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Cardiovascular System > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

Normal size of opening of mitral valve

A

4-6cm

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2
Q

Aetiology of mitral stenosis

A

Rheumatic heart disease
Congenital MS
Systemic conditions

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3
Q

Classification of mitral stenosis and pathophysiology

A

MV orifice<2cm

A-V pressure gradient increases
LA pressure increases
Pulmonary venous and capillary pressures increase
PVR increases
Pulmonary hypertension develops
RH dilatation
Left heart will be normal
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4
Q

Symptoms of mitral stenosis

A

Dyspnoea which could include pulmonary oedema
Haemoptysis due to rupture of capillaries
Systemic embolization due to enlargements of left atrium
IE
Chest pain
Hoarseness due to compression of left recurrent laryngeal nerve

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5
Q

Clinical examination for mitral stenosis

A 
Red cheeks
Normal pulse
Prominent A wave in JVP
Tapping apex beat with diastolic thrill
RV heave
Sound between S2 and S1
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6
Q

Investigations for mitral stenosis

A

ECG (not great but if P>0.12s)
CXR (LA enlargement)
Echocardiography (can see the narrowing)
Cardiac magnetic resonance

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7
Q

Treatment for mitral stenosis

A

Diuretics and restricted Na intake

If AF then SR restoration or ventricular rate control and anticoagulation

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8
Q

Aetiology of mitral regurgitation

A 
Rheumatic heart disease
Mitral valve prolapse (more common)
IE
Degenerative
Functional due to LV and annular dilatation (the left ventricular is hypertrophic and pulls apart it's valve)
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9
Q

Pathophysiology of MR

A

Not a fixed ERO (effective regurgitant orifice) as depends on preload, afterload and LV contractility
LV will compensate

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10
Q

LV compensation in acute MR

A

ESP and ESV drop and wall tension drops

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11
Q

LV compensation in chronic MR

A

EDV increases so ESV returns to normal but eccentric LVH develops

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12
Q

LA compliance in MR

A

Can be increased, reduced or a combination

Reduced because of the pressure rise, a thickening of the atrial myocardium, increase in PVR and remodeling with PHT

Increased because of the volume enlargement but AF

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13
Q

Acute MR clinical signs

A

Breathlessness, pulmonary oedema, cardiogenic shock

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14
Q

Chronic MR signs

A

Fatigue, exhaustion (low CO), right heart failure, dyspnoea or palpitations due to AFib

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15
Q

Clinical examination signs of MR

A 
Normal or reduced pulse in heart failure
JVP prominent if RH failure present
Brisk and hyperdynamic apex beat
RV heave
On auscultation, reduced S1 and split s2
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16
Q

Laboratory investigations for MR

A

ECG: LA enlargement so p>0.12s and RVH (prominent R wave in R precordial leads)

CXR: cardiomegaly, LA enlargement, calcification of mitral annulus

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17
Q

Treatment for mitral regurgitation

A

For acute, preload and afterload reduction (sodium nitroprusside, dobutamine)

For chronic, maybe LV function preservation

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18
Q

Normal size of aortic valve

A

3-4cm

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19
Q

Aetiology of aortic valve stenosis

A

Degenerative
Rheumatic
Could be bicuspid instead of tricuspid

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20
Q

Size of stenosis aortic valve

A

<1.5-2cm2

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20
Q

Size of stenosis aortic valve

A

<1.5-2cm2

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21
Q

Rheumatic aortic stenosis

A

Adhesion, fusion and retraction

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22
Q

Degenerative aortic stenosis

A

Linked to arthrosclerosis, a slow inflammatory process resulting in thickening and calcification of the cusps from bases to free margins

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23
Q

Effects of AS on the heart

A 
Increased LV systolic pressure
Hypertrophy
Increased LVEDP
PHT
Increased MVO2
Myocardial ischemia
LV failure
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24
Q

Symptoms of AS

A

Has a long asymptomatic phase

Chest pain, syncope/dizziness, breathlessness, heart failure

25
Q

Clinical examination for AS

A 
Small pulse volume that's slowly rising
Prominent JVP if right heart failure
Low BP
Vigourous and sustained apex beat
RV heave
Late peaking on auscultation which is loud at base and radiates to carotids
26
Q

Laboratory examination for AS

A

ECG: LV strain
CXR calcification
Echocardiography shows LV function and hypertrophy

27
Q

Medical treatment for AS

A

Only for heart failure

28
Q

Aetiology of AR at aorta

A

Dilated aorta

Connective tissue disorders

29
Q

Aetiology of AR

A

Bicuspid aortic valve
Rheumatic heart disease
Endocarditis
Myxomatous degeneration

30
Q

Cause of LV failure in AR

A 
LV accommodates SV and regVol
Increased pressure
Hypertrophy and dilatation 
Increased MVO2
Myocardial ischemia
31
Q

