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Medicine Notes Cardiology Notes

Valvular Heart Disease Notes

Updated Valvular Heart Disease Notes

Cardiology Notes

Cardiology

Approximately 27 pages

Complete set of notes on Cardiology. COvering all the main conditions with pathophysiology, presenting symptoms, investigation and management. Includes relevant pharmacology. Clear headings and concise bullet points, including table summaries. ...

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Heart Valve Disease

Mitral Valve

Mitral Stenosis

Common worldwide but decreasing in prevalence due to decrease in rheumatic fever

Causes

  • Rheumatic fever

  • Congenital

Pathophysiology

Valve narrowing

To maintain sufficient CO, left atrial pressure increases

= Left atrial hypertrophy and dilation

Pulmonary venous, pulmonary arterial and right heart pressures also increase

Increased pulmonary capillary pressure = pul. Oedema

Pulmonary hypertension

Right ventricular hypertrophy + failure

Symptoms Signs

Usually none until valve is moderately stenosed (i.e around 2cm2 from 5cm2)

Dyspnoea

Fatigue

Palpatations (AF in lt atrium)

Chest pain

Systemic emboli (AF in lt atrium)

Haemoptysis

Recurrent bronchitis

Face

- Mitral facies (due to arteriovenous anastomoses and vascular stasis from severe pul. Hypertension)

Pulse

  • Small volume

  • AF = irregularly irregular pulse

Jugular veins

- Distension, raised JVP in rt heart failure

Palpation

- Tapping impulse felt on left side parasternally

Auscultation

  • Loud S1 and opening ‘snap’

  • Heard best at apex in expiration with patient on left side + bell

  • Mid diastolic rumbling

Investigations

Bedside

  • ECG (EF, RVH)

Imaging

  • CXR (LA enlargement, pul. Oedema, mitral valve calcification)

  • Echo (diagnostic, follows disease progression)

  • Cardiac catheterization (only required if adequate echo is impossible to obtain or if there are co-existing cardiac problems e.g coronary artery disease suspected)

Management

  • AF

    • Rate control

    • Anticoagulation

  • Diuretics to reduce pre-load and pul. Venous congestion

  • Surgery

    • Balloon valvuloplasty (if pliable, non-calcified valve)

    • Open valvectomy

    • Valve replacement

Complications

  • Pulm. Hypertension

  • Emboli

  • Pressure from enlarged LA on local structures

    • Hoarsenss (recurrent laryngeal nerve)

    • Dysphagia (oesophagus)

    • Bronchial obstruction

  • Infective endocarditis

Mitral Regurgitation

  • Common valve lesion

Pathogenesis

Intrinsic valve disease

  • Rheumatic heart disease (commonest)

  • Infective endocarditis

  • Disease of valve-related apparatus e.g chordial rupture

  • Disease of the papillary muscles e.g rupture as result from MI (usually of circumflex)

Secondary/functional

  • Caused by stretching of the valve ring when LV dilated (e.g in LHF)

  • Collagen abnormalities e.g Ehlers-Danlos or Marfans Syndrome

  • Connective tissue disorders e.g Lupus

Regurgitation into left atrium

Left atrial dilatation

Clinical features

  • Often asymptomatic for many years

  • Symptoms

    • Dyspnoea

    • Fatigue

    • Palpatations

    • Infective endocarditis

Investigations

  • Bedside

    • ECG (AF, LVH)

  • Imaging

    • CXR

    • Echo (dilated left atrium and ventricle. TOE to assess severity and suitability for repair (Doppler for size and site of regurgitant jet)

    • Cardiac catheterization (confirm diagnosis, exclude other disease, assess CAD)

Management

  • AF

    • Control rate, anticoagulate

  • Symptom relief with diuretics

  • Surgery for deteriorating symptoms (aim to replace or repair valve before LV is irreversibly impaired)

Aortic Valve Disease

Aortic Stenosis

Causes

  • Congenital aortic stenosis

    • Very rare – may be result of bicuspid valve, or a subaortic membrane constricting the outflow tract

  • Premature calcification of a congenitally bicuspid aortic valve

    • Symptoms from age 40 onwards

  • Calcific aortic stenosis of a normal valve

    • Very common from age 65 onwards

    • ...

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