2: Valve Defects Flashcards
1
Q
What causes mitral stenosis
A
Rheumatic Disease/Fever
2
Q
What are 4 causes of mitral regurgitation
A
- IHD
- Mitral valve prolapse
- Degenerative calcification
- Dilated cardiomyopathy
3
Q
What are 2 causes of aortic stenosis
A
- Calcification
- Bicuspid aortic valve
4
Q
What are 3 causes of aortic regurgitation
A
- Bicuspid aortic valve
- Connective tissue disorder
- Infective endocarditis
5
Q
What are 2 causes of tricuspid stenosis
A
- Infective endocarditis in IVDU
- Rheumatic fever
6
Q
What are 4 causes of tricuspid regurgitation
A
- IE in IVDU
- Right-Ventricle dilation
- Rheumatic fever
- Connective tissue disorder
7
Q
What is a cause of pulmonary stenosis
A
Congenital
8
Q
What are 2 causes of pulmonary regurgitation
A
- Pulmonary HTN
- Dilated cardiomyopathy
9
Q
What can cause pulmonary HTN
A
VSD
TOF
10
Q
What is aortic stenosis
A
narrowing of the aortic valve
11
Q
What is the commonest valvular heart disease
A
aortic stenosis
12
Q
In which population is aortic stenosis more common
A
elderly
13
Q
What is a supra-valvular cause of aortic stenosis
A
william’s syndrome
14
Q
What are 2 causes of valvular aortic stenosis
A
- degenerative calcification
- bicuspid aortic valve
15
Q
What is the commonest cause of valvular aortic stenosis in >65y
A
- degenerative calcification
16
Q
What is the commonest cause of valvular aortic stenosis in <65y
A
- bicuspid aortic valve
17
Q
What is the most common congenital heart defect
A
bicuspid aortic valve
18
Q
Is bicuspid aortic valve more common in Male or females
A
male
19
Q
What is the problem with bicuspid aortic valve
A
predisposes to degenerative calcification. Meaning these individuals have aortic stenosis a lot younger than those with tricuspid valves
20
Q
What is a sub-valvular cause of aortic stenosis
A
HOCM
21
Q
what is the triad of symptoms associated with aortic stenosis
A
‘SAD’
Syncope
Angina
Dyspnoea
22
Q
what murmur is heard in aortic stenosis
A
Ejection Systolic Crescendo-Decrescendo murmur
23
Q
what pulse is associated with aortic stenosis
A
Pulsus parvus et tardes - slow rising pulse
24
Q
what is pulses parvus de tardus
A
slow rising pulse
25
how do heart sounds change in aortic stenosis
soft S2
| S4
26
what can be felt in aortic stenosis
Thrill
27
explain pathophysiological consequences of aortic stenosis
- narrowing in aortic valve causes back-up of pressure
- left ventricle undergoes hypertrophy to compensate
- initially keeps up with demands but eventually the left ventricle will become stiff resulting in diastolic dysfunction
- this means left-ventricle ejection depends on the atria which undergoes hypertrophy to maintain EDV
- hypertrophy increases oxygen demands leading to ischaemia
28
What investigations are performed in aortic stenosis
1. Trans-thoracic ECHO
| 2. ECG
29
What will an ECG show in aortic stenosis
Left Ventricular Hypertrophy
30
What criteria is used to diagnose LVH on ECG
Sokolow-Lyon Criteria
31
What value defines mild aortic stenosis on ECHO
1.2-.18
32
What diameter defines moderate aortic stenosis
0.8-1.2
33
What diameter defines severe aortic stenosis
0.6-0.8
34
What diameter defines critical aortic stenosis
<0.6
35
What are the two management options for aortic stenosis
Conservative
| Surgical
36
When is conservative management indicated
Asymptomatic
37
When is surgical management indicated
- Symptomatic
| - Asymptomatic with pressure gradient >40mmHg
38
What are the 3 surgical options for aortic stenosis
- Surgical aortic valve replacement
- Trans-catheter aortic valve implantation (TAVI)
- catheter ballon valvuloplasty
39
When are transcutaneous aortic valve implantation performed
if too high a surgical risk
40
When is catheter balloon valvuloplasty performed
Children - no aortic calcification
41
What can aortic stenosis cause
- Left-sided HF
- Infective endocarditis
- Sudden death
42
What is aortic regurgitation
- incomplete closing of the valve leaflets, resulting in the regurgitation of blood from the aorta to the left ventricle
43
How can the aetiology of aortic regurgitation be divided
- Acute
| - Chronic
44
What are 3 causes of acute aortic regurgitation
- Infective endocarditis
- Aortic dissection
- Trauma
45
What are 4 causes of chronic aortic regurgitation
- Congenital bicuspid aorta
- Rheumatic fever
- Syphillis
- Connective tissue disorder
46
What is the most common cause of chronic aortic regurgitation in developed countries
Congenital bicuspid aorta
47
What is the most common cause of chronic aortic regurgitation in developing countries
Rheumatic Fever
48
What are 3 symptoms of acute aortic regurgitation
- Dyspnoea
- Cardiac decompensation due to HF
- Pulmonary oedema
49
How may chronic aortic regurgitation present
- May be asymptomatic for years
- Present with left-sided HF
- Palpitations
50
What murmur is heard in aortic regurgitation
Early diastolic murmur
51
What type of pulse is present in aortic regurgitation
- Wide pulse pressure = waterhammer pulse
| - Collapsing pulse
52
What is a water hammer pulse
Also referred to as corigan's sign it is caused by a wide pulse pressure. The pulse will be forcefully present and suddenly disappear
53
What is another term for water hammer pulse of collapsing pulse when seen at the carotids
Corrigan's sign
54
What are 3 signs of aortic regurgitation
Quinicke's sign
De Musset's sign of regurgitation
Corrigan's sign
55
What murmur is heard in severe aortic regurgitation
Austin Flint Murmur = mid-diastolic murmur
56
Why does aortic regurgitation cause a wide pulse-pressure
In AR there is regurgitation of blood from the aorta into the left ventricle. This means already ejected blood (systolic BP) refluxes back, reducing diastolic blood pressure in the aorta giving a raised systolic and decreased diastolic BP
57
Explain pathophysiology of acute AR
The left ventricle cannot sufficiently dilate to accommodate blood increasing end diastolic pressure which is transmitted back to the pulmonary circulation to cause pulmonary oedema and breathlessness. Also will decrease cardiac output causing cariogenic shock
58
Explain pathophysiology of chronic AR
Initially there is a compensatory increase in SV. Over time increase in EDV will cause LV dilation and heart failure.
