Valvular Heart Disease Flashcards
Mitral stenosis
Narrowing of mitral valve opening
Aetiology of mitral stenosis
Rheumatic heart disease
Congenital
Systemic conditions e.g rheumatoid arthritis
Size of mitral orifice in mitral stenosis
<2cm2
Effects of mitral stenosis
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
The severity of mitral stenosis is dependent on
Trans-valvular pressure gradient and flow rate
Trans-valvular flow rate is indicated by
Increased cardiac output and heart rate
Clinical manifestations of mitral stenosis
Dyspnoea Haemoptysis Systemic embolism Infective endocarditis Chest pain Hoarseness
Clinical examination findings of mitral stenosis
Mitral facies (flushes red cheeks) JVP - prominent a wave Tapping apex beat and diastolic thrill RV heave Murmur between second and first heart sound
Mitral stenosis echocardiograph
Thickening and scarring of the leaflets
Fusion of the commissures
Mitral stenosis cardiac magnetic resonance
Enlarged right ventricle and very little opening of mitral valve
Medical treatment of mitral stenosis
Diuretics and restriction of sodium intake
Atrial fibrillation - sinus rhythm restoration or ventricular rate control
Anticoagulation
Mitral regurgitation
Leaky mitral valve
Aetiology of mitral regurgitation
Rheumatic heart disease Mitral valve prolapse Infection Degenerative Left ventricle and annular dilation
What causes annular enlargement of mitral valve in mitral regurgitation
Preload
Afterload
Left ventricular contractility
Results of annular enlargement of mitral valve in mitral regurgitation
Increase in regurgitant volume
Left ventricular compensation in acute mitral regurgitation
Decrease in end systolic pressure, end systolic volume and wall tension - ventricle contracts more
Left ventricular compensation in chronic mitral regurgitation
Increased end diastolic volume, end systolic volume returns to normal, eccentric left ventricular hypertrophy develops
Result of reduced left atrial compliance in mitral regurgitation
Pressure rise, thickening of atrial myocardium, increase in pulmonary vascular resistance, remodelling of pulmonary vasculature with pulmonary hypertension
Result of increase left atrial compliance in mitral regurgitation
Volume enlargement, lesser changes in pulmonary vasculature, develop partial fibrillation
Clinical manifestations of acute mitral regurgitation
Breathlessness
Pulmonary oedema
Cardiogenick shock
Clinical manifestations of chronic mitral regurgitation
Fatigue
Exhaustion (low CO)
Right heart failure
Dyspnoea or palpitations due to partial fibrillation
Clinical examination findings of mitral regurgitation
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
Mitral regurgitation echocardiography
Left ventricle contraction and dimension
Pulmonary artery pressure
Cause - leaflet dysfunction, chordae, papillary muscles, annular disease
Severity of MR
Mitral regurgitation magnetic resonance imaging
Accurate cardiac volumes
Volumetric determination of regurgitation volume
Medical treatment for acute mitral regurgitation
Preload and afterload reduction via sodium nitroprusside
Medical treatment for chronic mitral regurgitation
Left ventricle function preservation
Aortic stenosis
Narrowing of aortic valve opening
Aetiology of aortic stenosis
Degenerative
Rheumatic heart disease
Bicuspid - 2 leaflets instead of 3 (congenital)
Rheumatic aortic stenosis
Adhesion, fusion of the commissures
Retraction and stiffening of the free cusp margins
Degenerative aortic stenosis
Atherosclerosis link
Slow inflammatory process resulting in thickening and calcification of the cusps from base to free margine
Effects of aortic stenosis
Increase LV systolic pressure Severe concentric hypertrophy and left ventricular mass Increase end diastolic pressure Increase myocardial oxygen consumption Myocardial ischaemia Left venture failure
Symptoms of aortic stenosis
Large asymptomatic phase Chest pain (angina) Syncope/dizziness (exertional pre-syncope) Breathlessness on exertion Heart failure
Clinical examination findings of aortic stenosis
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
ECG of aortic stenosis
Left ventricular hypertrophy voltage criteria
ST-T changes
Chest x-ray of aortic stenosis
Calcification of aortic valve
Aortic stenosis echocardiography
Demonstrates the AV cusp mobility
LV function and hypertrophy
Doppler heamodynamic assessment of pressure gradient and aortic valve area
Magnetic resonance of aortic stenosis
Identification of bicuspid valves
Aortic regurgitation
Leaky aortic valve
Aorta aetiology of aortic regurgitation
Dilated aorta - hypertension
Connective tissue disorders
Leaflets aetiology of aortic regurgitation
Bicuspid aortic valve
Rheumatic heart disease
Endocarditis
Myxomatous degeneration
Effects of aortic regurgitation
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
Symptoms of acute aortic regurgitation
Emergency, poorly tolerated as wall tension cannot acutely adapt
Symptoms of chronic aortic regurgitation
Long asymptomatic phase
Exertional breathlessness
Clinical examination findings of aortic regurgitation
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
ECG findings of aortic regurgitation
ST-T changes
Left axis deviation
Chest X-ray of aortic regurgitation
Cardiomegaly (abnormal enlargement) in chronic aortic regurgitation
Aortic regurgitation echocardiography
Demonstrates AV cusp anatomy (thickening, number, prolapsing, vegetations)
LV function, dilation, hypertrophy
Doppler haemodynamic assessment of regurgitant flow
Medical treatment of aortic regurgitation
Vasodilator therapy delays the timing for surgical intervention
Which valvular disease is the only one treated with medicine
Aortic regurgitation
Mitral regurgitation ECG
LA enlargement
Right ventricular hypertrophy
Mitral regurgitation chest x-ray
Cardiomegaly
LA enlargement
Calcification of mitral annulus
Mitral stenosis ECG
Right ventricular hypertrophy
P wave>0.12sec
