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303 Lectures > Valvular heart disease > Flashcards

Valvular heart disease Flashcards

1
Q

Causes of valvular heart disease

A

Degenerative
- aortic > mitral

Infective

  • any valve
  • right atypical organism

Rheumatic

Congenital

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2
Q

Degenerative valve disease epidemiology

A

Reflects ageing population

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3
Q

Infective valve disease epidemiology

A

Most common on abnormal valves

Virulent organisms

Immunocompromised

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4
Q

Rheumatic valve disease epidemiology

A

Post streptococcal rheumatic fever

Children and young adults

Disease of poverty and overcrowding

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5
Q

Congenital heart disease epidemiology

A

Low static incidence in all populations

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6
Q

Pathology of valvular heart disease

A

Stenosis

  • fibrosis: fusion of leaflets
  • calcification: immobility of leaflets

Regurgitation

  • supporting structures: papillary muscles
  • dilatation of valve ring
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7
Q

Aortic stenosis aetiology

A

Congenital syndromes <60

Bicuspid valves 40-60

Degenerative >60

Post rheumatic fever

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8
Q

What is aortic stenosis?

A

Obstruction to blood flow- pressure overload in ventricle

Similar signs in other causes of obstruction
- HOCM, subvalvular/ supravalvular stenosis

Generation of high LV systolic pressure to force blood through the obstruction

Left ventricular hypertrophy

Eventually LV decompensation/ dilation

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9
Q

Aortic stenosis physiology

A

As ventricle contracts, pressure goes up forcing leaflets open

If stenosed it can’t open properly, producing turbulent flow- murmur

At beginning of systole pressure gradually rises so crescendo decrescendo sound, ejection systolic murmur

As the valve gets even thicker, doesn’t open properly or close properly so no second heart sound

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10
Q

Aortic stenosis symptoms

A

Chest pain

  • normal coronary arteries- supply/ demand
  • coronary artery disease

Breathlessness

Dizziness/ syncope

  • bradyarrhythmias
  • insufficient cardiac output

Sudden death

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11
Q

Aortic regurgitation aetiology

A

Aortic dilatation - loss of support
- connective tissue disease, hypertension, aortic dissection, degenerative, cystic medial necrosis, syphilis

Valvular
- bicuspid valve, infective endocarditis

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12
Q

Aortic regurgitation

A

At the end of systole the pressure in the ventricle falls and the valve leaflet closes

If it can’t close blood falls back into the ventricle

Early diastolic murmur

Normally abnormal valve so turbulence as blood comes out, commonly also systolic murmur

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13
Q

What is aortic regurgitation?

A

Blood falls back into LV during diastole

Resultant volume overload

LV dilatation to accommodate volume

Late decompensation of LV function

High volume circulation (as in pregnancy, anaemia, thyrotoxicosis)

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14
Q

Symptoms

A

Often asymptomatic

Chest pain

  • normal coronary arteries - supply demand
  • coronary artery disease

Breathlessness

Syncope- uncommon

Catastrophic decompensation if acute

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15
Q

Mitral regurgitation aetiology

A

Valvular

  • prolapse
  • infective
  • degenerative

Chordal/ papillary muscle failure
- acute/ chronic

Annular dilatation- secondary to left ventricular dilatation

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16
Q

Mitral regurgitation

A

As pressure in systole increases with ventricular contraction, the mitral valve is forced shut

If leaflets fail to coapt, blood squirts back into left atrium

Left atrium is low pressure and during systole the elft ventricle is high pressure, blood regurgitates back almost immediaitely and for the whole of systole

Mitral regurgitation classically produces pan-systolic murmur

17
Q

What is mitral regurgitation?

A

Blood ejected backwards during systole into the left atrium

Leads to transient elevation of left atrial pressure

Chronically affects the right heart raised PAP

Results in volume overload in subsequent cardiac cycles of left ventricle

As a result left ventricular dilatation and decompensation develops

18
Q

Symptoms of mitral regurgitation

A

Breathlessness- mitral valve next in line to lungs

Lethargy

Palpitations- atrial fibrillation

Peripheral oedema, hepatomegaly, JVP- decompensation (RHF consequence)

Chest pain- concomitant CAD

19
Q

Mitral prolapse

A

Initially valve shuts during early part of systole but then either because leaflet is too baggy or abnormal sub-valvular apparatus, the leaflets prolapse back into left atrium

Potentially allows through jet of regurgitation

As it prolapses back into LA mid-systolic click

If blood then flow into the atrium there’s a late systolic murmur

20
Q

Mitral stenosis aetiology

A

Almost always due to rheumatic fever

Congenital

Storage diseases

Malignancy

21
Q

Mitral stenosis

A

Problem with leaflets as well as the sub-valvular apparatus

Restricts blood flowing across the mitral valve from the left atrium into the left ventricle during diastole

Mid diastolic rumbling murmur

Opening snap as the restricted leaflets snap open

May have loud first heart sound if the leaflets are stiff but still relatively mobile

22
Q

What is mitral stenosis?

A

Failure of ejection of left atrial volume

Dominates by lung. right heart consequences

Left ventricle preserved

Exacerbated when atrial contraction lost or when high circulating volume

23
Q

Symptoms of mitral stenosis

A

Breathlessness

  • pulmonary oedema
  • pulmonary hypertension

Palpitations
- AF

Systemic emboli

Peripheral oedema

Fatigue

Haemoptysis

Compressive symptoms- stridor, dysphagia

24
Q

Prosthetic heart sounds

A

Position

First heart sound metallic- mitral/ tricuspid

Second heart sound metallic- aortic

Systolic murmurs common and not necessary pathological

Diastolic murmurs usually pathological

25
Q

Valvular heart disease treatments

A

Medical

  • HF
  • arrhythmias

Surgical

  • valve repair
  • valve replacement

Percutaneous intervention

  • BAVI
  • TAVI
  • mitraclip
  • paravalvular leak closure
26
Q

Tricuspid regurgitation

A

Organic tricuspid valve disease is rare

  • infective endocarditis
  • carcinoid
27
Q

Infective endocarditis

A

Microbial infectrion endothelial surface heart

Wide range bacteria and fungi but typically

  • streptococci
  • staphylococci
  • enterococci

Characteristic lesion is a vegetation

Heart valve typically affected

May present acutely with or sub acutely with a several week history

28
Q

Mimics

A

Infective/ sepsis

Embolic

Immunological

29
Q

Symptoms and signs of infective endocarditis

A

Constitutional symptoms

Emboli

Arthralgia

Splinter haemorrhages

Osteomyelitis/ discitis

Osler’s nodes

Glomerulonephritis

Vasculitic rash

30
Q

Peripheral manifestations of IE

A

Mycotic aneurysms

Septic emboli

Risk embolisation greatest 2 weeks anti-microbial therapy and for vegetations >1cm

20-40% patients clinical evidence emboli

31
Q

Diagnosis and management of IE

A

Duke criteria help

Blood cultures before antibiotics

Echocardiography to detect vegetations/ abscess formation

Antimicrobial therapy 2-6 weeks duration

Surgery

  • ongoing sepsis
  • worsening valve regurgitation
  • recurrent emboli
  • vegetations >1.5cm
  • removal intra-cardiac device
32
Q

IVDU associated with IE

A

Typically right heart valves but not exclusive

40-6-% pulmonary septic emboli

60% cases staphylococcus

Increased risk of death if left sided valves involved

Patients may have co-existent HIV infection

33
Q

Congenital heart disease

A

Failure of normal development of cardiac structures in utero

Severe

  • stillbirth
  • neo-natal heart failure

Mild
- presents in childhood or early adult life

34
Q

Left to right shunts

A

Atrial

Patent ductus arteriosus

Ventricular

303 Lectures (21 decks)

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