Valvular Heart Disease Flashcards
What is valvular heart disease
Any cardiovascular disease process involving one or more of the four valves of the heart
What are the four valvular diseases
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
What does one valve abnormality have the potential to do to the other valves
It can damage them and cause further valvular disease
What is mitral stenosis
Narrowing of the mitral valve
What is the threshold diameter for mitral stenosis
2cm
Anything less than 2cm is mitral stenosis
Is mitral stenosis common in the UK
NO (But it used to be)
What is the most common cause of mitral stenosis
Rheumatic heart disease
What is a rarer cause of mitral stenosis
Systemic lupus erythematosus (SLE)
What is Systematic lupus erythematosus (SLE)
An autoimmune disease. In this disease, the immune system of the body mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs.
What is Rheumatic heart disease
Antibodies that are created from strep throat infection attack the heart valve/tissue.
Causes adhesion and fusion of the commissures and retraction and stiffening of the free cusp margins.
Whats the pathophysiology for mitral stenosis causing heart problems
Left atrial pressure increases Pulmonary venous and capillary pressure increases Pulmonary hypertension develops RIGHT HEART DILATION TRICUSPID REGURGITATION PULMONARY REGURGITATION
Why is mitral stenosis difficult to detect
Pulse is fine
The left ventricle works fine
What are the presenting symptoms of mitral stenosis
S.O.B Haemoptosis Palpitations Stroke Chest pain Hoarse voice
What might be found on examination with mitral stenosis
Mitral facies (rosy cheeks) Normal pulse Prominent JVP Diastolic thrill RV heave Tapping apex beat
What the best investigation to use for diagnosing mitral stenosis
Echocardiography
What features does echocardiography show in mitral stenosis
Thickening and scarred leaflets
Fusion of the commissures
What other investigation (apart from echo) is always done when investigating heart disease
CXR
What can a chest XRAY show when investigating mitral stenosis
Pulmonary oedema
LA enlargement
What is the treatment for mitral stenosis
Manage cardiovascular risk eg smoking
diuretics and restriction of Na intake
mitral valve replacement (MVR) (valvotomy)
If patient is in AF due to their mitral stenosis then what drugs should be given and why
anti coagulants - to prevent a stroke
What is mitral regurgitation
When blood is pushed back into the left atrium, the the mitral valve on sytole
What are common causes of mitral regurgitation
Rheumatic heart disease
Mitral valve prolapse (common in men)
Age degeneration
What is a less common causes of mitral regurgitation
Infective endocarditis
What does the degree of regurgitation depend on in mitral regurgitation
The effective regurgitation Orrifice (ERO)
What are the two ways that mitral regurgitation can manifest
Acute
Chronic
What happens in acute mitral regurgation
The change is rapid (eg chordae tendenae breaks)
The ventricle takes control and the ventricle contracts rapidly.
Myocardium thickens
What happens to EDV in acute mitral regurgitation
It decreases
What happens in the chronic mitral regurgitation
Changes are slow and the ventricle has time to adapt and compensate
Myocardium thickens
What happens to EDV in chronic mitral regurgitation
It increases
What are presenting symptoms of acute mitral regurgitation
Breathlessness
Pulmonary oedema
Cardiogenic shock
What are presenting symptoms of chronic mitral regurgitation
Fatigue
Exhaustion
Right heart failure
Dyspnoea due to AF palpitations
What can be found on examination of mitral regurgitation
Normal or reduced pulse
JVP prominent
hyperdynamic apex beat
RV heave
What investigations are done for mitral regurgitation
ECG
CXR
ECHO
What treatment is used for acute mitral regurgitation
Need to reduce pre load and after load
sodium nitroprusside
dobutamine
intra aortic balloon pump
What treatment is used for chronic mitral regurgitation
Can be left alone until valve needs replaced
No emergency
What shape is the aortic valve
Tricuspid
Inverse mercedes benz sign
What causes aortic valve disease
degenerative (atherosclerosis)
rheumatic
bicuspid
What percentage of people have a bicuspid aortic valve
1.5-2%
What is aortic stenosis
Narrowing of the aortic valve
How common is Aortic stenosis
It is the leader for cardiac valve disease worldwide
What the pathophysiology of how aortic stenosis causes heart problems
Increased LV systolic pressure
severse concentric hypertrophy
increased Left ventricular end diastolic pressure and left atrial
increased myocardial oxygen consumption and myocardial ischaemia
Discuss the phases of aortic stenosis progression
Long asymptomatic phase - progression is slow
When symptomatic - life expectancy drops rapidly
What is observed in clinical exam of aortic stenosis
pulse has small volume and is slow rising
prominent JVP if RH failure is present
Vigorous and sustained apex beat (visible)
What investigation should be done for aortic stenosis
ECG
ECHO
What is treatment for aortic stenosis
Medical - only for those who have heart failure
Interventional - Aortic valve replacement or repair
What causes aortic regurgitation
Dilated aorta (aortic problem)
Connective tissue disorders (aortic problem)
Bicuspid valve
Rheumatic heart disease
endocarditis
Myxomatous degeneration (5th decade of life)
What the pathophysiology of how aortic regurgitation causes heart problems
Increased Left ventricular end diastolic volume and left ventricular systolic pressure
LV hypertrophy and LV dilation
Increased oxygen demand
Ischaemia
What are features of chronic aortic regurgitation
VERY slow progressing and asymptomatic
What are features of acute aortic regurgitation
Pulmonary oedema and cardiogenic shock
MEDICAL EMERGENCY
What can be found in clinical exam of aortic regurgitation
Pulse has large volume and is collapsing (Corrigans)
Apex beat is hyperdynamic and displaced
SYSTOLIC PRESSURE IS HIGH AND DIASTOLIC IS VERY LOW (RED FLAG)
What investigation should be done for aortic regurgitation
ECG
ECHO
What can ECG show in both aortic regurgitation and stenosis
ST changes due to LV strain
What is Medical treatment for aortic regurgitation
Vasodilator therapy which has been shown to delay the time needed until surgical intervention
What is surgical treatment for aortic regurgitation
Aortic valve replacement/repair
