Valvular Dysfunction: Prevalence, Symptoms and Principles of Treatment Flashcards
(36 cards)
What happens to the valves in normal circulation?
In normal circulation, the valves open fully to allow blood to flow through and close tightly to prevent backward flow.
What are the two main types of valve disease?
Stenosis: The valve doesn’t open all the way, resulting in reduced blood flow.
Regurgitation: The valve doesn’t close completely, causing blood to leak backward.
What are the common causes of valvular heart disease?
Degenerative: Valves wear out over time.
Congenital: Valvular abnormalities present at birth.
Rheumatic disease: Develops after rheumatic fever.
Infective endocarditis: Valve infections.
Annular dilation: Chronic strain on the valves.
What are some symptoms of heart valve disease?
Breathlessness
Lightheadedness
Chest pain
What are the two primary heart sounds and their characteristics?
S1: It is the “lub” sound and is caused by the closure of the mitral and tricuspid valves. It marks the start of systole.
S2: It is the “dub” sound and is produced by the closure of the aortic and pulmonary valves. It signifies the end of systole.
What are the characteristics of left heart murmurs?
Aortic Stenosis: Systolic murmur.
Aortic Regurgitation: Diastolic murmur.
Mitral Stenosis: Diastolic murmur.
Mitral Regurgitation: Systolic murmur.
What are some common investigations for evaluating heart conditions?
ECG (Electrocardiogram)
Echocardiogram (Transthoracic and Transesophageal)
Cardiac MRI Scan
Cardiac Catheterization
Where is the aortic valve located and what type of valve is it?
The aortic valve is located between the left ventricle (LV) and the aorta. It is a semi-lunar valve consisting of three cusps: the left coronary, right coronary, and non-coronary cusps. It is attached to a fibrous ring called the annulus.
What is aortic stenosis and its significance?
Aortic stenosis is the most common severe valve abnormality in the western world and is the most common indication for valve surgery. It results in pressure overload on the left ventricle (LV).
What are the signs of aortic stenosis?
Low volume, slow rising pulse.
Forceful impulse at the apex.
Soft second heart sound.
Ejection systolic murmur:
Loudest in the aortic area.
Radiated to the neck.
Thrill in the aortic area.
What are some diagnostic methods for aortic and mitral valve disease?
Echocardiography: Transthoracic and transesophageal echocardiograms.
Doppler ultrasound.
Cardiac catheterization.
Magnetic resonance imaging (MRI) of the heart.
Electrocardiogram (ECG).
What ECG findings are associated with aortic stenosis?
Left ventricular hypertrophy: Tall complexes and lateral T-wave inversion.
Left bundle branch block: Broad complexes, but it can have other causes as well.
What are the echocardiogram findings in aortic stenosis?
Left ventricular hypertrophy.
Calcified aortic valve with restricted mobility.
What are the medical treatment options for aortic stenosis?
There are no good medical options for aortic stenosis. Symptomatic patients typically require a new valve.
As a holding maneuver, diuretics may be used for breathlessness, and beta-blockers may be used for angina.
Vasodilators (e.g., ACE inhibitors) should be avoided.
What are the surgical and interventional treatment options for aortic stenosis?
Surgical valve replacement (AVR): It can involve tissue valve replacement (pig, cow, human) or mechanical valve replacement (requires warfarin). This is suitable for younger patients and those needing coronary artery bypass grafting (CABG).
Transcatheter aortic valve replacement (TAVR): It involves implanting a tissue valve via a peripheral artery. This is suitable for older patients and those with co-morbidities. Outcomes are comparable to surgery for routine patients, and TAVR is becoming the treatment of choice for most patients.
Where is the mitral valve located and what is its anatomy?
The mitral valve is located between the left atrium (LA) and the left ventricle (LV). It has more complex anatomy than the aortic valve. It consists of two leaflets, the anterior and posterior leaflets, with their tips attached to the LV muscle through chordae and papillary muscles. The mitral valve is also attached to a fibrous ring called the annulus.
What are the causes of mitral regurgitation?
Degenerative mitral regurgitation caused by mitral valve prolapse.
Degenerative mitral regurgitation caused by flail leaflet.
Volume overload of the left ventricle (LV), leading to LV dilation.
Volume overload of the left atrium (LA), resulting in LA dilation and atrial rhythm disturbances.
Congenital valve leaflet prolapse.
Chordal rupture/papillary muscle rupture.
Infective endocarditis.
Rheumatic heart disease.
Myocardial ischemia causing LV distortion or papillary muscle dysfunction.
Annular dilation, often seen in heart failure with LV dilation.
What is the significance of mitral regurgitation?
Mitral regurgitation is the second most common indication for valve surgery. It can lead to various complications and is associated with different underlying causes.
What are the signs of mitral regurgitation?
Displaced, forceful apex beat indicating left ventricular enlargement.
Palpable parasternal impulse suggesting right ventricular enlargement.
Pan systolic murmur, loudest in the mitral area, radiating to the left axilla.
Thrill in the mitral area.
What ECG findings are associated with mitral regurgitation?
Broad P waves (P mitrale) indicating left atrial dilation.
Left ventricular hypertrophy with tall complexes and lateral T-wave inversion.
Left bundle branch block, although it can have many other causes.
Atrial arrhythmias, such as atrial fibrillation.
What are the echocardiogram findings in mitral regurgitation?
Left ventricular dilation.
Left atrial dilation.
Mitral valve abnormalities, including prolapse, chordal rupture, and calcification/thickening.
Assessing the severity of leaky valves is more challenging compared to narrow valves.
What are the medical treatment options for mitral regurgitation?
Symptomatic patients typically require a new valve.
As a holding maneuver or when patients are not suitable for surgery:
Diuretics may be used for breathlessness.
ACE inhibitors may be prescribed for left ventricular dilation.
Beta-blockers and anticoagulation may be used for atrial fibrillation.
What are the surgical intervention options for mitral regurgitation?
Surgical valve replacement (MVR): It can involve mechanical valve replacement or tissue valve replacement. Degenerate valves that are unsuitable for repair may require replacement.
Surgical valve repair: This is the treatment of choice for mitral valve leaflet prolapse (MVLP) or chordal rupture. It can be performed minimally invasively.
Transcatheter options: While not yet an established treatment, mitraclip may be used for very symptomatic patients with no surgical option.
What happens in mitral regurgitation?
In mitral regurgitation, the leaflets of the mitral valve fail to close completely, allowing blood to leak back from the left ventricle (LV) into the left atrium (LA). The leakage occurs during diastole, resulting in left ventricular volume overload, LV dilation, and LV dysfunction.
