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A2. Respiratory system > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What is the annulus?

A

The base of a heart valve that supports the valve’s leaflets is called the annulus

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2
Q

What is rheumatic heart disease?

A

Disease of the heart that results from rheumatic fever and is characterized by inflamamtion of the myocardium and resultant reduced functional capacity of the heart and scarring of the valves.

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3
Q

What are the possible ways mitral stenosis can arise?

A

SLE - Autoimmune disease - when internal organs are involved, the condition is called systemic lupus erythematosus (SLE).

Congenital mitral stenosis

Rheumatic heart disease

Rheumatoid arthritis

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4
Q

What is mild mitral stenosis defined as?

A

When the valve orifice is less than 2 cm

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5
Q

What are the changes in pressure when there is an onset of mitral stenosis?

A

The pressure difference between left atrium and left ventricle increases.

Left atrial pressure increases

Pulmonary venous capillary pressure increases

Pulmonary hypertension develops

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6
Q

How do you determine the mitral tenosis severity?

A

Trans-valvar pressure gradient and transvalvar flow rate (cardiac output and heart rate)

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7
Q

How does a reduces transvalvar flow rate manifest itself?

A

Tachycardia:

  • Exercise
  • Acute illness
  • Pregnancy
  • Atrial fibrillation
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8
Q

What are the clinical manifestations of Mitral stenosis?

A
  • Dyspnoea: mild exertional to pulmonary oedema
  • Haemoptisis: rupture of thin-walled veins

•Systemic embolisation: LA and Left atrial appendage (a small, ear-shaped sac in the muscle wall of the left atrium) enlargement

  • IE – Infective endocarditis
  • Chest pain
  • Hoarseness (compression of the L recurrent laryngeal nerve)
  • Mitral facies – we don’t know why
  • Pulse – normal
  • JVP – prominent a wave
  • Tapping apex beat and diastolic thrill
  • RV heave
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9
Q

What are the likely heart sounds of mitral stenosis?

A

Left ventricle is normal so heart rate is normal – first heart sound is normal – systole. More severe stenosis – third heart sound. At the end of diastole

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10
Q

Look at the ECG for mitral stenosis

A
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11
Q

What would a chest X-Ray of mitral stenosis tell you?

A

Left atrial enlargement

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12
Q

What are the possible investgations for Mitral Stenosis?

A

X-Ray

Echocardiography

MRI

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13
Q

How can you tell a patient is suffering from mitral stenosis from echocardiography?

A
  • Thickening and scarring of the leaflets
  • Fusion of the commissures (line of adjacent heart valves)
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14
Q

What is treatment from Mitral Stenosis

A

Diuretics and restriction of sodium intake

Atrial Fibrilation - •Sinus rhythm restoration or ventricular rate control

•Anticoagulation: all those with AF, debatable in SR

Intervention treatment:

  • Valvotomy (balloon vs surgical) A balloon valvotomy is the preferred treatment for mitral valve stenosis. It is a procedure that widens the mitral valve so that blood flows more easily through the heart.
  • MVR - Mitral valve replacement is a cardiac surgical procedure in which a patient’s diseased mitral valve is replaced by either a mechanical or bioprosthetic valve.
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15
Q

What are the common causes of mitral regurgitation?

A
  • Rheumatic Heart Disease – most common reason for mitral incompetence
  • Mitral valve prolapse (MVP) – degenerative condition mostly in men (manifests in 4/5 th decade in life – chordae tendonae breaks?
  • IE
  • Degenerative
  • Functional MR due to LV and annular dilatation
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16
Q

Describe the changes to the annulus and the regurgitant volume in mitral regurgitation?

A

Annular enlargement and regurgitant volume increases

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17
Q

How does end systolic volume change from an acute to a chronic scenario?

A

End systolic volume in acute scenaria is reduced (reduced end systolic pressure and also reduced wall tension)

Chronic ESV returns to normal and end diastolic volume increases

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18
Q

What happens to the left ventricle in mitral regurgitation?

A

Left ventricular hypertrophy

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19
Q

What are the features of reduced LA compliance in mitral regurgitation?

A

Marked pressure rise

Thickening of the atrial myocardium

Increase in the pulmonary vascular resistance and remodelling of the pulmonary vasculature with Pulmonary hypertension

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20
Q

What are the features of increased left atrial copmliance in mitral regurgitation?

A

•marked volume enlargement, lesser changes in pulmonary vasculature, but develop AF

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21
Q

What are the clinical manifestations of acute mitral regurgitation?

A

•Breathlessness: pulmonary oedema, cardiogenick shock

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22
Q

What is a possible cause po acute mitral regurgitation?

A

Valver perforation - can happen as a result of acute infection

23
Q

What are the clinical presentations for chronic mitral regurgitation?

A
  • Fatigue, exhaustion (low CO), Right heart failure
  • Dyspnoea or palpitations due to AFib
24
Q

What are the clinical features of mitral regurgitation?

A
  • Pulse – normal or reduced in heart failure
  • JVP – prominent if RH failure present
  • Brisk and hyperdynamic apex beat
  • RV heave – because everything is backtracked on to the pulmonary circulation
25
Q

What are auscultation results for mitral regurgitation?

