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Cardiovascular system > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

in the mitral valve which leaflet is larger?

A

the anterior leaflet

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2
Q

what can cause mitral stenosis?

A

> rheumatic heart disease
congenital MS
systemic

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3
Q

what is the affect of mitral stenosis on the left atrium pressure?

A

it increases

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4
Q

how is the pulmonary venous and capillary pressure affected by mitral stenosis?

A

> it is increased

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5
Q

what is the effect of mitral stenosis on left ventricular pressure and systolic function?

A

they are normal

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6
Q

describe the clinical manifestations of mitral stenosis

A 
> dyspnoea
> haemoptysis
> systemic embolisation
> chest pain
> hoarseness ( compression of the left laryngeal nerve by the left atrium)
> infective endocarditis
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7
Q

what would you expect to find on examination of someone with mitral stenosis?

A 
> mitral facies
> normal pulse
> prominent jugular venous pressure
> tapping apex beat and diastolic thrill
> right ventricular heave
> auscultation
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8
Q

what investigations would you carry out for mitral stenosis?

A

> ECG
chest x-ray
echocardiology
cardiac magnetic resonance

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9
Q

if a patient has mitral stenosis what abnormality would you expect to see on their chest x-ray

A

left atrium enlargment

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10
Q

what would you expect to see on a cardiac magnetic resonance if the patient has mitral stenosis?

A

large left atrium, only the extrinsic flap opening

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11
Q

what medical treatment can be given to treat mitral stenosis?

A

> diuretics
restriction of sodium intake
atrial fibrillation: sinus rhythm restoration and ventricular rate control
anti-coagulation (atrial fibrillation)

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12
Q

what is the aetiology for mitral regurgitation?

A 
> rheumatic heart disease
> mitral valve prolapse
> infective endocarditis
> degenerative due to age
> functional: left ventricular and annular dilation
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13
Q

what is mitral regurgitation?

A

this is when the mitral valve is leaky or incompetent allowing blood to flow back into the left atrium

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14
Q

how does the left ventricle compensate in chronic mitral regurgitation?

A

it increases it contractibility and end diastolic volume by dilating to accommodate the extra blood. left ventricular hypertrophy develops.

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15
Q

describe the effects of acute mitral regurgitation on the heart

A

increased preload and decreases afterload causes an increase in end diastolic volume and a decrease in end systolic volume. all of this creates an increased stoke volume and an overall increase in left arterial pressure.

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16
Q

what is the clinical manifestations of an acute mitral regurgitation?

A

breathlessness
pulmonary oedema
cardiogenic shock

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17
Q

what are the clinical manifestations of mitral regurgitation?

A 
> fatigue
> exhaustion
> right heart failure
> dyspnoea
> palpitations
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18
Q

what would you expect to find on clinical examination of a patient with mitral regurgitation?

A

Pulse: normal or reduced in heart failure
JVP: prominent if right heat failure is present
Apex beat: brisk and hyper-dynamic
Right ventricular heave
Auscultations: reduced s1, split s2 with early a 2 and loud p3

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19
Q

what investigations would you carry out in a patient with a mitral regurgitation?

A

> ECG
chest x-ray
cardiac catheterisation

20
Q

what would you expect to see on a patients ECG who has a mitral regurgitation?

A

prominent P wave in r precordial leads due to right ventricular hypertrophy

21
Q

what would you expect to see on a patients chest x-ray if they have a mitral regurgitation?

A

left atrial enlargement
calcification of the mitral annulus
cardiomeggaly

22
Q

how could an acute mitral regurgitation be treated?

A

reduce preload and afterload with sodium nitroprusside, dobutamine and IABP.

23
Q

how would you treat chronic mitral regurgitation?

A

there is no therapeutic benefit for haemodynamic improvement but left ventricle function preservation

24
Q

what surgical intervention can be used to treat mitral regurgitation?

A

> mitral valve apparatus repair

> mitral valve replacement

25
Q

what is the aetiology of aortic stenosis?

A

> degenerative
rheumatic
bicuspid

26
Q

how does rheumatic disease lead to aortic stenosis?

A

there is adhesion and fusion of the commissures and retraction and stiffening of the free cusp margins

27
Q

how can aortic stenosis occur degenerately?

A

this is linked to atherosclerosis. it is a slow inflammatory process resulting in thickening and calcification of the cusps from base to free margins

28
Q

what are the effects of aortic stenosis?

A

there is increased left ventricular systolic pressure leading to severe concentric hypertrophy and left ventricular mass. this leads to increased left ventricular end diastolic pressure. this creates myocardial ischemia and results in left ventricular ischemia

29
Q

what symptoms can be caused by aortic stenosis?

A 
> there is a long asymptomatic phase
> chest pain
> syncope
> breathlessness of exertion
> heart failure
30
Q

what would be seen upon clinical examination of a patient with aortic stenosis?

A 
pulse: small volume and slowly rising
JVP: prominent if right heart failure is present. 
low blood pressure
apex beat: vigorous and sustained
right ventricle heave
31
Q

what would you expect to hear during auscultation of a patient with aortic stenosis?

A 
> normal s1. 
> less audible s2 with a2. 
> there is late peaking
> it is loud at the base
> harsh
> radiates to the carotids
32
Q

what would you expect to see on an ECG of an aortic stenosis?

A

left ventricular strain and hypertrophy

Doppler haemodynamic assessment of pressure gradient and AVA

33
Q

what would you expect to see on the chest xray of someone with an aortic stenosis?

A

calcification of the aortic valve

34
Q

describe what an aortic stenosis would look like in cardiac magnetic resonance

A

a fish mouth opening

35
Q

what medical treatment is available for patients with aortic stenosis?

A

it is limited for those that develop heart failure but you can replace or repair the aortic valve

36
Q

what aortic causes are there for aortic regurgitation?

A

> dilated aorta

> connective tissue disorders

37
Q

what problems with the leaflets of aortic valve causes regurgitation?

A

> bicuspid aortic valve
rheumatic heart disease
endocarditis
myxomatous degeneration

38
Q

what is the effect of aortic regurgitation on the heart?

A

the left ventricle is now accommodating both the stroke volume and the regurgitated volume. this increases left ventricular diastolic volume and systolic pressure. this causes left ventricular hypertrophy and dilatation. resulting in myocardial ischaemia and left ventricular failure

39
Q

what are the symptoms of chronic aortic regurgitation?

A

there is a long term asymptomatic phase and then exertional breathlessness

40
Q

why is acute aortic regurgitation worse than chronic?

A

the wall tension cannot adapt in such a short space of time

41
Q

what would you expect to see on clinical examination of a patient with aortic regurgitation?

A

pulse: large volume and collapsing
wide pulse pressure
apex beat: hyperdynamic and displaced

42
Q

what would you hear on auscultation on a patient with aortic regurgitation?

A

normal s1
normal s2
early diastolic, decrescendo
soft murmur

43
Q

what would ECG show for aortic regurgitation?

A

> it would demonstrate aortic valve cusp anatomy, thickening and vegetation’s
left ventricular function, dilation and hypertrophy
Doppler haemodynamic assessment of regurgitant flow

44
Q

what would you see on a chest xray of a patient with chronic aortic regurgitation?

A

cardiomegaly

45
Q

what medical treatment is used for aortic regurgitation?

A

vasodilator therapy has been shown to delay the timing for surgical intervention, aortic valve replacement or repair

Cardiovascular system (34 decks)

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