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Cardiovascular System > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

Objectives

A
  • Know common heart valve lesions
  • Learn about the patho-physiology of each
  • Recognise the symptoms of valve disease and natural progression of the disease
  • Learn about the diagnostic investigations
  • Learn about the treatment
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2
Q

In valvular heart disease, how does damage to one valve affect others?

A

If one valve is affected, there’s a high likelihood that others will be as well.

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3
Q

What is mitral stenosis?

A

Mitral stenosis is a narrowing of the mitral valve opening that blocks (obstructs) blood flow from the left atrium to the left ventricle.
- Mitral stenosis usually results from rheumatic fever.

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4
Q

Aetiology of Mitral stenosis

A
  • Rheumatic heart disease
  • Congenital MS
  • Systemic conditions: SLE, RA
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5
Q

Pathophysiology of mitral stenosis

A
  • MV orifice <2cm2
  • A-V p gradient increases
  • LA pressure increases
  • Pulmonary venous and capillary pressure increases
  • PVR increases
  • PaP increases and PHT develops
  • RH dilatation with TR and PReg
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6
Q

What occurs to LV pressures and systolic function in mitral stenosis?

A

They remain normal

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7
Q

Clinical manifestations for mitral stenosis

A
  • Dyspnoea: mild exertional to pulmonary oedema
  • Haemoptisis: rupture of thin-walled veins
  • Systemic embolisation: LA and LAA enlargement
  • IE
  • Chest pain
  • Hoarseness (compression of the L recurrent laryngeal nerve).
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8
Q

Clinical examination signs of mitral stenosis

A
  • Mitral facies: discolouration of the cheeks and the nose
  • Pulse: normal
  • JVP: prominent a wave
  • Tapping apex beat and diastolic thrill
  • RV heave
  • Auscultation
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9
Q

Investigation techniques for mitral stenosis

A
  • ECG
  • Cardiac catheterisation
  • Chest X-ray
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10
Q

Imaging in mitral stenosis

A
  • Echocardiography:
    thickening and scarring of the leaflets
    Fusion of the commissures
  • Cardiac magnetic resonance
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11
Q

What is the medical treatment used for mitral stenosis?

A
  • Diuretics and restriction of Na intake
  • AF: SR restoration or ventricular rate control
  • Anticagulation: all those with AF, debatable in SR
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12
Q

Interventional treatment for mitral stenosis

A
  • Valvotomy (balloon vs surgical)

- MVR (mitral valve replacement)

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13
Q

Aetiology and Pathology of mitral regurgitation

A
  • Rheumatic heart disease
  • Mitral valve prolapse (MVP)
  • IE
  • Degenerative
  • Functional MR due to LV and annular dilatation
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14
Q

Pathophysiology of mitral regurgitation

A
  • ERO - not fixed: preload, afterload, LV contractility
  • LV compensation:
    Acute: ESP and ESV decreases, Wall tension decreases
    Chronic: EDV increases and ESV returns to normal, eccentric LVH develops
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15
Q

What occurs due to reduced LA compliance in mitral regurgitation?

A
  • Marked pressure rise
  • Thickening of atrial myocardium
  • Increase in PVR and remodelling of the pulmonary vasculature with PHT.
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16
Q

What occurs due to increased LA compliance in mitral regurgitation?

A
  • Marked volume enlargement

- Lesser changes in pulmonary vasculature, but develops AF.

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17
Q

Clinical manifestations in mitral regurgitation

A
  • Acute MR (valve perfusion, chordal/pap muscle)
    Breathlessness: pulmonary oedema, cardiogenic shock
  • Chronic MR
    Fatigue, exhaustion (low CO), Right heart failure
    Dyspnoea or palpitations due to AFib
18
Q

Is acute mitral regurgitation quite bad?

A

Yes acute MR is an emergency

19
Q

Clinical examination signs for mitral regurgitation

A
  • Pulse: normal or reduced in heart failure
  • JVP: prominent if RH failure present
  • Brisk and hyperdynamic apex beat
  • RV heave
  • Auscultation: holosystolic, blowing, loud at apex, radiating to the axilla, no relationship between intensity and severity.
20
Q

What imaging is used for mitral regurgitation?

A

Echocardiography:

  • LV dimensions
  • Cause of MR: leaflet dysfunction, chordae, pap mscles, annular disease
  • Severity of MR and Pap
  • Accurate cardiac volumes
  • Volumetric determination of Reg Vol
21
Q

What medical treatment would be used for Acute MR?

