38. Valvular Heart Disease Flashcards
What is rheumatic heart disease?
What would you use to inspect heart valves?
What are the 6 types of common valve lesions?
From rheumatic fever, caused by strep, sore throat, autoimmune inflammatory reaction, affects heart valves -> scar -> valvular stenosis/regurg. particularly MITRAL valve affected. Lss common now b/c of environmental factors, decrease in virulence of group A strep, and surgery (valve replacement)
Echocardiogram + doppler, or 2D echo
AS MR AR MS (only caused by RHD) and mitral valve prolapse, R sided valve lesions
What is mitral valve prolapse?
What would you hear and when?
What is the treatment?
As L ventricle contracts and mitral valve shuts in systole, in pts with floppy valves, mitral valve prolapses back into L atrium -> click. (Sometimes producing mitral regurg).
Late systolic murmur (and possibly ejection click)
Usually not needed.
What is aortic steosis?
What are the causes?
What are the symptoms?
What are the signs?
Narrowing of aortic valve
Calcific disease, aging, congenital bicuspid valve (born with 2 leaflets instead of 3), rheumatic disease
L vent hypertrophy, increased pressure in pulmonary veins (and fluid leaks into lungs as pressure increases), dyspnoea, angina (hypertrophy). syncope (exertional= e.g. if run, BP decreases eventually b/c C.O can’t rise enough), LVFailure, sudden death (ventricular arythmia)
Slow rising carotid pulse, S4 (due to still vent) +/- ejection click (if valve still quite mobile), ejection systolic murmur at base of heart
How would you investigate aortic stenosis?
What pressure signal would you see?
What are the indications for surgery?
Doppler and echocardiogram
Sever pressure gradient across aortic valve, so prominent ‘a’ wave (arrow in pic)
Any AS symptoms, worsening LV dilation, peak systolic pressure gradient >50mmHg, can have TAVI if too sick for heart surgery
What are the 2 diseases (and their causes) that may cause aortic regurgitation?
What are the symptoms of AR?
What are the signs of AR?
1) Aortic valve leaflet disease: leaking back through valve, caused by calcific disease, congenital bicuspid valve, rheumatic disease, infective endocarditis
2) Aortic root dilating disease: valve leafets won’t meet in middle, cause by ankylosing spondylitis, Marfan syndrome, aortic dissection
Symptoms: dypnoea (contractile failure as vent dies), angina (O2 demand of hypertrophied LV) (AR usually well tolerated)
Signs: rapidly rising carotid pulse - vigerous ejection of volume loaded LV, early diastolic murmur, ejection murmur (turbulent ejection)
How would you investigate aortic regurgitation?
What are the indications for surgery?
Catheter in aorta and inject contrast -> shouldn’t see contrast in L vent. Can use echo dopp too.
Any symptoms of AR, echocardiographic evidence of worsening LV dilation. Can cure with valve replacemment.
What is the sole cause of mitral stenosis?
What are the symptoms?
What are the signs?
Rheumatic fever
Symptoms: dyspnoea (increased L atrial pressure b/c vave thickens), R ventricle failure, palpitations (AF), systemic emboli (static blood in dilated fibrillating L atrium predispose to thrombosis). HIGH STROKE RISK
Signs: pulse (AF), ausculatation: loud S1, opening snap, mid-diastolic murmur, increased JVP due to pulm pressure increase, basal creps, ankle oedema
How would you investigate mitral stenosis?
What is the treatment?
Echo dop, can use ECG and see biphasic P waves if in sinus rhythm = sign of L atrium enlargement.
Valvuloplasty, or can do with balloon
What are the 3 main causes of mitral regurgitation and the reasons for those causes?
What are the symptoms for MR?
What are the signs for MR?
1) Mitral valve leaflet disease: rheumatic disease, mitral valve prolapse, infective endocarditis
2) Subvalvar disease: chordal rupture, papillary muscle dusfunction (usually ischaemic)/rupture
3) Functional MR: (valve leaflets don’t meet in middle) LV dilation
Symptoms: dyspnoea, palpitations (AF), systemic emboli (static blood in dilated fibrillating L atrium predisposes to thrombosis)
Signs: pulse AF, auscultation: pansystolic murmur (from when valve opens to when it closes), S3, volume overload = increased JVP, basal creps, ankle oedema
How would you investigate mitral regurgitation?
What are the indications for surgery?
Echo dopp, or catheter and dye.
Symptoms that fail to respond to medical treatment, worsening CDV complications (e.g. pulm hypertension, LV dilation)
What are some medical treatments for valvular heart disease symptoms?
1) fluid retention - diuretics
2) low forward output due to aortic/mitral regurg - vasodilators
3) AF - digoxin, beta blockers, verapamil
4) Anticoagulants to protect against systemic embolisation (AF)
ALL PTS WITH MITRAL VALVE DISEASE SHOULD BE ON WARFARIN
