Valvular Heart Disease - Pathophysiology, Presentation and Investigations Flashcards
List the common heart valve lesions
- Mitral stenosis
- Mitral regurgitation
- Aortic stenosis
- Aortic regurgitation
What is the pathophysiology of MITRAL STENOSIS (6 key points)
- Atrium - ventricle pressure gradient increases
- Left atrial pressure increases
- Pulmonary venous and capillary pressures increase
- Pulmonary vascular resistance increases
- Pulmonary artery pressure increases and pulmonary hypertension develops
- Right heart dilatation with tricuspid regurgitation and pulmonary regurgitation
- LEFT VENTRICLE pressures and systolic function normal
What is the natural progression of heart valve disease?
Describe the common clinical features of mitral stenosis
- Dyspnoea: mild exertion to pulmonary oedema
- Haemoptisis: rupture of thin walled veins
- Systemic embolisation: Left atrium and left atrial appendage enlargement
- Infective endocarditis
- Chest pain
- Hoareness
List the diagnostic investigations appropriate for mitral stenosis as well as likely findings
- Mitral facies
- Pulse: normal
- JVP: prominent a wave
- Tapping apex beat and diastolic thrill
- RV heave
- Auscultation
- ECG: P wave >0.12sec
- CXR: LA enlargement
- Echocardiogram: thickening and scarring of the leaflets
What treatment options are available for mitral stenosis (what are their limitations)
- Diuretics and restriction of Na intake
- AF: restore sinus rhythm or ventricular rate control
- Anticoagulation: all those with AF, debatable for sinus rhythm
- Valvotomy (balloon vs surgical)
- MVR
What is the pathophysiology of MITRAL REGURGITATION
- Effective resurgent orifice: not fixed which is dependent on:
~ Preload
~ Afterload
~ Left ventricle contractility - Left ventricle compensation
~ Acute: End systolic pressure increases and end systolic volume decreases
~ Chronic: End diastolic volume increases and end systolic volume returns to normal
Describe the common clinical features of mitral regurgitation
Acute mitral valve regurgitation
= breathlessness: pulmonary oedema, cardiogenic shock
Chronic mitral valve regurgitation
= fatigue, exhaustion (low cardiac output), right heart failure, dyspnoea or palpitations due to AF
List the diagnostic investigations appropriate for mitral regurgitation
- Pulse: normal or reduced
- Increased JVP
- Risk and hyperdynamic apex beat
- RV heave
- Auscultation
- ECG - LA enlargement (P wave > 0.12 seconds
- CXR - cardiomegaly, LA enlargement, calcification of mitral annulus
- Echocardiogram - LV dimensions
What treatment options are available for mitral regurgitation (what are their limitations)
ACUTE MR:
- vasodilators
INTERVENTIONAL TREATMENT
- mitral valve apparatus repair
- mitral valve replacement
What is the pathophysiology of AORTIC STENOSIS
CAUSED BY EITHER:
- RHEUMATIC HEART DISEASE
- DEGENERATIVE HEART DISEASE
- Increased LV systolic pressure
- Severe concentric hypertrophy and increased LV mass
- Increased LVEDP
- Increased MV02
- Myocardial ischaemia
- LV failure
Describe the common clinical features of atrial stenosis
- Long asymptomatic phase
- Chest pain (angina)
- Syncope/dizziness
- Breathlessness on exertion
- Heart failure
List the diagnostic investigations appropriate for aortic stenosis
- Pulse - small volume and slowly rising
- JVP - prominent if RH failure present, low BP
- Vigorous and sustained apex beat
- RV heave
- Auscultation
ECG - LVH voltage criteria, ST/T changes
CXR - calcification of AV
Echocardiogram - demonstrated the AV cusp mobility, LV function and hypertrophy
CMR
What treatment options are available for ATRIAL STENOSIS (what are their limitations)
Aortic valve replacement or repair
What is the pathophysiology of AORTIC REGURGITATION
- Increased LVEDV and LV systolic pressure
- LV hypertrophy and LV dilation
- Increased MVO2
- Myocardial ischaemia
- LV failure
