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cardiovascular > valvular heart disaease > Flashcards

valvular heart disaease Flashcards

1
Q

what causes mitral stenosis

A

rheumatic heart disease

congenital mirtal stenosis

systemic conditions

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2
Q

when is the condition of the mitral valve for it to be stenosis

A

<2cm

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3
Q

what happens in mitral stenosis

A

left atrium pressure increases

the atrium ventricle pressure gradient increases (effects flow rate - CO, HR as well)

pulmonary venous and cappliary pressure increase

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4
Q

what are the clinical maifestations of mitral stenosis

A

dyspnoea

haemoptysis - rupture of thin walled veins

chest pain

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5
Q

what would indicate mitral stenois on clinical examination

A

tapping apex beat, diastolic thrill, RV heave,

murmur after S2

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6
Q

what might you see on the x ray of someone with mitral stenosis

A

Left atrium enlargement

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7
Q

what medical treatment could be used - mitral stenosis

A

diuretics and restriction of Na intake

antigoagulation

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8
Q

what interventional treatment could be used

A

valvotomy (ballon or surgical)

mitral valve replacement ( gold standard)

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9
Q

how might mitral regurgitation occur - why ?

A

rhematic heart dsease

mitral valve prolapse (due to leaflet dysfunction)

IE (infective endocarditis)

functional MR due to LV and anullar (fiboirus skeleton) dilation

why - its a degenerative disease

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10
Q

what does ERO stand for

A

effective regurgant orifice (size of the hole in the valve)

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11
Q

what factors effect annular enlargemement

A

preload
afterload
LV contractility

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12
Q

what are the clinical manifestations of acute Mitral regurgitation

A

breathlessness, pulmonary odema, cardiogenic shock

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13
Q

what are the clinical manifestations of chronic mitral regurgitation

A

fatigue, exhaustion (due to low cardiac output), right heart failure

dyspnoea - atrial fibrillation

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14
Q

what sings would you expect to find on clinical examination of patients with mitral regurgitation

A

normal or reduced in heart failure

prominent JVP in RH failure

RV heave

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15
Q

what might you expect to see on a chest radiograph of someone with mitral regurgitation

A

cardiomegaly, left atrium enlargement, white spots on mitral valve (calcification of mitral annulus)

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16
Q

what medical therapy helps in chronic mitral regurgitation

A

nothing

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17
Q

what medical therapy helps with acute mitral regurgitation

A

sodium nitroprusside, intra aortic balloon pump

all aimed to reduce preaload and afterload

life saving until surgery

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18
Q

what are the interventional treatments for mitral valve regurgitation

A

mitral valve apparatus repar

or replacement

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19
Q

what is the normal area of the aortic valve

A

about 3-4cm squared

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20
Q

what is the area of a aortic valve with stenosis

A

area less than 1.5-2cm squared

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21
Q

what causes aortic stenosis

A

rheumatic heart disease (adhesion and fusion of commissures - where to valves meet on the vessel at the base)

degenerative (due to atherosclerosis) - calcification of the cusps from base to free margins

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22
Q

what is the patho-physiology pathway once aortic stenosis occurs to lead to LV failure

A

increased LV systolic (squirts) pressure

hypertorophy of LV myocardium

increased LV end diastolic pressure

increased O2 requirements

myocardial ischaemia

LV failure

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23
Q

what is ‘‘good’’ about aortic stenosis

A

long asympotomatic phase meaning time without surgery can be postponed

24
Q

what is heard when osculating a aortic stenosis

A

a murmur between S1 and S2

25
Q

what might you see on the chest x ray of aortic stenosis

A

calcification of the AV

26
Q

when is treatment given for mitral stenosis - what treatment

A

limited to those who develop heart failure

aortic valve repair

27
Q

what can cause aortic regurgitation

A 
Dilated aorta (Marfans, hypertension)
Connective tissue disorders
28
Q

what doews aortic regurgitation lead to

A

LV hypertorophy, dilataion and eventually LV failure

29
Q

what are the symptoms of chronic aortic regurgitation

A

long asymptomatic phase

exertional breathlesness

30
Q

what are the symptoms of acute atrial regurgitation

A

Poorly tolerated as wall tension cannot acutely adapt

31
Q

what woul dyou find on clinical examination of aortic regurgitation (pulse)

A

larve volume and collapsing pulse

32
Q

what would yoi hear on auscultatin of aortic regurgitation

A

soft murmur after S2

33
Q

what treatment can delay surgery for aortic regurgitation

A

vasodilator therapy

aortic valve replacement or repair

34
Q

what are the factors that go into selecting a patient for CABG

A

adequate lung, hepatic, mental function

ascending aorta and distal coronary targets are ‘‘OK’’

LV ejection fracture is greater than 20%

35
Q

what blood vessels are often used for CABG

A

reversed saphenous vein (leg vein - reverse to switch valve direction)

internal mammary arteries

radial arteries

36
Q

what can occur due to the sternotomy - what is this

A

(breaking of the sternum)

wire infection

painful wires

37
Q

what are some post op problems after CABG

A

cardiac tamponade
death
stroke

38
Q

what is cardiac tamponade

A

when fluid fills the pericardium surrounding the heart leading to it losing its ability to contract/expand

39
Q

what are the symptoms of cardiac tamponade

A

raised CVP

raised HR

low BP

in turn leading to increase O2 requirements

40
Q

what is the treatment of cardiac tamponade

A

chest re opening

41
Q

what grafts have the best longevity

A

arterial grafts have BETTER longevity than veins

42
Q

what are the long term outcomes of CABG

A

50% no further problems 10 years later

rest have minor problems

with a few needing CABG again

43
Q

what valvular heart disease can be operated on in adults

A

mainly aortic and mitral valve

44
Q

what valvular heart disease can be operated on in peads

A

all 4 heart valves

45
Q

what does chronic rheumatic heart disease cause

A

gradually progressive mirtal valve diseases with/without atrial veal disease

46
Q

what are the two most common types of bacteria that cause endocarditis

A

strp viridans (sub acute)

staph aureus (acute)

47
Q

what antibiotics might be used to treat staph aureus

A

cephlasporins

48
Q

what antibiotic might be used to treat strep viridans

A

glycopeptides (vancomycin)

beta lactams (penicillin’s)

49
Q

what endocarditis has the better chance of cure

A

sterp viridans has higher chance

50
Q

what are the indications for surgery on endocarditis

A

severe regurgitation

large vegetations on the valves

51
Q

what is endocarditis

A

inflammation of the endocardium (which makes up the valves)

52
Q

what’s give after surgery on endocarditis

A

IV antibiotics for 6 weeks

53
Q

what are the type of prosthetic valves in use

A

biological valves

mechanical valves

54
Q

what are the pros of biological valves

A

no warfarin required (antiplatelet agent)

55
Q

what are the negatives of biological valves

A

the valve wears out after 15 years

56
Q

what are the pros of mechanical valves

A

the valve can last 40+ years

57
Q

what are the cons of the mechanical valves

A

warfarin treatment is required

cardiovascular (26 decks)

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