Flashcards in MHD: Clinical valvular heart disease Deck (27):
What is the predominant cause of mitral stenosis?
In rheumatic fever, what determines whether MS or MR is the predominant pathology?
Location of affected tissues. Fusion of leaflets results in MS, whereas involvement of the chordae tendinae with little fusion results in MR
What are the primary clinical manifestations of mitral stenosis?
Dyspnea due to reduced lung compliance
Hoarse voice due to laryngeal nerve compression
What sign seen on 2D echocardiograms indicates mitral stenosis?
Hockey stick deformity showing thickened, calcified leaflets
How is pressure half time used to quantify mitral valve stenosis?
You can calculate the pressure half time from doppler readings
Mitral area = 220/PressureHalfTime (msec)
What is the definitive treatment for mitral stenosis?
What are the causes of acute mitral regurgitation?
Libman-Sacks lesions (SLE)
LV dysfunction, MI, myocarditis
Prosthetic valve dysfunction
What are the causes of chronic mitral regurgitation?
Inflammatory (rheumatic, SLE)
Degenerative (MVP, Marfans, MAC)
Infective subacute endocarditis
Structural: ruptured chordai, CAD, LV dilatation, HCM, prothetic valve dysfunction
What is the difference between pressure overload and volume overload?
Pressure overload occurs with HOCM, aortic stenosis and involves hypertrophy
Volume overload occurs with mitral regurgitation and aortic regurgitation and involves acute processes (no time for remodeling)
Does end-systolic diameter predict the post-operative death probability for mitral regurgitation patients?
Yes. If the ESD is above 45mm, there are poor outcomes because the actin/myosin become permanently damaged due to overdilatation
What is the major structural difference seen between acute and chronic mitral regurgitation?
In acute, the LA is small, but at a high pressure.
In chronic, the LA is dilated
What is the hallmark physical exam sign for mitral regurgitation?
When do symptoms develop in patients with chronic MR?
When the left ventricle fails
Serious damage has often occurred before symptoms present
Which is more problematic clinically: mitral regurgitation or mitral stenosis?
Mitral regurgitation is often silent during progression, whereas stenosis is associated with early symptoms leading to better detection
What is the major medical treatment for mitral regurgitation?
Same as treating heart failure: afterload reduction
If it is easier to pump out, then less blood will regurgitate into the left atrium
What physiologic parameter of heart function predicts surgical outcome for mitral regurgitation patients?
Ejection fraction predicts surgical outcome
Physical exam finding of mitral valve prolapse
Mid systolic click
What are the two causes of aortic stenosis?
Bicuspid valve caused by either:
Describe the location of calcification in aortic stenosis in the elderly
In senile aortic stenosis, calcifications are at the flexion lines of the valve leaflets, with minimal consequences on valve function
What are the physical exam findings in aortic stenosis?
Aortic ejection sound (E) louder than S1
Systolic murmur crescendo-decrescendo
What symptoms decrease survival rate in aortic stenosis?
Angina, Syncope and Failure (most severe)
What is the main treatment for aortic stenosis?
Aortic valve replacement
*Valvuloplasty not successful due to restenosis
What is aortic regurgitation caused by?
Disease of valve leaflets, or wall of aortic root
What is the main treatment for aortic regurgitation?
Symptomatic: valve replacement
Asymptomatic: Depends on end-systolic diameter, ejection fraction
What is the most commonly used prosthetic valve today?
Bi-Leaflet tilting disc valve
"St. Judes valve"
What is the most common cause of tricuspid regurgitation?
Dilatation of the right ventricle and the tricuspid annulus