Evaluation of Valvular Heart Disease

Flashcards covering the definition, pathogenesis, clinical manifestations, pathophysiology, and management of Rheumatic Fever, Mitral Stenosis, Mitral Regurgitation, Aortic Stenosis, and Aortic Regurgitation.

Acute rheumatic fever

A systemic disease of childhood, often recurrent, that follows group A beta hemolytic streptococcal infection and involves inflammatory damage to the heart, blood vessels, joints, subcutaneous tissue, and CNS.

Jones Criteria (Major Manifestations)

The five primary clinical signs used to diagnose rheumatic fever: Carditis, Polyarthritis, Chorea, Erythema Marginatum, and Subcutaneous Nodules.

Jones Criteria (Minor Manifestations)

Clinical and laboratory findings supporting a diagnosis of rheumatic fever, including previous rheumatic fever/heart disease, arthralgia, fever, acute phase reactants (ESR, CRP, leukocytosis), and prolonged P-R interval.

Primary Prevention of Rheumatic Fever

Step I in treatment involving the eradication of streptococci using agents such as Benzathine penicillin G ($0.6M\,IU$ or $1.2\,M\,IU$) or Penicillin V for 10 days.

Secondary Prevention of Rheumatic Fever

Step IV in treatment aimed at preventing recurrent attacks, typically using Benzathine penicillin G $1\,200\,000\,U$ intramuscularly every 4 weeks.

Dyspnea

The uncomfortable awareness of breathing; in cardiac cases, it is often caused by pulmonary congestion and alveolar edema stimulating J receptors in the lung.

Central Cyanosis

Reduced $O_2$ saturation due to a right to left shunt or impaired pulmonary function, including late-onset cases like Eisenmenger syndrome.

Mitral Stenosis (MS)

A valvular lesion predominantly due to Rheumatic Fever characterized by the fusion of commissures, cusps, and chords, leading to a narrowed mitral valve orifice.

Opening snap

An auscultatory finding in Mitral Stenosis that implies valve pliability, caused by the sudden tensing of valve leaflets after their opening excursion.

Mitral Valve Area (MVA) Severity

Normal is $4-6\,cm^2$; mild stenosis is $2-4\,cm^2$; moderate is $1-2\,cm^2$; and severe MS is $<1\,cm^2$.

LAE P in II

An ECG finding in moderate to severe Mitral Stenosis where the P wave duration in lead II is $>0.12\,sec$.

Kerley A and B lines

Findings on a Chest X-ray indicating interstitial edema, typically seen in patients with Mitral Stenosis.

Pansystolic Murmur (PSM)

A blowing, high-pitched murmur characteristic of Mitral Regurgitation (MR).

Mitral Regurgitation (MR) Surgical Criteria

Intervention is indicated for patients in Functional Class III, or those with $ESD >45\,mm$, $EF < 60\%$, Atrial Fibrillation, or significant Pulmonary hypertension.

Aortic Stenosis (AS) Severity

Normal area is $3-4\,cm^2$; severe AS characterized by an area $<1.0\,cm^2$ and a mean pressure gradient $>50\,mmHg$ ($PIG > 60\,mmHg$).

AS Symptom Prognosis

Once symptoms appear, the average survival for Heart failure is 2 years, Syncope is 3 years, and Angina is 5 years.

Pulsus parvus et tardus

A physical exam finding in Aortic Stenosis where the pulse is slow rising and sustained.

Austin Flint rumble

A mid diastolic murmur at the apex caused by rapid antegrade flow across the mitral valve in cases of severe Aortic Regurgitation.

Corrigan's pulse

A clinical sign of Aortic Regurgitation also known as a collapsing or water-hammer pulse.

AR Surgical Treatment Threshold

Operation is recommended for symptomatic patients with severe AR, or asymptomatic patients with $LVEF <55\%$ or $LVESD >55\,mm$.