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Semiology second semester > VALVULAR HEART DISEASE > Flashcards

VALVULAR HEART DISEASE Flashcards

1
Q

Valvular heart disease

A 
■ MITRAL STENOSIS
■ AORTIC STENOSIS
■ MITRAL REGURGITATION
■ AORTIC REGURGITATION
■ TRICUSPID REGURGITATION
■ TRICUSPID STENOSIS
■ PULMONARY STENOSIS
■ PULMONARY REGURGITATION
■ MIXED LESION
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2
Q

MITRAL STENOSIS

Definition:

A

The mitral valve’s incapacity to open completely in diastole, due to

  • comisural fusion
  • cusps thickenning
  • remodeling of the subvalvular structures
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3
Q

MITRAL STENOSIS

Etiology

A 
Rheumatic fever - most of the patients,
 Other etiologies are very rare: 
–Congenital, MS+atrial septal defect= Lutembacher syndrome. 
–Mitral valve annular calcification - elderly. 
–Other causes of LV inflow obstruction:
■atrial myxoma
■LA ball thrombus
■cor triatriatum.
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4
Q

MITRAL STENOSIS-Pathology

A

Fusion of the comissures, cusps or chords.

Contracture and thickening of the cusps.

Shortening and fusion of the chordae tendinae.

Funnel –shaped orifice.
SLIDE 5

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5
Q

Mitral Stenosis

Pathophysiology

A 
■ Obstruction between LA and LV. 
■ Pressure gradient. 
■ Elevated LA pressure. 
■ LA pressure increases at elevated HR.
■ Pulmonary vascular resistance elevated.
■ Pulmonary hypertension
■ Right ventricular hypertrophy, enlargement.
■ Systemic venous congestion
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6
Q

Mitral stenosis-Classification

A

■ Large: more than 2 sqcm.
■ Medium: 1,5-2sqcm.
■ Severe:<1sqcm.

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7
Q

Mitral stenosis-Symptoms.

A 
■ Exertional dyspnea.
■ Fatigue.
■ Presyncope, syncope.
■ Cough, wheezing.
■ Paroxysmal nocturnal dyspnea.
■ Orthopnea.
■ Hemoptysis.
■ Hoarsenes(Ortner syndrome
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8
Q

Mitral stenosis

Physical findings

A 
■ Mitral facies.
■ Tachypnea.
■ Turgid jugulars.
■ Jugular pulse.
■ Pulmonary rales, 
pleural fluid. 
■ Diastolic thrill.
■ Sustained RV lift
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9
Q

Mitral stenosis

-Auscultaion

A

slide 10 ,11 ,12

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10
Q

Mitral stenosis- Complications

A 
■ Atrial fibrillation/flutter.
■ Embolism: Systemic:cerebral, coronary, preipheral; pulmonary.
■ Acute pulmonary edema.
■ RV heart failure.
■ Infective endocarditis. 
■ Chest pain/angin
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11
Q

Mitral regurgitation

A

Definition: Clinical syndrome determined by the

incomplete closure of the mitral valve during systole.

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12
Q

MR - Causes

A

SLIDE 15 , 16

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13
Q

MR-pathophysiology

A

■ A volume of blood is regurgitated from the LV to the LA
LV overload.
■ End diastolic pressure increases
LA preassure is increased,
LA is dilated,
Pulm HTN can develop.
■ LV is dilated
Syst LV dysfunction appears (may be irreversible)
■ Pulmonary arterial hypertension can appear
+
RV failure during evolution.

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14
Q

MR-pathophysiology

A

SLIDE 18

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15
Q

MR-physical examination

A

■ Carotid upstroke is brisk.
■ Laterally displaced apical impulse with enlarged LV.
■ Apical thrill-severe MR.
■ Left sternal border lift –RV dilation.
■ S1 is included in the murmur, usually normal, may be increased in rheumatic heart disease.
■ S3 gallop-large volume of regu

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16
Q

MR-physical examination (II)

A

■ The hallmark of MR is the systolic murmur-most often holosystolic, is of blowing type, but may be harsh in mitral valve prolapse

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17
Q

MR in mitral valve prolapse.

A

■ MR limited to telesystole.
■ Frequent -5%pop. especially in young women.
■ Habitus is sometimes characteristic: longiline- asthenic woman with mild chest
deformities:pectus excavatum, pectus carinatum.
■ Palpation- bifid apical impulse.
■ Meso or telesystolic click, followed by –in a minority of cases – by telesystolic murmur

18
Q

Mitral Valve Repair

A

SLIDE 22

19
Q

Aortic stenosis

A 
Definition: obstruction to blood outflow from the LV to the aorta.
Causes:
1. Congenital.
2. Acquired:
- Degenerative
- Rheumatic

Rare causes:

  1. Infective endocarditis
  2. Paget bone disease
  3. SLE
  4. Rheumatoid involvement
  5. Irradiation
20
Q

Aortic stenosis - PATHOLOGY

A

SLIDE 24

21
Q

Aortic stenosis - Pathophysiology

A 
■ Obstruction in LV outflow.
■ Gradient LV-Ao.
■ LV pressure rises,.
■ LV wall stress increases.
■ LV dysfunction develops
■ LV hypertophy develops.
■ LV filling pressure increaqses.
■ LV systolic failure develop
22
Q

Aortic stenosis-classification

A

SLIDE 26

23
Q

Aortic stenosis-symptoms

A 
■ Angina pectoris.
■ Exertional presyncope
■ Syncope.
■ Heart Failure
■ Pulmonary edema
24
Q

AS- CLINICAL FINDINGS

A

■ Peripheral pulse: parvus et tardus- taking longer time to reach the peak pressure, peak is reduced.
■ Heart size increased in heart failure.
■ Palpable G4(S4).
■ Aortic thrill at the base of the heart.

