Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

CVS Pathology > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

(124 cards)

Start Studying
1
Q

What valve is between the right atrium and the right ventricle?

A

Tricuspid valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What valve is between the right ventricle and the lungs?

A

Pulmonary oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What valve is between the left atrium and the left ventricle?

A

Mitral valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What valve is between the left ventricle and the aorta?

A

Aortic valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the parts of the mitral valve?

A

Anterior mitral valve leaflet (AMVL)

Posterior mitral valve leaflet (PMVL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Size of a normal aortic valve

A

3 - 4cm2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How many leaflets does the aortic valve have?

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the common heart valve lesions?

A

Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Definition of mitral stenosis

A

Narrowing of the mitral valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a normal mitral valve orifice?

A

Between 4 - 6cm2

Good dynamic range

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What size of mitral valve orifice is stenosed?

A

<2cm2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pathology of mitral stenosis

A 
A-V pressure gradient increases
LA pressure increases
Pulmonary venous and capillary pressures increase 
PVR increases 
PaP increases and PHTN develops
RH dilatation with TR and PReg

SO when valve becomes narrower, the pressure gradient between atrium and ventricles increases which backtracks through pulmonary circulation to the right side of the heart - called pulmonary HTN

LV pressures and systolic function is normal
LA suffers upstream of the valve
Downstream of the valve there is nothing wrong so left ventricle functions fine
Causes tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is mitral regurgitation?

A

Leaking or incompetent mitral valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of MVP

A

Rheumatic heart disease
Infective endocarditis
Degenerative
Functional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is functional mitral valve regurg?

A

Due to left ventricular and annular dilatation
Ventricle enlarges and then the annulus of the mitral valve when it is anchored will enlarge as well, and the posterior and anterior bits of the valve wont meet in the middle to shut and therefore the valve becomes incompetent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pathology of mitral valve regurg

A

Mitral valve leaky
LV compensation; ventricle doesn’t have time to adapt and has to do something
Acute
- ESP and ESV decrease, wall tension decreases, so the ventricle contracts much more forcefully and then the end systolic volume is much less - dilates much more slowly to compensate for blood
Chronic
- EDV increases and ESV returns to normal, eccentric LVH develops
LA compliance
- reduced; marked pressure rise, thickening of atrial myocardium, increase in PVR and remodelling of pulmonary vasculature with PHT
- increased; marked volume enlargement, lesser changes in pulmonary vasculature, but develop AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Types of aortic stenosis

A

Degenerative
Rheumatic
Bicuspid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pathology of Degenerative AS

A

Aortic valve tends to degenerate because it is subject to high velocities and pressures of blood. With time it wears and tears aortic valve.
Linked to atherosclerosis, a slow inflammatory process resulting in thickening and calcification of the cusps from base to free margins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pathology of rheumatic AS

A

Adhesion, fusion of the commissures and retraction and stiffening of the free cusp margins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Pathology of bicuspid AS

A

Two leaflet aortic valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the commonest congenital condition that survives in adulthood?

A

Bicuspid aortic valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What can happen to a bicuspid aortic valve?

A

Stenosis
Regurgitant
Both
Some no effects at all

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pathology of AS

A

Pressure in ventricle increases (increase in LV systolic pressure)
Ventricle hypertrophy to increase muscle mass (LVM) - increased pressure in left atrium and it goes back into the pulmonary circulation and to the right side of the heart. (causing pulmonary HTN)
The myocytes want to take more oxygen into the hypertrophic ventricle and so it is more common here to develop ischaemia - myocardial ischaemia
Left ventricular failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Causes of aortic regurgitation

