Valve disease 2 Flashcards
(30 cards)
What is aortic regurgitation?
Leakage of blood into LV during diastole due to ineffective coaptation of the aortic cusps
Aortic regurgitation epidemiology
- ends to present between the fourth and sixth decades of life. The prevalence of aortic regurgitation increases with advancing age.
- M>F
- Severe disease is seen in < 1% of the population.
What are the causes/ RFs of chronic aortic regurgitation (CAR)?
- Bicuspid aortic valve
- Rheumatic fever
- Infective endocarditis
- Connective tissue disorders
- Aortic dissection + aneursym
What is the pathophysiology of AR?
- Blood leaks from aorta into LV > ventricular BV increases > Increases SV
- More blood pumped out of heart per squeeze requires more pressure so Sytolic BP increases but diastolic BP decreases
- High systolic + low diastolic known as hyperdynamic circulation
- Overtime increase in BV in LV causes it to undergo ventricular hypertrophy
What do patients with hyperdynamic circulation have?
Bounding pulses / water hammer puleses
What do you find on the physical exams for AR?
- Wide pulse pressure: most sensitive
- Hyperdynamic and displaced apical impulse
- Early decrescendo murmur: due to blood flowing back into LV
- Soft S1 and S2
- Apex beat is displaced laterally
What is the natural history of AR?
Asymptomatic until 4th or 5th decade
Rate of Progression: 4-6% per year
Progressive Symptoms include:
Dyspnoea: exertional, orthopnea, and paroxsymal nocturnal dyspnea
Palpitations: due to increased force of contraction and ectopics
Symptoms of AR
- Dyspnoea
- Chest pain
- Palpitations
- Syncope
How can we evaluate AR?
- CXR: enlarged cardiac silhouette and aortic root enlargement
- ECHO: Allows evaluation of the AV and aortic root with measurements of LV dimensions and function (cornerstone for decision making and follow up evaluation)
How do we manage AR?
- General: consider IE prophylaxis
- Medical: Vasodilators (ACEI’s potentially improve stroke volume and reduce regurgitation but indicated only in CCF or HTN
- Root replacement or replacement of valve
- Serial Echocardiograms: to monitor progression.
- Surgical Treatment: Definitive Tx
What are the indications of surgery in AR?
ANY Symptoms at rest or exercise
Asymptomatic treatment if:
EF drops below 50% or LV becomes dilated > 50mm at end systole
Complications of AR
- Heart failure
- Pulmonary oedema
- Cardiogenic shock
What is mitral stenosis (MS)?
Mitral stenosis is a narrowing of the mitral valve orifice, making it difficult for blood to flow from the left atria to the left ventricle.
What is the normal mitral valve area?
4-6 cm2
When do transmitral gradients and symptoms begin?
areas less than 2 cm2
What is the predominant cause of mitral stenosis?
Rheumatic carditis
decreasing due to a reduction of rheumatic heart disease.
What are the causes of mitral stenosis?
- Rheumatic heart disease: 77-99% of all cases
- Infective endocarditis: 3.3%
- Mitral annular calcification: 2.7%
- Congenital MS
- Fabrys disease
After this flashcard look at slide 59 onwards of the valvular heart disease powerpoint
MS pathophysiology
MV dont open - LV dont fill
LA BV increases - higher pressures in LA - causes a snap when valve opens followed by disatolic rumble through smaller opening
What does a constant elevation in BV and pressure in the left atrium do?
Causes LA to dilate > allow blood back up into pulmonary circulation
Leads to Pulmonary congestion and oedema
Leads to PHT + Right sided HF
Effects of MS
- Progressive Dyspnoea (70%): LA dilation > pulmonary congestion (reduced emptying)
-worse with exercise, fever, tachycardia, and pregnancy - Increased Transmitral Pressures: Leads to left atrial - enlargement and atrial fibrillation.
- Right heart failure symptoms: due to Pulmonary venous HTN
- Hemoptysis: due to rupture of bronchial vessels due to elevated pulmonary pressure
Signs of MS
- Loud S1 snap
- Mid diastolic murmur
- A fib
- Signs of right sided HF
- Pulmonary HT
What is the natural history of MS?
Mild MS: 10 years after initial RHD insult
Moderate: 10 years later
Severe: 10 years later
What is the mortality of MS due to?
Due to progressive pulmonary congestion, infection, and thromboembolism.
What are the physical signs of mitral stenosis?
- prominent “a” wave in jugular venous pulsations: Due to pulmonary hypertension and right ventricular hypertrophy
- Signs of right-sided heart failure: in advanced disease
- Mitral facies: When MS is severe and the cardiac output is diminished, there is vasoconstriction, resulting in pinkish-purple patches on the cheeks
