Valvular heart disease Flashcards by Emily Ross

Common heart valve lesions

Mitral stenosis,
Mitral regurgitation,
Aortic stenosis,
Aortic regurgitation

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Symptoms of mitral stenosis

haemoptysis,
Chest pain,
Cough,
Hoarse voice (rare),
Infective endocarditis

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Mitral stenosis pathophysiology

MV orifice < 2cm^2,
Always chronic,

LA pressure increases,
= Pulmonary hypertension,
= Right heart dilatation

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Mitral stenosis signs

Mitral facies (red/purple cheeks),
Normal pulse,
JVP - prominent a-wave,
Tapping apex beat,
Diastolic thrill,
RV heave,
Diastolic murmur,
Pulmonary oedema

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Investigations for mitral stenosis

+ findings

ECG
CXR
Echo: Thickening and scarring of leaflets Cardiac MRI
Cardiac catheterisation: Large pressure gradient between LA and LV

FINDINGS:
RV Hypertrophy
LA enlargement/dilatation

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Mitral stenosis treatment

Valvotomy (balloon/surgical),

Mitral valve replacement

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Mitral regurgitation symptoms

ACUTE: dyspnoea, pulmonary oedema, cardiogenic shock

CHRONIC: Fatigue, right heart failure, dyspnoea/ palpitations (due to AFib)

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Mitral regurgitation signs

Normal/reduced pulse,
JVP - prominent if RH failure,
Brisk + hyperdynamic apex beat
RV heave,

Systolic “blowing” murmur - loud at apex, radiating to axilla.

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Mitral regurgitation investigations

+ likely findings

ECG
CXR
Echo: Dysfunction of leaflets, papillary muscles, chordae tendineae etc.

FINDINGS:
LA enlargement
RVH
Calcification of mitral annulus

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Mitral regurgitation treatment

Mitral valve apparatus repair,

Mitral valve replacement

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General symptoms of heart valve disease

Fatigue,
Dyspnoea,
Oedema

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Mitral regurgitation pathophysiology

ACUTE: ↓ End systolic pressure and end systolic volume = ↓ LV wall tension.

CHRONIC: ↓BP = ↑ EDV = normal ESV + LV hypertrophy

Orifice size depends on:
Preload, afterload and LV contractility

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Aortic stenosis pathophysiology

Aortic valve narrowing

↑LV systolic pressure = LV hypertrophy = ↑ LV myocardial O2 demand = ischaemia

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Aortic stenosis symptoms

Long asymptomatic phase

Angina,
Syncope,
Exertional dyspnoea,

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Aortic stenosis signs

Pulse - small volume and slowly rising,
JVP - prominent if RH failure,
Low BP, 
Vigorous and sustained apex beat, 
RV heave,
Late peaking systolic murmur, radiating to carotids

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Aortic stenosis investigations + likely outcomes

ECG: ST changes (show LV strain)
CXR: Calcification of aortic valve
Echo: Low AV cusp mobility
Cardiac catheterisation: High pressure gradient btw LV and aorta

FINDINGS:
LV Hypertrophy

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Aortic stenosis treatment

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Medical treatment: Limited to those who develop heart failure,
Interventional treatment: Aortic valve replacement or repair

Aortic regurgitation pathophysiology

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↓diastolic BP = ↑EDV = LV hypertrophy and dilatation

= ↑ LV myocardial O2 demand = ischaemia

Aortic regurgitation symptoms

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CHRONIC:
Long asymptomatic phase,
Exertional dyspnoea

ACUTE:
Poorly tolerated as wall tension cannot acutely adapt

Aortic regurgitation signs

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Pulse - large volume and collapsing
Wide pulse pressure,
Hyperdynamic, misplaced apex beat
Early diastolic, soft murmur

Aortic regurgitation investigations + likely findings

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ECG: ST changes (LV strain)
CXR
Echo: Regurgitant flow, Thickening/prolapsing/no. of AV cusps
Cardiac MRI

FINDINGS
LV Hypertrophy/ dilatation
Cardiomegaly (chronic)

Aortic regurgitation treatment

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Only valve disease that can use drug therapy:
Vasodilator therapy

Interventional treatment: Aortic valve replacement or repair

potential sternotomy complications

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Wire infection,
Painful wires,
Sternal dehiscence (splitting open),
Sternal malunion (fails to heal),
Cardiac tamponade (fluid in pericardial sac),
Stroke,
Death

Common valve problems requiring cardiac surgery

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Senile tricuspid aortic stenosis,
Bicuspid aortic stenosis

Degenerative mitral regurgitation

Indications for valve replacement

AS: severe AR: severe, especially with LV dilatation MS: orifice <1.5cm2 (audible murmur) MR: severe = systolic blood flow reversal in pulmonary veins.

Types of prosthetic valves | + results

Biological (e.g. pig) - wears out after 15 years Mechanical (plastic) - lasts > 40 years, warfarin required for life

Treatment of infective endocarditis of valves

Medical = antibiotics (much more successful if native valve compared to prosthetic) Surgery of severe or persistent

Use and results of mitral valve repair

Used in degenerative MR, | complete valve competence can be restored = better than valve replacement

Symptoms of infective endocarditis

``` Fever/ Chills Night sweats, fatigue, malaise, weight loss Weakness Arthralgia (joint pain) Headache Dyspnoea ```

Signs of infective endocarditis

``` Cardiac murmur Janeway lesions Osler nodes Splinter haemorrhages Petechial haemorrhage Roth spots vasculitic rash ```

Investigation of infective endocarditis

Blood culture: Identify causative bacteria FBC: Elevated acute inflammatory markers (ESR/ CRP) ECG: Prolonged PR interval Echocardiogram: Shows vegetations, damaged valves, turbulent flow etc. Urinalysis: Haematuria (blood in urine)

Treatment of infective endocarditis

Prolonged antibiotics Surgery (if severe regurgitation, large vegetations, persistent pyrexia or progressive renal failure)

Rheumatic heart disease symptoms

Symptoms of heart valve disease/ IE

Signs of rheumatic heart disease

Pericardial friction rub Murmurs Pancarditis

Rheumatic heart disease investigations

Blood culture: show previous strep infection FBC: Increased inflammatory markers Erythrocyte Sedimentation Rate (ESR): Shows clotting if increased ECG: features of heart block

Treatment of rheumatic heart disease

Anti-inflammatories Antibiotics Treatment of heart valve disease/ IE Surgery if unresolved by medical treatment Prevention = Prolonged antibiotics to prevent recurrent streptococcal infections

Sternotomy

Most common thoracic incision Used for: - heart valve replacements - cardiac transplant - CABG

Prevention of IE for high risk groups

E.g. previous IE, prosthetic valve, congenital heart disease ``` Prophylactic antibiotics before dental procedures Strict dental and cutaneous hygiene Disinfection of wounds Discourage piercing/ tattooing Limit invasive procedure ```

Contraction of endocarditis

Mitral valve prolapse Congenital heart disease (e.g. bicuspid aortic valve) Prosthetic valves Rheumatic heart disease ^ Damaged/diseased valves cause turbulent blood flow leading to endothelial damage - -> formation of NBTE - -> bacteria in bloodstream (due to infected needle, open wound etc.) adhere to NBTE - -> vegetation

Rheumatic heart disease pathophysiology

Strep infection causes immune system to make Abs that attack the endocardium (type II hypersensitivity reaction) = repeated inflammation of heart valves with fibrinous repair

Valvular heart disease Flashcards

(40 cards)