59
What is first-line investigation for AR
Transthoracic ECHO
60
What is the treatment of aortic regurgitation
Aortic valve replacement
61
What will aortic regurgitation eventually lead to
Heart Failure
62
What is mitral stenosis
abnormality of the mitral valve that obstructs flow from the left atrium to the left ventricle
63
What causes mitral stenosis
rheumatic fever
64
How will mitral stenosis present clinically
- Asymptomatic at first. May present up to 10y following rheumatic heart disease
- Dyspnoea
- Haemoptysis
- AF
65
What murmur is present in mitral stenosis
mid-diastolic murmur
66
How do heart sounds vary in mitral stenosis
loud S1 (opening snap)
67
What sign will be present in mitral stenosis and why
malar flush. Due to reduced cardiac output there is an accumulation of CO2 in tissues which has a vasodilatory effect
68
Why may AF occur in mitral stenosis
reduced flow from left atrium to ventricle increases EDV in the left atrium. This results in dilation of the left atrium. Dilation of the left atrium predisposes to AF.
69
What is palpable in mitral stenosis
LV heave
70
What eponymous name is given to the murmur in mitral stenosis
Graham-Steel murmur = a high pitched early diastolic murmur
71
Explain the pathophysiology of mitral valve stenosis
There is obstruction of flow from left atrium to ventricle. This decreases blood in the left ventricle and hence cardiac output. Initially the left atrium compensates by dilating. Eventually it will decompensated resulting in blood flowing back towards the lungs and increasing pulmonary capillary pressure resulting in pulmonary oedema.
72
What investigations are ordered for mitral stenosis
1. ECG
2. CXR
3. ECHO
73
What may be seen on ECG
P mitrale
| AF
74
What may be seen on CXR
Signs of pulmonary oedema (A-E)
75
What is the management of mitral valve stenosis
- Balloon valvuloplasty
- Mitral valve replacement
- Open commissurotomy
76
What are 3 complications of mitral stenosis
- AF- can lead to thrombotic event
- Left-sided HF
- Enlarged left atrium may compress oesophagus or recurrent laryngeal (rare)
77
What is mitral regurgitation
Reflux of blood from the left ventricle into the left atrium
78
What is the second most common type of valve disease
Mitral regurgitation
79
How can aetiology of mitral valve disease be divided
Primary
| Secondary
80
What is primary mitral valve regurgitation
No underlying heart disease
81
What can cause primary mitral valve regurgitation
Rheumatic Fever
Infective endocarditis
Mitral valve prolapse
82
What is secondary mitral valve regurgitation
MR due to underlying cardiac disease
83
What can cause secondary mitral valve regurgitation
- MI involving papillary muscles
- Dilated cardiomyopathy
- Left-sided HF
84
What is a major risk factor for mitral valve regurgitation
Connective tissue disorders
85
How do patients with mitral valve regurgitation typically present
Asymptomatic.
| If symptoms - caused by left ventriclar failure
86
What are symptoms of mitral valve regurgitation
- Left sided HF
- Pulmonary Oedema
- Palpitations
87
What murmur is heard in mitral regurgitation
pan systolic murmur
88
How do heart sounds vary in MR
Quiet S1
| Split S2
89
Explain the pathophysiology of MR
Reflux of blood from the left ventricle to the left atrium. This decreases cardiac output. To try and maintain CO, the left ventricle undergoes hypertrophy but this increases oxygen demand
90
What may be seen on ECG in MR
P mitrale
91
What investigation is ordered for MR
Transthoracic ECHO
92
How is acute MR managed pharmacologically
Need to try and stabilise the patient by giving nitrates, diuretics (offload fluid) and anti-HTN
93
If pharmacological management is insufficient how should acute MR be managed
intra-aortic balloon pump
94
When is conservative management chosen in chronic MR
if ejection fraction is normal (>60%) and patient is asymptomatic
95
When is valve replacement indicated in MR
1. Symptomatic
| 2. Or, asymptomatic and decreased ejection fraction <60%
96
What are the complications of MR
- AF
- HF
- Endocarditis
