Valvular Heart Disease - INCOMPLETE Flashcards
Which of the mitral valve cusps is the biggest?
- Anterior
How are the cusps anchored to the papillary muscles?
- By the chordae tendinae - Both cusps are anchored to both papillary muscles
What conditions can lead to mitral stenosis?
- Rheumatic heart disease - Congenital mitral stenosis (rare) - SLE - Rheumatoid arthritis
What size is diagnosed as mitral stenosis?
- An MV orifice of <2cm^2
What happens to the AV pressure gradient during MS?
- Increases
What happens to the pulmonary venous and capillary pressures during MS?
- Increases
What happens to PVR and PaP in MS?
- Increase
What develops in response to MS?
- PHT - RH dilatation with TR and PReg
What two things do you use to asses M stenosis severity?
- Effect on trans valvular pressure gradient - Effect on trans valvular flow rate
What are the clinical presentations of M stenosis?
- Dyspnoea (mild exertional all the way to pulmonary oedema) - Haemoptysis - Systemic embolisation - Infective endocarditis - Chest pain - Hoarseness
What causes haemoptysis in MS?
- Rupture to thin walled veins
What causes systemic embolisation in MS?
- LA enlargement - LAA enlargement
What causes hoarseness in MS?
- Compression of the L recurrent laryngeal nerve
What signs are apparent on examination?
- Mitral facies - Normal pulses - Prominent a wave of JVP - Tapping apex beat - Diastolic thrill - RV heave - Diastolic murmur on auscultation
Describe the ECG of someone with M stenosis
- Atrial fibrillation - No visible P wave (irregularly irregular)
- Suggestion of LVH from right axis deviation and deep S waves in lateral leads
What will the blue area here show?
The bigger the blue area the more severe the M sten
What will be seen on the CXR of a Msten patient?
LA enlargement
What will be the only real evident feature of a CXR pointing towards Msten?
Pulmonary oedema from PHT
What echocardiogram investigations can be done with Msten?
- Imaging and ventricular velocity
What will show severity of Msten on a ventricular velocity map?
- Higher areas will show higher severity
What can a CT thorax be used for in Msten?
Can be used to directly look at mitral valve and see it’s maximum opening
What other imaging techniques can be used to look at the heart chambers and valves?
MRI
What non invasive treatment is available for Msten?
- Diuretics and restriction of Na intake
- Sinus Rhythm (SR) restoration and ventricular rate control in those with AF
- Anticoagulation in those with AF
What invasive treatment is available for Msten?
- Valvotomy (balloon or surgical)
- Mitral valve replacement (MVR)
What are the aetiologies and pathologies of mitral regurgitation (M Reg)
- Rhuematic Heart Disease
- Mitral valve prolapse
- IE
- Degeneration (tissue becomes thicker/calcifies/fibrosis)
- LV and annular dilatation resulting in anterior and posterior cusps being far apart
How can mitral regurgitation occur from mitral valve prolapse?
- Chordae tendinae snap
- Blood can flow back through the mitral valve
What happens to the ventricle during acute mitral regurgitation?
- Ventricle can’t adapt as it doesn’t have enough time
- ESP (end systolic pressure) and ESV (end systolic volume) reduced as is wall tension
How is chronic mitral regurgitation different to acute?
- EDV increases as the ventricle can hypertrophy to compensate
- ESV returns to normal
What happens to LA compliance in mitral regurgitation?
Can be reduced if
- Pressure rises,
- Thickening of atrial myocardium
- Increase in PVR
- Changes in pulmonary vasculature
Can be increased if
- Marked volume enlargement
- Lesser changes in pulmonary vasculature
What are the clinical signs of acute Mreg?
- Breathlesness
- Pulmonary oedema
- Cardiogenic shock
