CAM201 Lecture Notes - Lecture 9: Pulse Pressure, Aortic Valve Replacement, Pressure Overload

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8 Jun 2018
Department
Course
Professor
The Basics
Valves are thin, translucent membranes
Allow blood to flow freely in one direction
Stenotic
Incompetent (regurgitation)
Can be congenital or acquired
Acute or chronic
Spectrum changes (as with Rheumatic fever)
Management
Medical
Prevent endocarditis
Prevent thromboembolism and arrhythmias
Reduce preload (diuretics via increasing salt and water excretion)
Reduce afterload (vasodilators to reduce systemic BP)
Surgical
Repair
Replace
Tissue (Xenograft, Homograft)
Prosthetic valves
Bioprosthetic from cadava or animal
Why do Hearts Fail?
increased afterload and work causes hypertrophy
Increased volume causing dilation
Starlings Law dictates that efficiency will decrease overtime after a certain dilation
Hypertrophy increases ventricular stiffness and increase filling pressure
Decreased CO causes catecholamine drive (more adrenaline and NA)
Prolonged catecholamine drive results in catecholamine depletion
Decreased CO reduces GFR causing fluid retention and aldosterone release
Chronic volume and pressure overload leads to eventual muscle failure
Manifestations of Heart Failure
Forward (increased)
Fatigue
Dyspnoea
Syncope
Angina
Backwards (decreased)
Pulmonary oedema
Right heart strain and failure as pressure rises
Elevated JVP
Hepatosplenomegaly
Ascites
Peripheral oedema
Approach
What is the lesion?
Where?
Severity?
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Consequences?
Aetiology?
Management?
Mitral Stenosis (MS)
Aetiology
Rheumatic
Congenital
Calcification
Haemodynamics
Elevated LA pressure, due to narrowed valve
Elevated Pulmonary arterial pressure
JVP prominent 'a' wave and gradual 'y' descent
Normal LV diastolic pressure
Clinical Features
Examination
Inspection
Malar flush
Peripheral cyanosis (severe MS)
Jugular venous distension (RV failure)
Palpation
Parasternal RV impulse
Palpable pulmonary arterial impulse
Palpable S1, S2, and occasionally, the diastolic rumble
Auscultation
Increased intensity of the first heart sound
Opening snap
Low-pitched diastolic rumbling murmur
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Diastolic murmur in MS
OS is opening snap and diastolic gurgling of mitral valve
Investigation
LA/LAA enlargement
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Document Summary

The basics: valves are thin, translucent membranes, allow blood to flow freely in one direction. Incompetent (regurgitation: can be congenital or acquired, acute or chronic. Medical: prevent endocarditis, prevent thromboembolism and arrhythmias, reduce preload (diuretics via increasing salt and water excretion, reduce afterload (vasodilators to reduce systemic bp) Surgical: repair, replace, tissue (xenograft, homograft, prosthetic valves, bioprosthetic from cadava or animal. Why do hearts fail? increased afterload and work causes hypertrophy. Syncope: angina, backwards (decreased, pulmonary oedema, right heart strain and failure as pressure rises, elevated jvp, hepatosplenomegaly, ascites, peripheral oedema. Haemodynamics: elevated la pressure, due to narrowed valve, elevated pulmonary arterial pressure. Jvp prominent "a" wave and gradual "y" descent: normal lv diastolic pressure. Inspection: malar flush, peripheral cyanosis (severe ms) Palpation: parasternal rv impulse, palpable pulmonary arterial impulse, palpable s1, s2, and occasionally, the diastolic rumble. Increased intensity of the first heart sound: opening snap.

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