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Flashcards in Heart Valvular Disease Deck (22)
0

What are the two principle changes in valve anatomy and physiology?

Stenosis and regurgitation

1

What are the consequences of valve stenosis?

Symptoms of heart failure may develop (shortness of breath, dizziness) fainting may be a sign of more severe stenosis.

2

Why is valvular stenosis important to dentistry?

People with valvular stenosis may need to take antibiotics before undergoing any type of medical, surgical or dental procedure

3

What happens in aortic valve stenosis?

1. Pressure overload leading to increased systolic stress which could lead to wall thickening and concentric hypertrophy.
2. Volume overload which could lead to increased systolic stress which could lead to increased left ventricular volume leading to eccentric hypertrophy

4

What are the signs and symptoms of aortic valve stenosis?

Shortness of breath on exercise, palpitations or an irregular heart rhythm, arrhythmia, fainting or dizziness, chest pain or angina because of increased demand for oxygen by the thickened ventricle and because of insufficient blood flow to the coronary arteries.

5

What are the causes of aortic valve stenosis? the aortic valve is a flap like opening between the left side of the heart and the aorta

-congenital heart disease: born with a bicuspid or unicuspid aortic valve rather than a tricuspid one therefore doesn't open widely enough leading to a turbulent and rough flow. The resulting wear and year on the valve can lead to aortic stenosis
-build up of calcium causing the valve cuspids to become thick and stiff reducing their mobility and overworking the heart as it tries to pump an adequate blood flow to the rest of the body
- rheumatic fever

6

What is aortic regurgitation/aortic valve prolapse?

When the blood flows backwards into the left side of the heart through the aortic valve

7

What are the symptoms of aortic regurgitation?

Fatigue, shortness of breath, oedema, heart arrhythmia's, angina pectoris (chest pain due to reduced blood supply to the heart muscle), abdominal discomfort, excessive sweating, palpitations, pulse:irregular, racing, abnormal, fainting, weakness, angina, crushing squeezing pressure tightness, pain increases with exceed use relieved with rest

8

What causes aortic regurgitation?

Congenital defects, aortic dissection (tear), high blood pressure, infective endocarditis, Reiter syndrome (arthritic disorder that affects adult males), rheumatoid arthritis, syphilis, systemic lupus erythematosus (an autoimmune disorder in which the person creates antibodies against his or her own tissues), dilation of the aortic root due to tissue abnormality

9

What does aortic regurgitation cause?

Higher risk of developing endocarditis therefore before dental or surgical procedures antibiotics should be taken

10

What is the mitral valve?

It's found between the left atrium and left ventricle. It's got two leaflets.

11

What can mitral stenosis cause?

It can overburden the right side of the heart as blood backs up through the lungs and pulmonary vessels putting additional pressure on the right ventricle and atrium, could lead to right sided heart failure

12

What are the causes of mitral stenosis?

Women who've had rheumatic fever as it can cause fusion of the valve leaflets, thickening and shortening of the valve leaflets to the heart wall or calcification of the valve leaflets

13

What are the symptoms of mitral stenosis?

Usually appear into 40s or 50s, often aggravated by exercise or periods of excitement, sometimes appear earlier ie in pregnancy when the body's increased blood demands lead to increased hearts workload

14

What is mitral valve prolapse?

When the two valve leaflets buckle back into the left atrium during left ventricular contraction. Can be worsened in situations where the left ventricular cavity is smaller (eg when patient dehydrated or standing). It's a common cause of regurgitation and the most common heart valve abnormality in the us.

15

What are the different types of mitral valve prolapse?

Primary: occurs on it's own for no apparent reason
Secondary mitral prolapse: associated with another disease including Marfan syndrome, ehlers-danlos syndrome etc. same structural abnormalities as seen in primary prolapse.
Functional mitral valve prolapse: caused when an anatomically normal mitral valve is affected by abnormalities within the heart structure. May occur in patients with hypertrophic cardiomyopathy.

16

What are mitral valve prolapse complications?

Infective endocarditis, mitral valve regurgitation, arrhythmia's, sudden cardiac death.

17

What's the treatment of valve stenosis?

Observation, non-invasive dilate toon of the stenosis, Surgical intervention: repair or replacement

18

What's the treatment for valve regurgitation?

Observation and medications
Surgery: preservation of the native valve (repair) or replacement with artifIcial valves (mechanical or biological)

19

Where is the tricuspid valve found?

Between the right atrium and the right ventricle. Tricuspid stenosis is quite rare.

20

What's rheumatic fever?

The immune systems response to bacteria. Can follow an untreated throat infection. Symptoms: joint pain and swelling (arthritis), inflammation of the heart which can cause shortness of breath and chest pain.

21

Should AB prophylaxis be given before procedures expected to produce bacteraemia to prevent endocarditis?

Merits serious consideration. Evidence for:
Clinical experience documents endocarditis following bacteraemia. Antibiotics to which known offending organisms are sensitive are available. In lab animal testing been shown to be effective as do small clinical studies in humans.
BUT:
-lack of large controlled clinical trials involving humans.
-clinical reports of AB prophylaxis not being effective
-evidence that dental and other procedures causing endocarditis is circumstantial.
-in some cases risk of death from prophylaxis may be higher than that for infective endocarditis.