This is an extract of our Valvular Heart Disease document, which we sell as part of our Cardiology Notes collection written by the top tier of University Of Leicester students.
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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 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
- 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
- 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)
- AF o Rate control o Anticoagulation
- Diuretics to reduce pre-load and pul. Venous congestion
- Surgery o Balloon valvuloplasty (if pliable, non-calcified valve) o Open valvectomy o Valve replacement Complications
- Pulm. Hypertension
- Pressure from enlarged LA on local structures o Hoarsenss (recurrent laryngeal nerve) o Dysphagia (oesophagus) o Bronchial obstruction
- Infective endocarditis
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