Valvular Heart Disease - Pathophysiology, Presentation & Investigation Flashcards
What are some examples of valvular heart disease?
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
What is mitral stenosis?
Narrowing of the mitral valve opening that blocks blood from from the left atrium to the left ventricle
What is narrowing of the mitral valve opening that blocks blood flow from the left atrium to the left ventricle called?
Mitral stenosis
What is the aetiology and pathology of mitral stenosis?
Rheumatic heart disease
Congenital mitral stenosis
]Systemic lupus erythematosus
Rheumatoid artheritis
What is the pathophysiology of mitral stenosis?
Lef atrium pressure increases
Left ventricle pressures normal
Pulmonary venous and capillary pressures increased
Pulmonary vascular resistance increases
Right heart dilation
What is the clinical examination for mitral stenosis?
Dyspnoea
Haemoptysis
Systemic embolism
Infective endocarditis
Chest pain
Hoarseness
What is hoarseness?
Abnormal voice changes
What are abnormal voice changes called?
Hoarseness
What are clinical examination findings for mitral stenosis?
Mitral facies
Pulse normal
JVP prominant
Tapping apex beat and diastolic thrill
Right ventricle heave
What investigations are done for mitral stenosis?
ECG
Chest X-ray
Echocardiogram
Cardiac MRI
What can be seen in the ECG for mitral stenosis?
P wave > 0.12s
What can be seen in the chest X-ray for mitral stenosis?
Left atrium enlargement
What can be seen in the echocardiogram for mitral stenosis?
Thickening and scarring of the leaflets
What is the treatment for mitral stenosis?
Diuretics and restriction of Na intake
Anticoagulants
Valvotomy
Mitral valve replacement
What is a valvotomy?
Incisions to relieve valvular stenosis
What are incisions to relieve valvular stenosis called?
Valvotomy
What is mitral regurgitation?
Leakage of blood backward through the mitral valve each time the left vantricle contracts
What is leakage of blood backward through the mitral valve each time the left ventricle contracts called?
Mitral regurgitation
What is the aetiology and pathology of mitral regurgitation?
Rheumatic heart disease
Mitral valve prolapse
Infective endocarditis
Degenerative
What is pathophysiology of mitral regurgitation?
Changes preload, afterload and left ventricular contractility
Left ventricular compensation
What are the clinical manifestations of mitral regurgitation?
Breathlessness
Pulmonary oedema
Fatigue
Exhaustion
Right heart failure
Dyspnoea
Palpitations
What are the examinations findings for mitral regurgitation?
Pulse normal or reduced in heart failure
JVP prominant if right heart failure present
Brisk and hyperdynamic apex beat
Right ventricle heave
What investigations are done for mitral regurgitation?
ECG
Chest X-ray
Cardiac catheterisation
Echocardiogram
What is seen in an ECG for mitral regurgitation?
P wave > 0.12s
What is seen in a chest X-ray for mitral regurgitation?
Cardiomegaly
Left atrium enlargement
What is cardiac catheterisation?
Invasive diagnostic procedure that provides important information about the structure and function of the heart, uses X-rays of the coronary arteries using coronary angiography
What is seen in an echocardiogram for mitral regurgitation?
Left ventricle dimensions
What is the treatment for mitral regurgitation?
Preload and afterload reduction using nitroprusside
Mitral valve repair
Mitral valve replacement
What is aortic stenosis?
Narrowing of the aortic valve restricting blood flow from the left ventricle to the aorta
What is narrowing of the aortic valve called?
Aortic stenosis
What is the aetiology of aortic stenosis?
Degenerative
Rheumatic heart disease
Bicuspid aortic valve
What is the pathophysiology of aortic stenosis?
Rheumatic cause - adhesion of the commissures and stiffening of the free cusp margins
Degenerative cause - linked to atherosclerosis, thickening and calcification of the cusps from the base to free margins
Increase left ventricular systolic pressure leading to left ventricle failure
What are the manifestations of aortic stenosis?
Long asymptomatic phase
Chest pain (angina)
Syncope
Dizziness
Breathlessness on exertion
Heart failure
What are the examination findings for aortic stenosis?
Pulse small volume and slowly rising
JVP prominent if right heart failure present
Low blood pressure
Vigorous and sustained apex beat
Right ventricle heave
What investigations are done for aortic stenosis?
ECG
Chest X-ray
Cardiac catheterisation
Echocardiogram
Chest MRI
What is seen in the ECG for aortic stenosis?
ST/T changes
What is seen in the chest X-ray for aortic stenosis?
Calcification of aortic valve
What is seen in the echocardiogram for aortic stenosis?
Demonstrates the aortic valves cusp mobility
Shows left ventricle function and hypertrophy
What is the treatment for aortic stenosis?
Limited to those who develop heart failure
Aortic valve repair
Aortic valve replacement
What is aortic regurgitation?
Leaking of the aortic valve that causes blood to flow from the aorta into the left ventricle during diastole
What is leaking of the aortic valve called?
Aortic regurgitation
What is the aetiology of aortic regurgitation?
Dilated aorta (Marfan’s, hypertension)
Leaflets (bicuspid aortic valve, rheumatic heart disease, endocarditis)
What is the pathophysiology of aortic regurgitation?
Increase left ventricle systolic pressure
Left ventricle hypertrophy and dilation
Increase oxygen demand
Myocardial ischaemia
Left ventricle failure
What are the clinical manifestations of aortic regurgitation?
Long assymptomatic phase
Exertional breathlessness
What are examination findings for aortic regurgitation?
Pulse large volume and collapsing
Wide pulse pressure
Hyperdynamic, displaced apex beat
What investigations are done for aortic regurgitation?
ECG
Chest X-ray
Cardiac catheterisation
Echocardiogram
Chest MRI
What is seen in the ECG for aortic regurgitation?
ST/T changes
What is seen in the chest X-ray for aortic regurgitation?
Cardiomegaly
What is seen in the echocardiogram for aortic regurgitation?
Demonstrates aortic valve cusp anatomy (thickening, prolapsing, number of cusps etc)
Shows left ventricle function, dilation and hypertrophy
What is the treatment for aortic regurgitation?
Vasodilator therapy
Aortic valve replacement
Aortic valve repair