Symptoms of AR

A

Chronic - long asymptomatic then exertional breathlessness

Acute- poorly tolerated as wall tension can’t adapt

32
Q

Clinical examination of AR

A

Large volume and collapsing pulse
Wide pulse pressure
Hyperdynamic, displaced apex beat
Early diastolic with decrescendo but normal S1 and S2

33
Q

Lab investigations of AR

A

ECG: ST change as LV strain
CXR: cardiomegaly in chronic
Echocardiography: thickening,prolapse, vegetations, number of cusps, LV function, dilatation and hypertrophy
Doppler assessment of regurgitation flow

34
Q

Medical treatment of AR

A

Vasodilators delay timing for surgery

34
Q

Medical treatment of AR

A

Vasodilators delay timing for surgery

35
Q

Causes of cardiac ischaemia

A 
Arthrosclerosis
Embolism
Coronary thrombosis
Aortic dissection
Arteritides(inflammation)
Congenital
36
Q

Manifestations (results) of IHDx

A 
Angina
MI
Arrythmias
Chronic heart failure
Sudden death
37
Q

2 most dangerous types of coronary artery disease

A

Left main stem stenosis or 3 vessel artery disease

38
Q

When would coronary artery bypass grafting surgery be done

A

If any CAD is symptomatic

Or if it’s LMSS or 3VDx

39
Q

Patient criteria for CABG

A

Adequate Lung, mental, hepatic function
Ascending aorta and distal coronary artery targets OK
LV EF>20%

40
Q

What vessels can be used in CABG

A

Reversed saphenous vein (back of leg)
Internal mammary arteries
Radial arteries

41
Q

Problems from sternotomy

A

Wire infection
Painful wires
Sternal dehiscence
Sternal malunion

42
Q

Post operative problems in cardiac surgery

A

Cardiac tamponade (large pericardial effusion)
Death
Stroke

43
Q

Cardiac tamponade after surgery

A

Fluid around the heart.
Primary features are raised CVP, tachycardia, low BP

Secondary features are oliguria, needing more oxygen and metabolic acidosis

Treated by chest reopening

44
Q

Long-term outcomes of CABG

A

50% have no further cardiac problems 10 years later

Majority of problems are minor and can be controlled with medication

5% need a repeat CABG

45
Q

Main types of surgery for ages

A

Adult- aortic and mitral valves

Paediatrics- all four with roughly equal frequency

46
Q

Three most common valve problems needing surgery in Aberdeen

A

Senile tricuspid AS
Bicuspid AS
Degenerative MR

47
Q

Rheumatic fever

A

A relapsing illness related to streptococcal infections.
Causes pancarditis (whole heart inflammation) with skin and joint manifestations and Sydenham’s chorea/st Vitus dance
Treated with aspirin and bed rest

48
Q

Chronic rheumatic heart disease

A

Gradually progressive MVDx and AVDx , worldwide most common heart problem
Causes death in pregnancy and sometimes means cardiac surgery is performed during pregnancy

49
Q

Organisms that causes endocarditis

A

Strep viridans - subacute

Then staph. Aureus - acute

50
Q

Chances of cures with different valves for endocarditis

A

NVE- 90% chance with ABx
PVE- 50% chance with ABx

Chances cute higher for viridans too

51
Q

Indications for endocarditis surgery

A

Severe valvular regurgitation
Large vegetations
Persistent pyrexia
Progressive renal failure

Give IV ABx 6 weeks after surgery

52
Q

Aortic stenosis

A

HF, angina, syncope, incidental
Easily heard murmur and loss of aortic S2
LVH, AV gradient of over 59mmHg
AVR for severe

53
Q

Aortic regurgitation

A

HF, angina or incidental
Difficult murmur
AVR for severe especially with LV regurgitation
In severe, LV is filled with contrast after one diastolic interval during aortography

54
Q

Mitral stenosis

A

Difficult murmur unless severe or exercised
May have presystolic accentuation
Surgery if MVA on echo is <1.5cm

55
Q

Mitral regurgitation

A

Easy murmur
Associated with LV and LA dilatation and AF and pulmonary hypertension if severe
MVR if severe
On echo, systolic blood flow reversal in pulmonary veins (severe)

56
Q

Cardiopulmonary bypass

A

Blood drained from RA and returned to AA
CFB machine operated by perfusionists takes over heart and lung
Systemic anticoagulation used and induced hypothermia
There will be non-pulsatile flow and max time is 12 hours. Maximum cardiac ischaemic time is 6.
Air embolism is more common in open cardiac surgery eg valve replacement than CABG

57
Q

Choice of heart valve prosthesis

A

Biological don’t need warfarin but wear out after 15 years
Mechanical do but wear out after 40
Mitral valve repair can be possible in degenerative MR instead of replacement

58
Q

Choice of heart valve prosthesis

A

Biological don’t need warfarin but wear out after 15 years
Mechanical do but wear out after 40
Mitral valve repair can be possible in degenerative MR instead of replacement

Cardiovascular System (33 decks)

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