Valvular heart disease Flashcards
an aortic valve area of less than … cm2 is considered severe
<1
6 causes of aetiology of aortic stenosis
Calcific/ degenerative (most common cause in Western countries)
Bicuspid aortic valve (congenital abnormality often associated with aortic coarctation)
William’s Syndrome (associated with supravalvular AS)
Sub-valvular (congenital abnormalities such as sub-aortic membrane)
Post–rheumatic aortic stenosis (restricted cusp excursion due to fibrosis)
Rare causes: Heyde’s syndrome
clinical presentation of aortic stenosis
Progressive shortness of breath Angina Pre-syncope/ syncope Previous radiotherapy to chest (e.g. for treatment of cancer) Ejection systolic murmur/ ‘seagull’ murmur Obliteration of S2 Raised JVP Slow rising carotid pulse Heaving apex beat
Ix for aortic stenosis
ECG- left axis deviation, LV hypertrophy
transthoracic echo
Mx of aortic stenosis
Mild or moderate aortic stenosis:
6-12 monthly surveillance by echocardiography to detect progression
Severe AS:
Interventional: trans-catheter aortic valve implantation (TAVI) or surgical aortic valve replacement (AVR)
Conservative: for patients with severe frailty, co-morbidities with poor prognosis or unwilling to undergo intervention
4 factors favouring TAVI
frailty
previous cardiac surgery/sternotomy
CKD/ESRF
extensive co-morbidity list
4 features favouring surgical AVR
Bicuspid aortic valve
Large aortic annulus
Severely atheromatous ascending aorta
Additional co-existing valve or coronary artery disease (e.g. severe MR, multi-vessel CAD)
aetiology (causes) of aortic regurgitation
rheumatic disease calcific degradation congenital abnormalities endocarditis connective tissue disease dilated proximal aorta aortic dissection aortitis iatrogenic
signs and symptoms of aortic regurg
Progressive shortness of breath
Angina
Known connective tissue disease
Diastolic murmur of AR
Austin-flint murmur: late diastolic murmur due to premature mitral valve closure (causing function mitral stenosis) due to jet of severe AR upon anterior MV leaflet
Corrigan’s sign: wide pulse pressure manifesting as ‘water-hammer pulse’
Quincke’s sign: capillary pulsations in finger tips
Duroziez’s sign: systolic and diastolic bruit heard over femoral arteries
DeMusset’s sign: head bobbing with pulsation
Mx of aortic regurg
Mild or moderate aortic regurgitation (without aortic root pathology):
6-12 monthly surveillance TTE
Medical management for symptoms (e.g. low dose maintenance frusemide; avoid excess dose of beta-blocker)
Severe aortic regurgitation (without aortic root pathology):
Surgical aortic valve repair or replacement
Severe aortic regurgitation (with aortic root pathology):
Replacement of aortic valve + aortic root + re-implantation of coronary arteries into graft (Bentall procedure)
aetiology of mitral stenosis
rheumatic fever
ESRF
Inflammatory conditions
congenital abnormalities
Px of mitral stenosis
Progressive shortness of breath on exertion
Palpitations (due to AF)
Dysphagia (due to compression of oesophagus from giant left atrium)
Diastolic murmur Malar flush AF Left parasternal heave (due to RV hypertrophy secondary to pulmonary hypertension) Loud P2 Raised JVP
Mx of mitral stenosis
Valve area >1.5cm2: 6-12 monthly surveillance echocardiogram, anticoagulate, diuretics beta blockers
VALVE AREA: <1.5 cm2 and symptomatic: percutaneous mitral commisurotomy, surgical valve replacement
Valve <1.5cm2 and asymptommatic: weigh up intervention vs conservative in scenario
aetiology of mitral regurg
AF endocarditis dilated cardiomyopathy rheumatic heart disease trauma Marfan's syndrome ischemic heart disease
Mitral regurg signs and symptoms
Progressive shortness of breath on exertion Palpitations (due to AF) Atypical chest pains Pan-systolic murmur at apex AF Laterally displaced apex beat Raised JVP
