6261971
Description
Flashcards by Rahul sharma, updated more than 1 year ago
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Created by Rahul sharma
almost 8 years ago
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| Question | Answer |
| Explain how the first and second heart sounds are generated, relate these to cardiac cycle and valve opening and closure. | S1 - “lubb” Closure of tricuspid/mitral values at beginning of ventricular systole S2 - “dupp” Closure of aortic/pulmonary valves at beginning of ventricular diastole |
| Symptoms of aortic stenosis | The classical clinical presentation of AS is the triad of Angina Syncope on exertion development of congestive cardiac failure AS is also an important cause of unexpected sudden death due to arrhythmias. |
| Signs of Aortic stenosis | Slow rising pulse with narrow pulse pressure heaving Non-displaced apex beat LV heave, aortic thrill Ejection systolic murmur |
| Define stenosis | Failure of a valve to open completely-- impede forward flow. Stenosis is virtually always caused by a chronic process. the chronicity of the process allows time for compensatory changes in heart, blood vessels and other organs. |
| Define regurgitation (incompetence) | Failure of a valve to close completely - reverse flow occurs. Regurgitation may be caused by an acute or chronic process. |
| Common causes of Aortic stenosis (Bicuspid cusp calcification) | Cusp calcification of a bicuspid valve. Normal aortic valve is tricuspid. About 1-2% of population have bicuspid valve. There is a strong association with aortic coarctation. Calcification develops by approx. by 30 years. It is thought that years of turbulent flow across the abnormal valve disrupt the endothelium and collagen matrix of the leaflets, resulting in gradual calcium deposition. |
| Common causes of Aortic stenosis | Age related calcification of a tricuspid valve Post rheumatic fever valve disease |
| pathophysiology of Aortic stenosis | Blood flow across the aortic valve is impeded during systole. A significantly elevated left ventricular pressure is required to drive blood into the aorta. The LV is able to compensate by undergoing hypertrophy in response to high systolic pressure it must generate to maintain output. The hypertrophy reduces the compliance of the ventricles and causes LA hypertrophy in order to fill the stiff 'LV' . |
| Symptoms and signs of aortic sclerosis | It is senile degeneration of the valve. There is an ejection systolic murmur, no carotid radiation, and normal pulse (character and volume) and S2. |
| Symptoms and signs of mitral regurgitation | Dyspnoea, fatigue, palpitations, infective endocarditis AF, displaced hyperdynamic apex, RV heave, soft S1, split S2, and loud P2 (pulmonary hypetension), pansystolic murmur at apex radiating to axilla. |
| Common causes of mitral regurgitation | Mitral annulus ( valve ring): LV dilation causes secondary stretching of the valve ring, so that the valve can not close properly. Cusps: Mitral valve prolapse, Infective Endocarditis, Post-rheumatic fever. papillary muscles: rupture post MI, ischaemia due to coronary artery atheroma (impaired contraction of the papillary muscle causes failure of complete valve closure) |
| Define acute mitral regurgitation | Sudden onset is usually due to infective endocarditis or rupture of a papillary muscle after MI. The heart does not have time to undergo compensatory changes. blood flows back into the left atrium, causing the pressure in the LA to rise. The high pressure in the LA is transmitted backwards into the pulmonary circulation, which causes transudation of fluid from the circulation into the lung interstitium and alveoli (pulmonary oedema) i.e. acute left heart failure. |
| Define chronic mitral regurgitation of the gradual onset | Due to dilation of the mitral valve ring, mitral valve prolapse, post rheumatic fever or papillary muscle ischaemia. The heart has time to undergo compensatory changes: the LA dilates to accommodate the back flow of blood without a substantial increase in LA pressure. the LV undergoes hypertrophy. patient may be asymptomatic for many years. LV begins to decompensate and development of progressive LV failure. |
| What is mitral valve prolapse (MVP)? | MVP is the most common cause of mitral regurgitation. It is common with an incidence of approx. 5%, mainly women. MVP is usually an isolated finding but it may be found as part of a variety of other conditions such as Marfan's syndrome. |
| Pathophysiology of MVP | In MVP the normal dense collagen and elastin matrix of the valve is replaced with loose myxomatous connective tissue containing abundant glycosaminoglycans ( so called- myxomatous degeneration). The leaflets become enlarged and one of the leaflets prolapses back in to the LA during systole. |
| Causes of tricuspid regurgitation | Common Functional (common) due to RV dilation (pulmonary HT due to lung disease or cardiac disease), RV infraction, intracardiac shunt, congenial heart disease (ASD) Intrinsic (rare) -- rheumatic fever, endocarditis, Ebstein's anomoly, carcinoid syndrome, myxomatous disease, connective tissue disease. |
| Symptoms and signs of tricuspid regurgitation | Symptoms: SOB and fatigue, right sided heart failure, ascites, oedema Signs: Elevated JVP with prominent v waves, S3, Loud pansystolic murmur in inspiration. |
| Symptoms and signs of pulmonary stenosis | Dyspnoea, fatigue, oedema, ascites. Signs: Harsh ejection systolic murmur loudest with inspiration, widely split S2. dysmorphic causes (congenital causes), prominent a wave in JVP. |
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