Valvular Heart Disease Flashcards
Epidemiology
degenerative (largely aortic, ageing population)
infective (any valve, virulent orgamisms)
rheumatic valve disease (largely mitral, disease of poverty/overcrowding)
congenital valve disease (any valve)
Pathology
Calcification - immobility of leaflets
Fibrosis - fusion of leaflets
Dilation - of valve ring
Stenosis
narrowing of valve leaflets
valve leaflets fail to open completely
leads to build up of back pressure and loss of stroke volume
Regurgitation (or incompetence)
Failure of leaflets to meet in systole
allows reverse flow of blood during relaxation of the heart
Management of Valvular Heart Disease
Medical: heart failure, arrhythmias
surgical: valve repair/replacement - mechanical or biological replacements possible
percutaneous: BAV/TAVI
Patient Evaluation
Clinical assessment: symptoms, comorbidities, ausculation
ECG: severity and prognosis
Exercise testing, stress ECG, MRI, multi-lice CT, cardiac catheterisation
Aortic Stenosis
Congenital syndromes, bicuspid valves, degenerative, post-rheumatic fever
Syncope, angina dyspnoea, fatigue sudden death
Pressure overload - high LV systolic pressure –> hypertrophy and dilation, decompensation
Heart Sounds: systolic crescendo/decrescendo murmur
Aortic Regurgitation
Aortic dilation, valvular, bicuspid, endocarditis
Asymptomatic, chest pain, breathlessness, syncope
Volume overload, LV dilation & failure –> PV hypertension and PE
Heart Sounds: early diastolic murmur
Mitral Stenosis
Rheumatic fever
Palpitations, systemic emboli, fatigue, breathlessness, PE
Lung/right heart consequences, LV physiology preserved, unless atrial contraction is lost/ high circulating volume
Heart Sounds: mid-diastolic rumbling murmur and opening snap
Mitral Regurgitation
Valvular prolapse, infection, degenerative
Breathlessness, lethargy, palpitations, PE
Chordal rupture/papillary muscle failure –> volume overload in LV, elevation of LA and right heart pressure, LV dilation, decompensation
Heart Sounds: pan-systolic murmur