A

Since preload and afterload reduction may be life-saving

- Sodium nitroprusside, dobutamine, IABP

22
Q

What medical treatment would be used for Chronic MR?

A

Lack of evidence that any therapy is beneficial for haemodynamic improvement
- LV function preservation

23
Q

Interventional treatment for Mitral regurgitation

A
  • Mitral valve apparatus repair

- Mitral valve replacement

24
Q

Structure and function of the aortic valve

A
  • It is one of the semilunar valves
  • It normally has three cusps
  • The aortic valve opens, allowing blood to exit the left ventricle into the aorta depending on pressure.

Normal AVA= 3-4cm2

25
Q

Aortic stenosis aetiology

A
  • Degenerative
  • Rheumatic
  • Bicuspid

AVA< 1.5-2cm2

26
Q

Patho-physiology of aortic stenosis

A

Rheumatic: adhesion, fusion of the commissures and retraction and stiffening of the free cusp margins.

Degenerative: linked to atherosclerosis, a slow inflammatory process resulting in thickening and calcification of the cusps from base to free margins.

27
Q

Order of pathophysiology of aortic stenosis

A

Increased LV systolic pressure > Severe concentric hypertrophy and LVM > Increased LVEDP (left atrial pressure increases, PHT) > Increased MVO2 > Myocardial ischaemia > LV failure

28
Q

Symptoms of Aortic stenosis

A
  • Long asymptomatic phase
  • Cardinal symptoms:
  • Chest pain (angina)
  • Syncope/Dizziness (exertional pre-syncope)
  • Breathlessness on exertion
  • Heart failure
29
Q

Clinical examination signs of aortic stenosis

A
  • Pulse: small volume and slowly rising
  • JVP: prominent if RH failure present, low BP.
  • Vigorous and sustained apex beat
  • RV heave
  • Auscultation: late peaking, loud at the base, harsh, radiating to the carotids
30
Q

Laboratory investigations for aortic stenosis

A
  • ECG: LVH voltage criteria, ST/T changes (LV strain)
  • Chest X-ray: calcification of AV
  • Cardiac catheterisation: Peak LV-peak aortic gradient-obsolete.
31
Q

Imagine used for aortic stenosis

A
  • Echocardiography

- CMR (cardiovascular magnetic resonance)

32
Q

Features of Echocardiography in aortic stenosis

A
  • Demonstrates the AV cusp mobility
  • LV function and hypertrophy
  • Doppler haemodynamic assessment of pressure gradient and AVA
33
Q

Who gets medical treatment for aortic stenosis and what is the treatment?

A
  • Limited to those who develop heart disease.

- May be treated with digoxin, diuretics, ACE inhibitors, or angiotensin receptor blockers.

34
Q

Interventional treatment for aortic stenosis

A

Aortic valve replacement or repair

35
Q

Aetiology of aortic regurgitation

A
  • Aorta: dilated aorta(Marfans, hypertension), connective tissue disorders
  • Leaflets: bicuspid aortic valve, rheumatic heart disease, endocarditis, myxomatous degeneration
36
Q

Order of pathophysiology of aortic regurgitation

A

LV accommodates both SV and RegVol > Increased LVEDV and LV systolic pressure > LV hypertrophy and LV dilatation > Increased MVO2 > Myocardial ischaemia > LV failure

37
Q

Symptoms of chronic aortic regurgitation

A
  • Long asymptomatic phase

- Exertional breathlessness

38
Q

Symptoms of acute aortic regurgitation

A
  • Poorly tolerated as wall cannot acutely adapt

LV pressure x LV radius/wall thickness

39
Q

Clinical examination signs of aortic regurgitation

A
  • Pulse: large volume and collapsing (Corrigan sign)
  • Wide pulse pressure
  • Hyperdynamic, displaced apex beat
  • Auscultation: early diastolic, descresendo, soft murmur
40
Q

Imaging used in aortic regurgitation

A
  • Echocardiography: Demonstrates the AV cusp anatomy (thickening, prolapsing, number of cusps, vegetations)
  • LV function, dilatation and hypertrophy
  • Doppler haemodynamic assessment of regurgitant flow
  • Cardiovascular magnetic resonance (CMR)
41
Q

Medical treatment used for aortic regurgitation

A
  • Vasodilator therapy shown to delay the timing for surgical intervention.
42
Q

Interventional treatment used for aortic regurgitation

A

Aortic valve replacement or repair

Cardiovascular System (36 decks)

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