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Valvular heart disease Flashcards

(47 cards)

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1
Q

Name the heart valves and describe where they are.

A

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

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2
Q

Which heart valves are semi-lunar?

A

Pulmonary

Aortic

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3
Q

Which heart valves are atrioventricular?

A

Mitral (bicuspid)

Tricuspid

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4
Q

Which of the heart valves have 2 cusps?

A

Mitral

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5
Q

Which of the heart valves have 3 cusps?

A

Tricuspid
Pulmonary
Aortic

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6
Q

Which valves create the S1 heart sound?

What does the S1 sound like?

A

S1 = atrioventricular valves

‘lub’

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7
Q

Which valves create the S2 heart sound?

What does the S2 sound like?

A

S2 = semilunar valves

‘dub’

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8
Q

What is the purpose of the heart valves?

A

To prevent backflow

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9
Q

What is meant by valve stenosis?

A

Narrowing of the valve

The valve doesn’t open properly

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10
Q

What is meant by valve regurgitation?

A

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

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11
Q

What is meant by an incompetent valve?

A

A regurgitant one

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12
Q

What is aortic stenosis?

A

Stenosis, narrowing, inability to shut properly

of the aortic valve

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13
Q

What problems occur as a result of aortic stenosis?

A

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

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14
Q

What causes aortic valve stenosis?

A

Congenital:

  • aortic stenosis
  • having a bicuspid valve when it should be tricuspid

Aging:

  • degenerative calcification
  • rheumatic heart disease
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15
Q

How do patients with aortic stenosis present?

A

Syncope and dyspnoea on exertion

Angina

Sudden death due to V arrhythmias

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16
Q

What are the signs of aortic stenosis?

A

Slow rising carotid pulse (pulsus tardus)

Decreased pulse amplitude (pulsus parvus)

Systolic ejection murmur

Soft or absent 2nd heart secong

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17
Q

What is the prognosis like for people with aortic stenosis?

A

Not great at all!

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18
Q

Investigation of aortic stenosis.

A

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

ECG:
Evidence of LV hypertrophy
Depressed ST segment

CXR:
Prominence of ascending aorta

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19
Q

Management of aortic stenosis.

Study These Flashcards
A

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

SURGICAL
Valve replacement essential for survival

20
Q

What is aortic regurgitation?

Study These Flashcards
A

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
Q

What problems occur as a result of aortic regurgitation?

Study These Flashcards
A

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
Q

What causes aortic regurgitation?

Study These Flashcards
A 
Infective endocarditis
Arthritides
Severe hypertension
Rheumatic heart disease
Marfan's
23
Q

How do patients with aortic regurgitation present?

Study These Flashcards
A

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

Often asymptomatic until 40s-50s

24
Q

What are the signs of aortic regurgitation?

Study These Flashcards
A

Wide pulse pressure: large difference between diastolic and systolic BP

Collapsing pulse

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

Cardiovascular (18 decks)

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