A 
Dilated aorta (marfans, HTN)
Connective tissue disorders 
Bicuspid aortic valve
Rheumatic heart disease
IE
Myxomatous degeneration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Pathology of aortic regurg
``` LV accommodates both SV and reg volume Increased LVEDV and LV systolic pressure LV hypertrophy and LV dilatation Increased MVO2 Myocardial ischaemia LV failure ```
26
Presentation of MS
``` SOB (pulmonary oedema) Haemoptysis Systemic embolization (LA and LAA enlargement) IE Chest pain Hoarseness (compression of L recurrent laryngeal nerve) Stroke Mitral facies Normal pulse JVP prominent a wave Tapping apex beat ```
27
Why can you get haemoptysis in MS?
Rupture of thin walled veins
28
What is mitral facies?
Decolourisation of nose and cheeks
29
What murmur is heard in MS? What other heart signs?
Tapping apex beat DIASTOLIC THRILL (discrete) - a blow in diastole RV heave
30
Why does MS give the murmur it does?
Diastolic thrill Takes a while for the mitral valve to open as it is stenosed (more the stenosis, the longer it takes) - so there is a 3rd heart sound which is the MV snap when it opens under pressure Systole is unaffected
31
Causes of acute MR
Valve perforation | Chordal/papillary muscle rupture
32
Presentation of acute MR
SOB (pulmonary oedema, cardiogenic shock)
33
Which valve injury is an emergency?
Acute MR
34
Presentation of chronic MR
Fatigue Exhaustion (Low CO) Right heart failure SOB or palpitations due to AF
35
Signs of MR
Normal or reduced in HF JVP (prominent if RH failure present) Brisk and dynamic apex beat RV heave
36
What heart signs are seen in MR?
Brisk and hyperdynamic apex beat RV heave REDUCED S1 and SPLIT S2
37
Pathology of murmur in MR
``` Reduced SI, SPLIT S2 SPLIT S2 - early A2 and loud P2 Holosystolic, blowing Loud at apex, radiating to axilla Systolic murmur so loud it will obscure other heart sounds ```
38
Where is MR best heard?
Apex
39
Presentation of AS
``` Long asymptomatic phase (incidental finding) Chest pain (angina) Syncope/dizziness (exertional pre-syncope) SOB on exertion HF Small pulse and slowly rising Low BP JVP prominent if RH failure present Vigorous and sustained apex beat RV heave ```
40
Heart signs with AS
``` Vigorous and sustained apex beat RV heave NORMAL S1, S2 LESS AUDIBLE LATE PEAKING, HARSH Loud at base RADIATING TO CARTOIDS ```
41
Where does AS murmur radiate to?
Carotids
42
Where does MR murmur radiate to?
Axilla
43
What is the issue with acute AR?
EMERGENCY Regurg makes a sudden whoosh of blood back into the ventricle which it is not expecting, so heart cannot cope. Tension cannot acutely adapt
44
Presentation of chronic AR
Long asymptomatic phase (incidental finding) Exertional SOB HF Angina Large hearts - dilates ventricles chronically to cope with increased volume
45
Signs of AR
Large volume and collapsing pulse (Corrigan sign) Wide pulse pressure Hyperdynamic as a volume overloaded heart, displaced apex beat
46
Heart signs of AR
Displaced apex beat | NORMAL S1 , NORMAL S2, EARLY DIASTOLIC MURMUR
47
Pathology of murmur of AR
Normal S1 - systole completely clear Normal S2 Early diastolic, decrescendo, soft murmur
48
How to listen for murmur of AR?
Patients sitting forward holding out breath
49
Investigations of MS
``` ECG; - LA enlargement - larger P wave (>0.12 sec) - Prominent R wave - RVH Cardiac catheterisation CXR - LA enlargement / pulmonary oedema ECHO - thickening and scarring of leaflets - fusion of commissures Cardiac MRI ```
50
Investigations of MR
``` ECG - LA enlargement - P tall and > 0.12sec - RVH (prominent R wave in R Precordial leads) CXR - cardiomegaly - LA enlargement - calcification of mitral annulus Cardiac catheterisation - LV angiography ECHO ```
51
Investigations of AS
