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Cardiovascular System > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

Mitral stenosis

A

Narrowing of mitral valve opening

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2
Q

Aetiology of mitral stenosis

A

Rheumatic heart disease
Congenital
Systemic conditions e.g rheumatoid arthritis

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3
Q

Size of mitral orifice in mitral stenosis

A

<2cm2

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4
Q

Effects of mitral stenosis

A

Increases arterial ventricle pressure gradient
Increase left heart pressure
Increase pulmonary venous and capillary pressure
Increased pulmonary vascular resistance
Pulmonary hypertension
Increase peripheral artery pressure
Right heart dilation with tricuspid and pulmonary regurgitation

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5
Q

The severity of mitral stenosis is dependent on

A

Trans-valvular pressure gradient and flow rate

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6
Q

Trans-valvular flow rate is indicated by

A

Increased cardiac output and heart rate

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7
Q

Clinical manifestations of mitral stenosis

A 
Dyspnoea
Haemoptysis
Systemic embolism
Infective endocarditis
Chest pain
Hoarseness
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8
Q

Clinical examination findings of mitral stenosis

A 
Mitral facies (flushes red cheeks)
JVP - prominent a wave
Tapping apex beat and diastolic thrill
RV heave
Murmur between second and first heart sound
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9
Q

Mitral stenosis echocardiograph

A

Thickening and scarring of the leaflets

Fusion of the commissures

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10
Q

Mitral stenosis cardiac magnetic resonance

A

Enlarged right ventricle and very little opening of mitral valve

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11
Q

Medical treatment of mitral stenosis

A

Diuretics and restriction of sodium intake
Atrial fibrillation - sinus rhythm restoration or ventricular rate control
Anticoagulation

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12
Q

Mitral regurgitation

A

Leaky mitral valve

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13
Q

Aetiology of mitral regurgitation

A 
Rheumatic heart disease
Mitral valve prolapse
Infection
Degenerative
Left ventricle and annular dilation
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14
Q

What causes annular enlargement of mitral valve in mitral regurgitation

A

Preload
Afterload
Left ventricular contractility

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15
Q

Results of annular enlargement of mitral valve in mitral regurgitation

A

Increase in regurgitant volume

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16
Q

Left ventricular compensation in acute mitral regurgitation

A

Decrease in end systolic pressure, end systolic volume and wall tension - ventricle contracts more

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17
Q

Left ventricular compensation in chronic mitral regurgitation

A

Increased end diastolic volume, end systolic volume returns to normal, eccentric left ventricular hypertrophy develops

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18
Q

Result of reduced left atrial compliance in mitral regurgitation

A

Pressure rise, thickening of atrial myocardium, increase in pulmonary vascular resistance, remodelling of pulmonary vasculature with pulmonary hypertension

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19
Q

Result of increase left atrial compliance in mitral regurgitation

A

Volume enlargement, lesser changes in pulmonary vasculature, develop partial fibrillation

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20
Q

Clinical manifestations of acute mitral regurgitation

A

Breathlessness
Pulmonary oedema
Cardiogenick shock

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21
Q

Clinical manifestations of chronic mitral regurgitation

A

Fatigue
Exhaustion (low CO)
Right heart failure
Dyspnoea or palpitations due to partial fibrillation

22
Q

Clinical examination findings of mitral regurgitation

A

Pulse normal or reduced in heart failure
JVP prominence in right heart failure
Brisk and hyper dynamic apex beat
Right ventricular heave
Reduced S1, spilt S2 - early A2, loud P2
Murmur - holosystolic, blowing, loud at apex and radiation to axilla

23
Q

Mitral regurgitation echocardiography

A

Left ventricle contraction and dimension
Pulmonary artery pressure
Cause - leaflet dysfunction, chordae, papillary muscles, annular disease
Severity of MR

