Valvular Heart Disease Flashcards
(49 cards)
Mitral stenosis causes
Rheumatic fever is more common cause
Other less common - calcifcation, masses
RF
Involves heart, skin and conn tissue
Follows URI vause by GAS
Mainly in childre nadn adolescents
2-3 weeks adter initial (if acute)
Cardiac comps of RF
Autoimmiune cross reactivity between pacterial and cardiac antigens
Affects all 3 layers of the ehart
Pathology of RF
Aschoff body - focal fibrinoid necrosis surroundedb y infalmatory cells that resolves to fibrous scar tissue
Rheumatic fever path (non-histo)
Damage to valvular endocardium leads to chronic RHD characterized by permanent deformity
Jones criteria
Carditis/valvulitis Arthritis CNS involvement (chorea) Subq nodules Erthemia marginatum
Minor - arthrlagia, fever, ESR/CRP, prolonged PR
2 major or 1 major and 2 minor
Also need pos culture of ASO
Tx fo acute epsiodes of RF
Aspirin, peniccilin, supportive care
mitral stensosi featurees
Fibrous thickening and calcification of valve leaflets
Fusion of commissures
Thickening and shortening of the chardae tendinae
Pathophys of mitral stenossi
More obstruction to BF…empyting is empeded and abnormal pressure gradient created bt La and LV….dec preload
Backpressure inc and blood moves into LV at higher gradient…LA enlargement, LA pressure inc, puml HTN
Chronic LA pressure elevation
Pulm HTN with rupture of bronchial veins and hemoptysis
LA enlargement - stretching of atrial tissue and afib…stagnation of blood flow and intra-arterial thrombus formation
Turbulent BF across the valve
Presnet of mitral stensosi
Depend on CSA of the valve
Earliest are dyspnea and exerciwse intole
Inc HR and inc FLow….dec diasotlic filling time…inc LA presure
Long stading pulm HTN induces RHF
Loud S1
Mitral stensosi
High pressure connection slams the leflets together…may dec as progresses
Opening snap
Sudden tensing of stenotic leaflets on opening of the valve
Interval bt S2 and OS relate INVERSELY to the severity of MS…more severe means higher LA pressure and earlier the valve is forced to open in diastole
Diastolic rumble
Turbulent blood flow across the stenotic valve
Relate to severity
Pre-systolic accentuation
Contraction of LA cuases pressure gradient between La and LV to rise again
Physical findings of mitral stensosi
Mitral “facies”
Loud S1 and opening snap
Diastolic rumble at apex
Systolic MR (holo)
LA impulse in axilla
RV life due to RVH
Loud P2
Mitral stenosis test of choice
Echo - look for MR, calcification and LA thrombus
Severity of MS
MPG - under 5, 5-10, over 10
MVA - over 1.5, 1-1.5, under 1
Tx of MS
Sx control - HR control with beta blocker and CCB…relief of HF with diuretics…anticoag if afib
If sx persist - need mech correction
Percutaenous balloon mitral valvuloplasy
Bloon catheter inserted into RA and crosses the IAS into the LA and is inflated to open stenotic mitral valve
Other options of MS tx
Open mitral commussuroomy
Mitral valve replacement
Mitral regurg physiology
Valve is no longer competent and blood ejected into both aorta and LA
LA pressure rises and pulm edema develops
Gap between LA and LV decreases during systole
Chronic MR
Overitme the LA dilates to accommodate the inc volume
Decreases the LA pressure
LV also dilates because of the increased volume load…regurged blood goes through LV repetitively
Clinical MR
Acute - LA pressure rapdily inc and pulm edema ensures
Chronic - LA dilates and is abkle to accomodate more BV
LA pressure rises but less so than acute
Fatigue and weakness
Once LV dysfxn occurs - dyspnea, orthopnea and PND
If RV failure, then ascities/LE edema may develop