A

Reduced S1

Split S2: early A2, loud P2

26
Q

What are the relevant investigations for mitral regurgitation?

A

ECG

CXR

Echocardiography

MRI?

27
Q

What does will the results of an ECG be for mitral regurgitation?

A

Will indicate Left atrial enlargement (P>0.12 sec, tall) and right ventricular hypertrophy (prominent R wave in R precordial leads).

28
Q

What will the chest X-ray of mitral regurgitation show you?

A

Cardiomegaly, LA enlargement, calcification of mitral annulus

29
Q

Why is cardiac catheterisation obselete for the investigation of mitral regurgitation?

A

•only used to view coronary arteries

30
Q

What will echocardiography of mitral regurgitation show you?

A

LV dimensions

Cause of mitral regurgitations (leaflet dysfunction, chordae tendonae, papillary muscles, annular disease)

Severity of Mitral regurgitation

31
Q

What will an MRI of mitral regurgitation show you?

A
  • Accurate cardiac volumes
  • Volumetric determination of Reg Vol
32
Q

What is the medical treatment for acute mitral regurgitation?

A

Preload and afterload reduction (sodium nitroprusside, dobutamine, IABP)

33
Q

What is the medical treatment for chronic mitral regurgitation?

A

•Chronic MR: lack of evidence that any therapy is beneficial for haemodynamic improvement, LV function preservation

34
Q

What is interventional treatment for mitral regurgitation?

A
  • Mitral valve apparatus repair or
  • Mitral valve replacement
35
Q

What are the various causes for aortic stenosis?

A

Degenerative

Rheumatic

Bicuspid - can become stenotic/regurgitant

36
Q

How does rheumatic disease result in aortic stenosis?

A

Adhesion, fusion of the commissures and retraction and stiffening of the free cusp margins

37
Q

How does degenerative disease result in aortic stenosis?

A

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

38
Q

How does aortic stenosis result in left ventricular failure?

A

There is an increased left ventricular systolic pressure

Left ventricular hypertrophy

Increased left end diastolic pressure (left atrial pressure increases)

Pulmonary Hypertension

Increased myocardial oxygen demand

Myocardial ischaema

Left ventricular failure

39
Q

What are the symptoms for aortic stenosis?

A

Cardinal symptoms:

Chest pain (angina) – myocardial cells are more susceptible to ischaemia

Syncope/Dizziness (exertional pre-syncope) – less blood goes to oxygenate the brain

Breathlessness on exertion

Heart failure

40
Q

What clinical features are present in aortic stenosis?

A
  • Pulse – small volume and slowly rising
  • JVP – prominent if RH failure present, low BP
  • Vigurous and sustained apex beat

RV heave

41
Q

What are the relevant investigations for aortic stenosis?

A

ECG

CXR

Echocardiography

MRI

42
Q

What are the features of an ECG of aortic stenosis?

A

LVH voltage criteria, ST/T changes (LV strain)

43
Q

What will a chest X-ray of aortic stenosis tell you?

A

Calcification of AV

44
Q

What will you see in an echocardiography of aortic stenosis?

A
  • Demonstrates the AV cusp mobility
  • LV function and hypertrophy
  • Doppler haemodynamic assessment of pressure gradient and AVA
45
Q

What is treatment for aortic stenosis?

A

Limited to those who develop heart failure

•Aortic valve replacement or repair

46
Q

What are the different ways aortic regurgitation can arise?

A

Problems with the aorta and the leaflets

Aorta: Dilated (marfans, hypertension)

Connective tissue disorders

Leaflets: Bicuspid aortic valve

Rheumatic heart disease

Endocarditis

Myxomatous degeneration

47
Q

How does aortic regurgitation result in left ventricular failure?

A

Left ventricle has to accomodate both stroke volume and regurgitation volume

There is an increased left ventricular end diastolic pressure and left ventricular systolic pressure

Left ventricular hypertrophy and left ventricular dilation to cope with increased volume

Increased myocardial oxygen demand

Myocardial ischaemia

Left ventricular failure

48
Q

What are the symptoms of aortic regurgitation in chronic and acute scenarios?

A

Chronic: Long asymptomatic phase

Exertional breathlesness

Acute:

Poorly tolerated as wall tension cannot acutely adapt

(LV pressure x LV radius /wall thickness)

49
Q

What are the clinical features of aortic regurgitation?

A

•Pulse – large volume and collapsing (Corrigan sign) – you can see this in the carotid

Wide pulse pressure

Hyperdynamic displaced apex beat

50
Q

What does an ECG show for aortic regurgitation?

A

•ST/T changes (LV strain), LAD

51
Q

What does a chest X-ray show for aortic regurgitation?

A

Cardiomegaly

52
Q

What does echocardiography show in aortic regurgitation?

A
  • Demonstrates the AV cusp anatomy (thickening, prolapsing, number of cusps, vegetations)
  • LV function, dilatation and hypertrophy
  • Doppler haemodynamic assessment of regurgitant flow
53
Q

What is the medical treatment for aortic regurgitation

A
  • Vasodilator therapy shown to delay the timing for surgical intervention
  • Aortic valve replacement or repair

A2. Respiratory system (77 decks)

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