25
Q

AS-Auscultation

A

■ Systolic ejection click(bicuspid)
■ Paradoxically split S2.
■ Systolic ejection murmur.
■ In older patients ejection murmur is atypical, heard at the apex as seagull sound – Gallavardin phenomenon.
■ Ejection murmur decreased when LV failure occurs

26
Q

AORTIC VALVE REPLACEMENT

A 
TAVI=
Transcatheter
Aortic
Valve
Implantation
SLIDE 30
27
Q

AORTIC REGURGITATION

A

Definition:
Incomplete closure of the aortic cusps in diastole and regurgitation of blood from the aorta to the left ventricle.
Aortic regurgitation can be acute or chronic.

28
Q

AORTIC REGURGITATION-Etiology

A

SLIDE 32

29
Q

AORTIC REGURGITATION-Pathology

A 
■ Dilatation of the annulus  AR.
■ Valves can show – Thickening
– Shortening
– Comisural lesions – Calcification, .
■ LV – dilated – hypertrophied.
■ LV dysfunction
30
Q

AORTIC REGURGITATION-Symptoms

A 
■ Pounding of the head or palpitations.
■ Dyspnea on exertion.
■ Orthopnea, paroxysmal nocturnal dyspnea.
■ Fatigue and weakness.
■ Angina pectoris
31
Q

AORTIC REGURGITATION-peripheral signs

A

■ Pulse pressure –elevated.
■ Corrigan pulse- celer et altur.
■ Atrerial hyperpulsatility:
■ Musset sign-bobbing of the head with each heartbeat.
■ Traube sign-pistol-shot heard over the femoral artery.
■ Duroziez sign-systolic murmur fem.a.when compressed proximally, diastolic distally.
■ Quincke pulse-capillary pulsations detected pressing a glass over the patients lips.
■ Arterial dance- carotid pulsations.
■ Waterhammer sign-pulsatons of the forearm when pressed.
■ Landolfi sign – intermittant pupillary hippus – miosis in systole, midriasis in diastole

32
Q

AORTIC REGURGITATION-physical examination

A

■ The chest may rock, cardiac impulse may be visible.
■ Diastolic thrill-severe AR.
■ S1 usually soft.
■ Systolic ejection murmur.
■ Early or immediate, blowing descrescendo diastolic murmur, after S2.
■ IN severe AR the murmur is holodiastolic.
■ Austin-Flint murmur of functional mitral stenosis.
■ Signs of left or global heart failure

33
Q

Tricuspid regurgitation

A

Definition: incapacity of the tricuspid valve to close completely during systole, resulting in
regurgitation of blood from the right ventricle to the right atrium.

34
Q

Tricuspid regurgitation -etiology

A

■ Primary TV disease: – Congenital:Ebstein anomaly – Rheumatic, assoc. with mitral disease. – Infective endocarditis. – Iatrogenic: pacemaker wire trauma. – Degenerative:TV prolapse.
■ Secondary TV disease: – RV dilatation
– Pulmonary hypertension. – Cardiomyopathies – Segmental RVdysf. Due to ischemia, ARVD

35
Q

Tricuspid regurgitation-symptoms

A

■ TR is not associated with any complaint until the late phases of the disease when RV dysfunction develops resulting in overt rihgt heart failure syndrome.
■ Symptoms: fatigue, right upper quadrant discomfort, dyspepsia due to gut congestion

36
Q

Tricuspid regurgitation –

physical examination

A 
■ Edema of the lower limbs.
■ Ascites.
■ Jugular congestion
■ Cachexia due to low cardiac output 
■ Right parasternal lift.
■ Systolic pulsa
37
Q

Tricuspid regurgitation

Auscultation

A

SLIDE 42

38
Q

Tricuspid stenosis

A

■ Rare condition
■ Etiology: rheumatic in most of the cases.
■ Simptoms and general signs similar to those met in TR.
■ Auscultation: low to medium pitched diastolic rumble with inspiratory accentuation,
localized to the lower sternal border.

39
Q

Pulmonary valve dissease

A

■ Apart from congenital conditions is very rare.
■ Congenital: PV stenosis, Pulmonary atresia, Bicuspid valve, Infundibular(subvalvular pulmonary stenosis), Idiopathic dilatation of the pulmonary artery.
■ Acquired: reheumatic, Infective endocarditis, carcinoid heart disease, pulmonary hypertension, iatrogenic-Ross operation.

40
Q

Pulmonary stenosis –physical examination

A

■ Mild stenosis - systolic ejection click+early systolic murmur.
■ Severity progresses the murmur gets louder and peaks later in systole.
■ S2 is splitted with dealyed pulmonary component, but with further widening in inspiration

Semiology second semester (13 decks)

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