Flashcards in Valvular Heart Disease Deck (24)
What valves are commonly affected by rheumatic fever (rheumatic heart disease)?
This infection of group A streptococci causes the inflammation of the mitral valve mainly (65%), or the mitral and aortic valves (25%), and this can lead to defects such as prolapse, stenosis or regurgitation
What are common valve lesions?
Mitral valve prolapse, aortic stenosis/regurgitation, mitral regurgitation/stenosis and right-sided valve lesions
What is the most common valve lesion?
Mitral valve prolapse
What is mitral valve prolapse?
This is where the valve leaflets prolapse back into the left atrium during systole and are therefore non-functional
What are the signs of mitral valve prolapse?
Ejection click and/or late systolic murmur
What is aortic stenosis?
The narrowing of the aortic valve leaflets
What are the causes of aortic stenosis?
Calcific disease associated with ageing, congenital bicuspid valve (instead of three valve leaflets there are two) and rheumatic disease
What are the symptoms of aortic stenosis?
Dyspnoea due to pulmonary congestion (due to increased diastolic pressure on the stiff/non-compliant left ventricle), angina (due to increased oxygen demand as a result of left ventricular hypertrophy), left ventricular failure and sudden death (due to ventricular arrhythmia)
What are the signs of aortic stenosis?
Slow, rising carotid pulse, an ejection systolic murmur and additional heart sounds
What is aortic regurgitation?
When blood flow can back-track into the left ventricle from the aorta during ventricular systole
What may cause aortic regurgitation?
Aortic valve leaflet disease: calcific disease, congenital bicuspid valve, rheumatic disease and infective endocarditis
Aortic root dilating disease: ankylosing spondylitis, marfan syndrome and aortic dissection
What are the symptoms of aortic regurgitation?
Often there are no symptoms, but they may be dyspnoea or angina
What are the signs of aortic regurgitation?
Rapidly rising carotid pulse (due to vigorous ejection of the volume-loaded left ventricle), early diastolic murmur (due to aortic back flow) and ejection murmur (turbulent ejection heard)
What is the most common cause of mitral stenosis?
What are the symptoms of mitral stenosis?
Dyspnoea (due to pulmonary oedema), right ventricular failure, palpitations
What are the signs of mitral stenosis?
Irregular pulse if there is atrial fibrillation, loud S1 sound, increased JVP and basal lung crepitations (oedema)
What may cause mitral regurgitation?
Mitral valve leaflet disease (mitral valve prolapse, rheumatic disease and infective endocarditis), subvalvular disease or functional mitral regurgitation due to left ventricular dilatation
What are the signs of mitral regurgitation?
Irregular pulse if there is atrial fibrillation, pansystolic murmur, third heart sound (S3), increased JVP, basal crepitation and ankle oedema
What are the symptoms of mitral regurgitation?
What types of valvular disease are likely to lead to atrial fibrillation?
Mitral stenosis or regurgitation
Why may beta blockers, digoxin or verapamil be used in the treatment of valvular heart disease?
If there are any signs of atrial fibrillation
What drugs are commonly given in the treatment of valvular heart disease?
Diuretics, vasodilators, beta blockers and anticoagulants
Why are vasodilators given in the treatment of valvular heart disease?
These are given to treat low forward-output lesions such as mitral/aortic regurgitation