``` ECG - LVH voltage criteria - ST/T changes (LV strain) CXR - calcification of AV Cardiac catheterisation - Peak LV peak aortic gradient ECHO - AV cusp motility - LV function and hypertrophy CMR ```
52
Investigations of AR
``` ECG - ST/T changes (LV strain) - LAD CXR - cardiomegaly in chronic AR Cardiac catheterisation ECHO - AV cusp anatomy - LV function, dilation and hypertrophy CMR ```
53
Treatment for MS
``` Diuretics Restriction of Na intake If AF - sinus rhythm restoration or ventricular rate control Anticoagulation Watchful waiting Invertational treatment - valvotomy (balloon vs surgical) - mitral valve replacement ```
54
Treatment for acute MR
``` Preload and afterload reduction - Diuretics - Sodium nitroprusside - Dobutamine - IABP Invertational treatment - mitral valve apparatus repair - mitral valve replacement ```
55
Treatment for chronic MR
Interventional treatment - mitral valve apparatus repair - mitral valve replacement
56
Treatment for AS
Aortic valve replacement or repair
57
Treatment for AR
Vasodilator therapy | Aortic valve replacement or repair
58
Who is treatment for AS saved for?
Those who develop HF
59
Causes of cardiac ischaemia
``` Atherosclerosis Embolism Coronary thrombosis Aortic dissection Arteritides Congenital ```
60
What are Arteritides?
Inflammatory cells infiltrate into the walls of the artery and cause inflammation
61
Presentation of ischaemic heart disease
``` Angina MI Arrhythmias Chronic heart failure Sudden death ```
62
What are the dangerous heart conditions (2)?
Left main stem stenosis | 3 vessel coronary artery disease
63
Causes of valvular heart disease in adult
``` Degenerative Congenital Infection Inflammatory LV or RV dilatation Trauma Neoplastic Paraneoplastic ```
64
What is rheumatic fever related to?
Streptococcal infections
65
Where is rheumatic fever common in?
Africa / developing countries
66
What is the hallmark pathology in rheumatic fever?
Pancarditis (effects myocardium, pericardium and epicardium)
67
What manifestations are also common in rheumatic fever?
Skin - cellulite on legs - migratory erythema (blotchy red swelling of skin) Joint
68
Pathology of chronic rheumatic fever
Gradually progressive MVDx +/- AVDx
69
What is the most worldwide cause of death in pregnancy?
Chronic rheumatic fever
70
What sugical technique can be used to treat IHD?
CABG
71
Indications for CABG
Symptomatic (any CAD pattern) | Prognostic (LMSS, 3VDx)
72
What does CABG stand for?
Coronary artery bypass grafting
73
Selection of patients for CABG must have...
``` Adequate - lung function - mental function - hepatic function Ascending aorta OK Distal coronary artery targets OK LVEG >20% ```
74
Conduits for CABG
Reversed saphenous vein Internal mammary arteries Radial arteries
75
Sternotomy problems
Wire infection Pain Sternal dehiscence Sternal malunion
76
Post op complications of cardiac surgery
Cardiac tamponade Death Stroke
77
Risk of death with CABG
2%
78
What is cardiac tamponade?
Collection of blood in the pericardial sac which is under pressure, so doesn't allow the atrium to fill in diastole so have a fast HR and low BP
79
Presentation of cardiac tamponade
``` Primary - raised CVP - Raised HR - Low BP Secondary - oliguria - increased O2 requirements - metabolic acidosis ```
80
What % of patients may need a repeat CABG?
5%
81
Treatment of cardiac tamponade following cardiac surgery
Chest re-opening
82
Which valves are most frequently operated on in adult cardiac surgery?
Aortic | Mitral
83
What differentiates aortic stenosis from aortic sclerosis?
Loss of A2
84
Is AS an easy murmur to hear?
Yes
85
What is on an ECG/ECHO of AS?
LVH
86
Is the murmur of AR easy to hear?
No
87
Is murmur of MS easy to hear? What may have to be done to hear it?
No - if easily hear then stenosis is severe | May need to exercise the patient to hear it
88
Is the murmur of MR easy to hear?
