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CVS pathophysiology > Valvular Heart disease > Flashcards

Valvular Heart disease Flashcards

1
Q

What is valvular heart disease?

A
  • Valvular heart disease is the damage to/defect in one of the heart valves
  • A stenotic valve ( narrowing) decreases filling of blood in the chamber
  • Incompetent valve( widening) valve allows blood to leak back into the chamber it previously exited.
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2
Q

What is mitral stenosis?

A

-stenosis of the mitral valve which restricts blood flow into the left ventricle

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3
Q

Causes of mitral stenosis

A
  • rheumatic heart disease/fever
  • congenital MS
  • systemic conditions ( SLE, RA)
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4
Q

Describe the pathophysiology of mitral stenosis

A
  • MV orifice is <2cm2 ( normal is 4-6cm2)
  • this increases the A-V pressure gradient
  • LA pressure increases in order to overcome the increased A-Vp gradient
  • eventually increased BV in LA +backflow of blood from LA>pulmonary veins occur. This causes pulmonary venous and capillary pressures to increase. > pulmonary oedema(maybe)
  • PVR +PaP increases and PHT develops
  • LA dilation ( due to excess blood in LA > AF as pacemaker cells stretched > stagnant blood) TR and PRea increases
  • RH hypertrophy to overcome the pulmonary pressure > RS heart failure
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5
Q

Mitral stenosis severity dependent on?

A

trans valvular pressure gradient

  • trans valvular flow rate (CO + HR)
  • tachycardia ( excercise, AI, pregnancy, AF)
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6
Q

Clinical symptoms of mitral stenosis

A
  • dypsonea
  • haemoptysis: rupture of thin walled veins
  • chest pain
  • hoarseness( compression of L recurrent laryngeal nerve)
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7
Q

Clinical presentation of mitral stenosis

A
  • Mitral facies
  • normal pulse
  • JVP ( prominent A wave)
  • tapping apex beat + diastolic thrill
  • RV heave
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8
Q

Investigations of mitral stenosis

A
  • ECG catheterisation useless but will show P wave more prominent.
  • CXR ( LA enlargement)
  • Imaging: ECHO ( thickening and scarring of the leaflets + may show fusion of commissures/valves),
  • Cardiac magnetic resonance
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9
Q

Medical treatment of mitral stenosis

A
  • Diuretics and restriction of Na+ intake
  • AF:Sinus rythm restoration/ventricular rate control
  • anticoagulation; all those with AF debateable in SR

Intravenal treatment

  • valvotomy ( balloon vs surgical)
  • MVR
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10
Q

Causes of mitral regurgitation

A
  • rheumatic heart disease/fever
  • mitral valve prolapse( failure of CT/PM)
  • IE
  • degenerative with age
  • functional MR due to LV and annular dilation
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11
Q

Pathology of mitral regurgiation

A

Mitral regurgitation is leakage of blood backward through the mitral valve each time the left ventricle contracts.

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12
Q

Pathophysiology of mitral regurgitation

A
  • LA compliance is reduced,
  • hypertrophy of LA
  • increase in PVR + remodelling of pulmonary vasculature with PHT
  • can also devvelop AF
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13
Q

Clinical symptoms of mitral regurgitation

A

Acute MR

-breathlessness: pulmonary oedema, cardiogenick shock

Chronic MR
-fatigue, exhaustion, low CO, right heart failure, dypsonea, palpitations(due to AFib)

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14
Q

Clinical examination of mitral regurgitation

A
  • pulse ( normal/reduced in HF)
  • JVP ( prominent if RH failure present)
  • brisk and hyperdynamic apex breat
  • RV heave
  • asucultation ( reduced S1. split S2: ; click due to the leaflet folding into atrium and being stopped by the CT ; loud at apex, holysystolic, radiating to axilla
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15
Q

Investigations of mitral regurgitation

A

ECG: LA enlargement ( tall), RVH ( prominent R wave in R preccordial leads)

CXR: cardiomegaly, LA enlargement, calcification of mitral annulus

Cardiac cathetirsation; LV angiography ( obsolete)

Imaging: echocardiography( LV dimensions. Cause of MR: leaflet dysfunction CTae, pap muscles, annular disease)
-severity of MR and pap?

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16
Q

T

A

??-.???Accurate cardiac volumes

Volumetric determination of Reg Vol

17
Q

Medical treatment on MR

A

Acute MR
-preload and afterload reduction ( sodium nitroprusside, dobutamine, IABP)

Chronic MR
-no therapy beneficial

Interventional treatment

  • mitral valve apparatus repair
  • mitral valve replacement
18
Q

State the normal aortic valve area (AVA) + the aortic stenosis area

A

Normal:3-4cm2

Stenosis AVA: 1.5-2cm2

19
Q

Causes of aortic stenosis

A

Rheumatic + degenerative

Rhemuatic
- adhesion, fusion of the commissures and retraction + stiffeninf of free cusp margins

Degenerative
-linked to atherosclerosis; slow inflammatory process resulting in thickening and calcification of cusps from base to free margins

20
Q

Mechanism of of aortic stenosis

A

Increased

21
Q

Symptoms of aortic stenosis

A
  • asymptomatic

- cardinal symptoms include chest pain(angina), syncope/dizziness, breathlessness on exertion, heart failure

22
Q

Clinical examination of aortic stenosis

A

Pulse- small volume + slowely rising
JVP- prominent if RH failure present, low BP
-vigorous apex beat
-RV heave
-auscultation ( late peaking, loud at base +r adiating to carotids)

23
Q

Investigations of aortic stenosis

A
  • ECG: LVH voltage criteria, ST/T changes, (LV strain)
  • CXR ( calcification of AV)
  • cardiac catheterisation: peak LV-peak aortic gradient ( obsolete)
  • Imaging: CMR, Echocardiography ( shpws AV cusp mobility, function of LV + hypertrophy)
24
Q

Medical treatment of aortic stenosis

A

Interventional treatment

-AVR(surgically/percutaneously/repair

25
Q

Causes of aortic regurgitation

A
  • dilated aorta ( hypertension)
  • connective tissue disorders (myoxmatous degeneration, marfan’s)
  • bicuspid aortic valve
  • rheumatic HD
  • endocarditis
26
Q

Pathophysiology of aortic regurgitation

A
  • LV accomodates both SV and RegVol
  • increased LVEDV + LV systolic pressure
  • LV hypertrophy + LV dilation
  • increased MMVO2
  • myocardial isachemia
  • LV failure
27
Q

Symptoms of aortic regurgitation

A

Chronic

  • long asymptomatic phase
  • dypsonea upon exertion

Acute
-poorly tolerated as wall tension cannot acutely adapt

28
Q

Clinical presentation of aortic regurgitation

A
  • pulse ( large volume + colapsing) = corrigan sign
  • wide pulse pressure
  • hyperdynamic, displaced apex beat
  • normal S1..?
29
Q

Aortic regurgitation investigation

A
  • CXR: cardiomegaly (bovine heart) in chronic AR
  • cardiac cathetiisation ( obsolete, aortogram
  • Imaging; ECG: ST/T changes (LV strain, LAD), echocardiography(shows AV cusp thickening, prolapsing, number of cusps, vegetations)
  • LV function, dilation and hypertrophy, doppler haemodynamic
30
Q

Medical treatment of aortic regurgitation

A
  • vasodilator therapy to delay timing for surgical intervention
  • Interventional treatment; AVR/repair

CVS pathophysiology (23 decks)

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