Valvular heart disease Flashcards Preview

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Flashcards in Valvular heart disease Deck (36)
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1
Q

Name the 4 heart valves

A

Aortic: Lv -> Aorta
Pulmonary: Rv -> Pulmonary artery
Mitral: La -> Lv
Tricuspid: Ra -> Rv

2
Q

How many cusps does aortic valve have?

A

3

3
Q

What percentage of population have 2 cusps?

A

2%- bicuspid aortic valve

4
Q

When does aortic valve open?

A

During systole when left ventricular pressure exceeds the aortic pressure

5
Q

What heart sound does the aortic valve give rise to and how?

A

The aortic component of the second heart sound (dub)- when the Lv pressure is lower than aortic pressure, causing aortic valve to close

6
Q

What causes the first heart sound?

A

Closure of tricuspid and mitral valves

7
Q

What causes the second heart sound?

A

Closure of the pulmonary and aortic valves

8
Q

How common is aortic stenosis?

A

Fairly- affects 5% of people over 60

9
Q

What are the symptoms of aortic stenosis?

A
Breathlessness
Chest pain
Blackout/syncope
Tiredness
Palpitations
10
Q

What is the first thing you do if aortic stenosis is suspected?

A
Take detailed history and examination
History:
Red flag symptoms
Exercise intolerance
Palpitations
Symptoms of heart failure
Examination:
Slow rising pulse
Narrow pulse pressure
Ejection systolic murmur
Soft or absent second heart sound
Displaced or heaving apex beat
Sings of heart failure/pulmonary oedema
11
Q

What is the ECG of someone with aortic stenosis like?

A

Can be normal or signs consistent with aortic stenosis
Tall QRS complexes that interfere with lines above- sign of left ventricular hypertrophy (occurs secondary to aortic stenosis)

12
Q

What would you look for in blood tests of someone with suspected aortic stenosis?

A

Anything else that could cause symptoms (anaemia- breathlessness)
Other biomarkers such as BNP (brain natriuretic peptide) which correlates with severity of aortic stenosis

13
Q

What does measuring velocity through the valve by echocardiography allow you to do?

A

It allows you to calculate the pressure using Bernoulli principle

14
Q

What is Bernoulli principle?

A

In a moving fluid, the velocity of the fluid and the pressure exerted by the fluid are inversely proportional

15
Q

If you recorded a high velocity through the valve, what does this tell you?

A

The smaller the area of open valve and the more severe the stenosis

16
Q

What can be used to work out velocity through valve?

A

Doppler ultrasound

17
Q

What causes leaky valves?

A

A lack of apposition between the cusps

18
Q

What is the most common type of leaky valve?

A

Aortic regurgitation

19
Q

What is the history of someone with aortic regurgitation?

A

Breathlessness
Palpitations
Symptoms of heart failure

20
Q

What would be found on examination of someone with aortic regurgitation?

A
High volume pulse
Collapsing pulse
Wide pulse pressure
Diastolic murmur
Signs of heart failure
21
Q

What investigations are involved for suspected aortic regurgitation?

A

Simple and uncomplicated procedures first e.g. blood pressure, oxygen saturation, CXR, ECG and blood tests

22
Q

What causes of stenosis are there?

A

Calcification
Bicuspid aortic valve
Infective endocarditis

23
Q

What causes of regurgitation are there?

A

Rheumatic heart disease
Dilation of the aorta
Bicuspid aortic valve
Infective endocarditis

24
Q

What treatment options are there for aortic stenosis and regurgitation?

A

Nothing that stops progression of aortic stenosis or regurgitation
Conservative- supportive measures
Medical- Managing heart failure symptoms (e.g. diuretics). Look for arrhythmia. Anticoagulation
Surgical- Percutaneous intervention, TAVI or open heart surgery

25
Q

What is TAVI?

A

Transcatheter aortic valve implanatation- inserte dinto femoral artery in groin and pushed up to aorta so valve can be replaced

26
Q

What are the two different types of replacement valve and what are they like?

A

Metallic- used more in younger people because can last upto 30-40 years but requires warfarin
Prosthetic- last for 10-12 years and don’t require warfarin whereas metallic valve does

27
Q

What is the EUROSCORE?

A

Algorithm that predicts how well people will fair after surgery. Based on several factors including age, gender, renal function and breathlessness

28
Q

What would you do if someone has a EUROSCORE < or > than 20?

A

<20 consider for surgery

>20 consider TAVI

29
Q

What are the symptoms of mitral regurgitation?

A
Breathlessness
Palpitations
Tiredness
Cough
Symptoms of heart failure
30
Q

What would you find on examination of mitral regurgitation?

A

Pansystolic murmur
Displaced apex beat
Atrial fibrillation

31
Q

What are the symptoms of mitral stenosis?

A
Breathlessness
Fatigue
Palpitations
Embolic events
Haemoptysis
32
Q

What would you find on examination of mitral stenosis?

A

Diastolic murmur
Loud first heart sound
Atrial fibrillation

33
Q

What is the treatment for mitral stenosis?

A

Mechanical valves are generally put in

34
Q

What is more common in tricuspid: stenosis or regurgitation?

A

Regurgitation

35
Q

What are the symptoms of tricuspid valve like?

A

Similar to left heart valve disease

36
Q

What are abnormalities in pulmonary valve usually due to?

A

Congenital abnormalities