24
Q

Mitral regurgitation magnetic resonance imaging

A

Accurate cardiac volumes

Volumetric determination of regurgitation volume

25
Q

Medical treatment for acute mitral regurgitation

A

Preload and afterload reduction via sodium nitroprusside

26
Q

Medical treatment for chronic mitral regurgitation

A

Left ventricle function preservation

27
Q

Aortic stenosis

A

Narrowing of aortic valve opening

28
Q

Aetiology of aortic stenosis

A

Degenerative
Rheumatic heart disease
Bicuspid - 2 leaflets instead of 3 (congenital)

29
Q

Rheumatic aortic stenosis

A

Adhesion, fusion of the commissures

Retraction and stiffening of the free cusp margins

30
Q

Degenerative aortic stenosis

A

Atherosclerosis link

Slow inflammatory process resulting in thickening and calcification of the cusps from base to free margine

31
Q

Effects of aortic stenosis

A 
Increase LV systolic pressure
Severe concentric hypertrophy and left ventricular mass
Increase end diastolic pressure
Increase myocardial oxygen consumption
Myocardial ischaemia
Left venture failure
32
Q

Symptoms of aortic stenosis

A 
Large asymptomatic phase
Chest pain (angina)
Syncope/dizziness (exertional pre-syncope)
Breathlessness on exertion
Heart failure
33
Q

Clinical examination findings of aortic stenosis

A 
Pulse - small volume, rising
JVP - prominent if RHF, low bp
Vigorous and sustained apex beat
Right ventricular heave
Normal S1, less audible S2
Auscultation - late peaking, loud at base, harsh, radiation to the carotids
34
Q

ECG of aortic stenosis

A

Left ventricular hypertrophy voltage criteria

ST-T changes

35
Q

Chest x-ray of aortic stenosis

A

Calcification of aortic valve

36
Q

Aortic stenosis echocardiography

A

Demonstrates the AV cusp mobility
LV function and hypertrophy
Doppler heamodynamic assessment of pressure gradient and aortic valve area

37
Q

Magnetic resonance of aortic stenosis

A

Identification of bicuspid valves

38
Q

Aortic regurgitation

A

Leaky aortic valve

39
Q

Aorta aetiology of aortic regurgitation

A

Dilated aorta - hypertension

Connective tissue disorders

40
Q

Leaflets aetiology of aortic regurgitation

A

Bicuspid aortic valve
Rheumatic heart disease
Endocarditis
Myxomatous degeneration

41
Q

Effects of aortic regurgitation

A

LV accommodates both stroke volume and regurgitation volume
Increase LV end-systolic volume and systolic pressure
LV hypertrophy and dilation
Increase myocardial oxygen consumption
Myocardial ischameia
LV failure

42
Q

Symptoms of acute aortic regurgitation

A

Emergency, poorly tolerated as wall tension cannot acutely adapt

43
Q

Symptoms of chronic aortic regurgitation

A

Long asymptomatic phase

Exertional breathlessness

44
Q

Clinical examination findings of aortic regurgitation

A

Pulse - large volume and collapsing
High systolic bp, low diastolic bp (wide pulse pressure)
Hyperdynamic displaced apex beat
Norrmal S1 and S2, soft murmur and early diastolic

45
Q

ECG findings of aortic regurgitation

A

ST-T changes

Left axis deviation

46
Q

Chest X-ray of aortic regurgitation

A

Cardiomegaly (abnormal enlargement) in chronic aortic regurgitation

47
Q

Aortic regurgitation echocardiography

A

Demonstrates AV cusp anatomy (thickening, number, prolapsing, vegetations)
LV function, dilation, hypertrophy
Doppler haemodynamic assessment of regurgitant flow

48
Q

Medical treatment of aortic regurgitation

A

Vasodilator therapy delays the timing for surgical intervention

49
Q

Which valvular disease is the only one treated with medicine

A

Aortic regurgitation

50
Q

Mitral regurgitation ECG

A

LA enlargement

Right ventricular hypertrophy

51
Q

Mitral regurgitation chest x-ray

A

Cardiomegaly
LA enlargement
Calcification of mitral annulus

52
Q

Mitral stenosis ECG

A

Right ventricular hypertrophy

P wave>0.12sec

Cardiovascular System (27 decks)

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