Yes | If loud - severe
89
What is severe MR usually associated with?
LV and LA dilatation Onset of AF Pulmonary HTN
90
What is severe MR on ECHO characterised by?
Systolic blood flow reversal into the pulmonary veins
91
What does a cardiopulmonary bypass do?
Blood is drained from right atrium and is returned to the ascending aorta Heart and lung function taken over by the CPB machine Induced hypothermia
92
What is required with CPB?
Systemic anticoagulation
93
What is the max time limit with CPB?
12 hours
94
What is the max cardiac ischaemic time in CPB?
6 hours
95
What is a common problem in CPB?
Coagulopathy
96
Types of heart valve prosthesis
Biological valve | Mechanical valve
97
Features of biological valve
No warfarin required | Wears out after 15 years
98
Features of mechanical valve
Warfarin required for life | Valve lasts for > 40 years
99
What is better for the mitral valve, repair or replacement?
Repair
100
Who would get biological valve replacements?
Patients who are elderly as wont live that long
101
What is the most common organism causing IE? What does it give rise to?
Strep viridans | Subacute bacterial endocarditis
102
What is the second most common organism causing IE? What does it give rise to?
Staph aureus | Acute bacterial endocarditis
103
Indications for surgery in IE
Severe valvular regurgitation Large vegetations Persistent pyrexia (fever) Progressive renal failure
104
In surgery for IE, what is given post op and for how long?
Ax IV for 6 weeks post op
105
What valvular problem is associated with polycystic kidney disease?
Mitral valve prolapse
106
What drugs are contraindicated in aortic stenosis?
Nitrates
107
Criteria for aortic stenosis management
Symptoms | Aortic valve gradient of 40mmHg
108
What is a clinical sign of AR?
De musset sign (Head bobbing)
109
How can functional tricuspid regurgitation occur?
Secondary to pulmonary HTN as a result of chronic lung disease
110
What murmurs cause an ejection systolic murmur?
AS Pulmonary stenosis, HOCM ASD Teratology of fallot
111
What murmurs cause a holosystolic (Pansystolic) murmur?
MR / TR (high pitched and blowing in character) | VSD (harsh in character)
112
What murmurs cause a late systolic murmur?
MVP | Coarctation of aorta
113
What murmurs cause a early diastolic murmur?
AR (high pitched, blowing in character) | Graham steel murmur (pulmonary regurg, high pitched and blowing in character)
114
What murmurs cause a mid-late diastolic murmur?
MS (rumbling in character) | Austin-Flint murmur (severe AR, again rumbling)
115
What causes a continuous machine like murmur?
PDA
116
What is an atrial myxoma?
Commonest benign tumour most commonly occurring in the left atrium (75%) attached to the fossa ovalis
117
Presentation of atrial myxoma
``` Mitral valve obstruction Systemic embolization Constitutional symptoms - SOB - weight loss - fever - clubbing ```
118
Which gender gets atrial myxoma more commonly?
Females
119
Heart signs of atrial myxoma
Mid diastolic murmur - 'tumour plop' ECHO - pedunculated heterogenous mass typically attached to the fossa ovalis region of the interatrial septum
120
What type of pulse is shown in aortic stenosis?
Slow rising pulse
121
What type of pulse is shown in HOCM?
Jerky pulse
122
What heart sound does pulmonary HTN cause?
A loud second heart sound
123
Murmurs are often described using what scale?
Levine scale
124
Describe the levine scale
Grade 1 - very faint murmur Grade 2 - Slight murmur Grade 3 - Moderate murmur WITHOUT palpable thrill Grade 4 - Loud murmur WITH palpable thrill Grade 5 - Very loud murmur with extremely palpable thrill. Can be heard with stethoscope edge Grade 6 - Extremely loud murmur - can be heard without stethoscope touching the chest wall

CVS Pathology (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions