heart failure symptoms
What are the typical signs of mitral regurgitation? [4]
- Pansystolic murmur
- Quiet first heart sound
- Displaced apex beat
- Signs of heart failure
What types of investigations would you use for assessing valvular heart disease? [13]
- History
- Examination
- Blood pressure
- ECG
- Exercise Tolerance Test
- CPET (cardiopulmonary exercise testing)
- Stress echo
- Echo
- CT
- MRI
- Left heart catheterisation
- Right heart catheterisation
What are the types of intervention used for valvular heart disease? [4]
- Surgical:
- valve replacement
- Procedural:
- TAVI (transcatheter aortic valve implantation)
- mitraclip
- valvuloplasty (Melody valve)
