Flashcards in Valvular Heart Disease Deck (37):
What is Rheumatic Fever?
Immune response to Group A beta haemolytic strep (Strep pyogenes). Antibody cross reactivity precipitates Type II hypersensitivity.
Epidemiology Rheumatic fever?
-Commonest in children 6-15y.
-Rare in AUS except NT
Clinical features Rheumatic Fever?
-Arthritis: migratory polyarthrititis affecting large joints.
-Rash: erythema marginatum
-S/C nodules: over bones, tendons
Mx Rheumatic Fever?
-Long term ABx prophylaxis
What is the effect of aortic regurgitation?
LV eccentric hypertrophy
What is the effect of mitral regurgitation?
LV eccentric hypertrophy
What is the effect of aortic stenosis?
LV concentric hypertrophy
What are the causes of aortic stenosis?
-Congenital 0.33% births
-Bicuspid aortic valve 1-2%
-Rheumatic fever (rare)
-Calcific (most common)
What are the symptoms of aortic stenosis?
-CP on exertion
When do symptoms of stenosis appear?
-When stenosis is severe (asymptomatic mild-mod stenosis)
Signs of aortic stenosis in carotid pulse?
-Slow upstroke: "plateau pulse"
Indicative of reduced systolic ejection.
Apex beat in aortic stenosis?
Does aortic stenosis have a thrill?
Over upper R sternal edge (if loud murmur)
What causes the murmur in aortic stenosis?
Due to turbulence at LV to Ao pressure gradient during systolic ejection.
What is the type of murmur in aortic stenosis?
Crescendo decrescendo "ejection systolic" murmur.
What aortic valve area on echo correlates with stenosis?
Ao Valve area
N = 3-4cm2
Mild = 1.5+
Mod = 1 - 1.5
Severe = 1
Mx severe AS (w/ symptoms)?
-Open aortic valve replacement
-Transcatheter aortic valve implant (TAVI)
What are the causes of aortic regurgitation?
-Aortic leaflet damage (endocarditis, rheumatic fever)
-Aortic root dilated so leaflets don't close:
--> Aortic dissection
--> Collagen vascular disorders
Symptoms of AR?
Even severe AR asymptomatic (until LV decompensates) ==> then Sx of HF e.g. SOB.
What are the signs of AR?
Relate to high volume pulse:
-Collapsing pulse (fast up and down stroke)
-Wide pulse pressure
-Early diastolic murmur
-Echo monitoring 6-12 monthly for severe AR
-Indicators of decompensation (increase in LV size or decrease in fxn) trigger for op before symptoms occur.
What are the causes of mitral regurgitation?
-Myxomatous degeneration (mitral valve prolapse)
-Ruptured chordae tendinae (flail leaflet)
-MI -> papillary muscle rupture
-Collagen vascular disease
-Cardiomyopathy -> change in ventricle shape
What causes the murmur in mitral regurgitation?
Pressure gradient from LV to LA: pan systolic murmur.
Very high gradient throughout systole so murmur has same intensity.
Where is mitral regurgitation usually heard?
Usually confined to the apex but
-severe: also at base (upper R sternal edge)
Mx mitral regurgitation?
-Follow with 6-12/12 echo
-Indicators of early LV dysfunction (change in size or function) ==> operation before onset of symptoms
What are the causes of mitral stenosis?
-Rheumatic Fever (commonest cause)
Symptoms of mitral stenosis?
What are the signs of mitral stenosis?
-Mitral facies - facial flushing
-"tapping" apex beat correlated with loud S1
Auscultation of mitral stenosis?
-Diastolic opening snap (mitral valve opens after S2)
-Diastolic rumbling murmur
-Pre systolic accentuation due to atrial systole
Describe the progression / complications of MS?
-Thromboembolism (high risk if MS + AF)
Mx mitral stenosis?
-Follow w/ echo
-Anticoags esp if AF
-Mitral valve intervention
Echo features followed in MS?
-Pulmonary artery pressure
Causes of TR?
-Endocarditis (esp IVDU)
-Pacemaker leads interfering with valve
Signs of TR?
How does infective endocarditis usually present?
-+/- heart murmur
Signs of inflammation/embolisation now rare.
How is infective endocarditis diagnosed?
-Echo (esp TOE)