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Flashcards in Valvular heart disease Deck (47):
1

Name the heart valves and describe where they are.

Tricuspid valves: between RA and RV

Mitral (bicuspid): between LA and LV

Pulmonary valves: between RV and pulmonary artery

Aortic valve: between LV and aorta

2

Which heart valves are semi-lunar?

Pulmonary
Aortic

3

Which heart valves are atrioventricular?

Mitral (bicuspid)
Tricuspid

4

Which of the heart valves have 2 cusps?

Mitral

5

Which of the heart valves have 3 cusps?

Tricuspid
Pulmonary
Aortic

6

Which valves create the S1 heart sound?
What does the S1 sound like?

S1 = atrioventricular valves

'lub'

7

Which valves create the S2 heart sound?
What does the S2 sound like?

S2 = semilunar valves

'dub'

8

What is the purpose of the heart valves?

To prevent backflow

9

What is meant by valve stenosis?

Narrowing of the valve
The valve doesn't open properly

10

What is meant by valve regurgitation?

A leaky heart valve

Blood leaks back to where it was just pumped from

Or blood leaks through when the valves are supposed to be shut

11

What is meant by an incompetent valve?

A regurgitant one

12

What is aortic stenosis?

Stenosis, narrowing, inability to shut properly

of the aortic valve

13

What problems occur as a result of aortic stenosis?

Not all the blood in the LV can leave and enter the aorta at each ventricular contraction

The body becomes starved of oxygenated blood

LV must generate higher pressure to get the blood through the valve to the aorta
This leads to LV hypertrophy

You also get ventricular arrythmias

14

What causes aortic valve stenosis?

Congenital:
- aortic stenosis
- having a bicuspid valve when it should be tricuspid

Aging:
- degenerative calcification
- rheumatic heart disease

15

How do patients with aortic stenosis present?

Syncope and dyspnoea on exertion

Angina

Sudden death due to V arrhythmias

16

What are the signs of aortic stenosis?

Slow rising carotid pulse (pulsus tardus)

Decreased pulse amplitude (pulsus parvus)

Systolic ejection murmur

Soft or absent 2nd heart secong

17

What is the prognosis like for people with aortic stenosis?

Not great at all!

18

Investigation of aortic stenosis.

Echo:
See LV hypertrophy & dilation
See a reduced ejection fraction

ECG:
Evidence of LV hypertrophy
Depressed ST segment

CXR:
Prominence of ascending aorta

19

Management of aortic stenosis.

GENERAL
Reduce risk of infective endocarditis: prophylaxis & good dental hygiene

SURGICAL
Valve replacement essential for survival

20

What is aortic regurgitation?

Leakage of blood from the aorta to the LV during diastole (after the blood has been pumped from the LV to the aorta

Backflow

21

What problems occur as a result of aortic regurgitation?

Backflow of blood into the LV causes excess loading in the LV

This leads to LV hypertrophy & dilation

This eventually leads to heart failure

22

What causes aortic regurgitation?

Infective endocarditis
Arthritides
Severe hypertension
Rheumatic heart disease
Marfan's

23

How do patients with aortic regurgitation present?

Asymptomatic until they get LV failure:
Dyspnoea
Orthopnoea (SOB lying flat)
Fatigue

Often asymptomatic until 40s-50s

24

What are the signs of aortic regurgitation?

Wide pulse pressure: large difference between diastolic and systolic BP

Diastolic blowing murmur
Head bobbing

25

Investigations of aortic regurgitation.

CXR:
cardiomegaly and aortic root enlargement

Echo:
Look at aortic valve, see LV hypertrophy & dilation

ECG: evidence of LV hypertrophy

26

Management of aortic regurgitation.

GENERAL
Infective endocarditis prophylaxis

MEDICAL
Vasodilators, ACE inhibitors

MONITORING
Regular Echos

SURGICAL
valve replacement

27

What is mitral stenosis?

Stenosis, narrowing of the mitral valve

Which restricts blood flow from LA to LV

28

What problems result from mitral stenosis?

Reduced flow from LA to LV means pressure builds up in the LA

LA hypertrophy

This can also cause a backlog of blood into the lungs: pulmonary hypertension

Atrial fibrilliation due to dilatation of LA walls

Thrombus formation in LA

29

What complications arise from pulmonary hypertension?

Pulmonary oedema

Increased pulmonary vascular resistance, which puts strain on the right heart

30

What causes mitral stenosis?

Most often rheumatic fever

It is rare b/c incidence of rheumatic fever is low

31

How do patients with mitral valve stenosis present?

Progressively worsening exertional dyspnoea

Haemoptysis

Atrial fibrillation

Right heart failure

32

What are the signs of mitral stenosis?

Mitral facies: cyanotic, dusky pink flushing of upper cheeks

Irregular pulse due to AF

Tapping apex beat
Diastolic murmur

33

Investigations of mitral stenosis?

ECG: signs of AF
Also LA enlargement

CXR:
Pulmonary congestion
LA enlargement
Calcified mitral valve

ECHO:
assess mitral valve

34

Management of mitral stenosis.

GENERAL
IE prophylaxis

MONITOR
Regular Echo

MEDICAL
B-blockers, Ca channel blockers, digoxin
Diuretics for fluid overload

SURGICAL
Percutaneous mitral balloon valvotomy (balloon to open out valve)
Replacement

35

What purpose do drugs like B-blockers & digoxin serve in valve stenosis?

They control heart rate prolonging diastole for improved diastolic filling

36

What is mitral regurgitation?

Backflow of blood from the LV back into the LA during diastole

37

What problems occur as a result of mitral regurgitation?

Over time, you get an increase in pressure in the LA
Which is accommodated by LA enlargement

If severe it can lead to backlog of blood into lungs - pulmonary hypertension & pulmonary oedema

38

What are the causes of mitral regurgitation?

Rheumatic heart disease
Mitral valve prolapse
IE

39

How do patients with mitral regurgitation present?
Acute vs chronic

Acute MR: pulmonary oedema

Chronic MR:
progressive exertional dyspnoea
fatigue
symptoms of R heart failure

40

Why do disorders of the mitral valve cause lethargy?

Because they cause a reduced cardiac output

The body receives less blood, and thus oxygen

41

What are the signs of mitral regurgitation?

Laterally displaced apex beat

Soft S1 sound

3rd heart sound: lub-dub-ta

Pansytolic murmur

42

Investigations of mitral regurgitation.

ECG:
signs of LA enlargement
AF
LV hypertrophy

CXR:
LA enlargement

ECHO:
Trans-oesophageal echo
LA and LV size & function

43

Management of mitral regurgitation.

MEDICAL
vasodilators
rate control: B-blockers, digoxin, Ca channel blockers

Anti-coagulants (due to AF)

Diuretics

MONITOR
Regular Echos

GENERAL
IE prophylaxis

SURGERY
Replacement

44

What is prolapsing mitral valve?

When one or both of the mitral valve leaflets prolapse back into the LA during ventricular systole

It can lead to mitral regurgitation in some cases

45

What is rheumatic fever?

An inflammatory disease that occurs in young people

A complication of an infection with a group A streptococci

It develops because of an autoimmune reaction triggered by the bacteria

46

What does rheumatic fever do to the body?

Damages heart valves

Polyarthritis

Skin problems: erythema marginatum (pink rings on the trunk), non-tender subcutaneous nodules over tendons, joints & bony prominences

CNS problems

47

What is the progression of rheumatic fever?

You get attacks now and then.
Once you have had one you are very likely to get attacks in the future