PBL 4 - Heart Valve Disease Flashcards
(68 cards)
what is heart valve disease?
diseases or abnormality of any one of the heart valves for any number of reasons
what is a murmur?
abnormal blood flow across a heart valve or across a structure within the heart
how is a HVD diagnosed?
- through auscultation of a murmur
- can also be picked up via an ECG or people having other cardiac tests
how is HVD most commonly treated and why?
watchful waiting as most people are asymptomatic — patients are just monitored in secondary care or in the community over time
if HVD becomes symptomatic and severe, how is it then treated?
either open heart surgery (cardiopulmonary bypass and valve replacement) or repair surgery, or increasingly transcatheter therapies for certain valve lesions
describe aortic stenosis and how it results in LV hypertrophy
- aortic valve becomes heavily calcified with reduced opening — valve becomes thicker
- heart has to pump with lots of extra force to get the valve to open
- LV becomes hypertrophied so has to pump harder to punish blood around the body (doesn’t become bigger but more muscular. apex is more forceful)
when is the abnormal blood flow in aortic stenosis and what effect does the thickened valve have on the blood ?
in systole — blood becomes turbulent and gets churned up by the thickened aortic valve
where can the aortic valve be auscultated?
right 2nd IC space parasternal
what kind of systolic murmur can be heard and where in aortic stenosis?
crescendo decrescendo ejection systolic murmur — harsh murmur best heard in the aortic area, radiating to the carotids
what is the pulse pressure like in aortic stenosis?
low
symptoms of aortic stenosis
- elevated LVEDP
- increased pressure in LA
- increased pressure in pulmonary veins
- SOB
- angina
- exertional dizziness/syncope
what is aortic stenosis most commonly caused by?
degenerative aortic valve disease — get calcification deposition on the aortic valve leaflets so it becomes thickened and calcified — usually associated with an ageing process
what other 2 things can aortic stenosis also be caused by?
- bicuspid aortic valve — 2 leaflets instead of 3 — these degenerate much more quickly
- rheumatic heart disease — rare
what are 2 methods of aortic stenosis treatment?
- surgical aortic valve replacement
- increasingly transcatheter approach = TAVI
briefly describe a TAVI (transcatheter aortic valve implantation)
go in the groin under local anaesthetic, valve loaded onto a national frame, goes into the femoral artery up into the aorta and crush the old valve out of the way
what is aortic stenosis characterised by?
obstruction of the left ventricular outflow —> decreased CO
which is the only valve that usually has 2 leaflets instead of 3?
mitral/bicuspid
S1 vs S2 heart sounds
S1 = AV valves close (blood in ventricles and ventricles begin to contract)
S2 = aortic/pulmonary valves close
when is systole in terms of S1 and S2?
in between S1 and S2
when is diastole in terms of S1 and S2?
in between S2 and S1
when is the murmur in aortic stenosis heard in terms of S1 and S2?
in between S1 and S2
what is mitral valve regurgitation?
when there is a leak of blood from the LV into the LA during systole due to incompetence of the mitral valve for various reasons
= 2nd most common cause of HVD after aortic stenosis
where is the mitral valve?
between LA and LV
what kind of murmur can be heard in mitral regurgitation? what does it sound like?
holosystolic/pan systolic murmur:
lub-whoooooo-dub (sounds like wind through tunnel)
