10 minute topic Valvular Heart Disease

Question 1

Valvular heart disease

Answer 1

abnormality or dysfunction of any of the heart’s four valves: the mitral and aortic valves (left side) and the tricuspid and pulmonic valves (right side)

Question 2

Valvular Stenosis

Answer 2

Narrowed opening that impedes blood moving forward

Question 3

Valvular Insufficiency

Answer 3

improper closure, some blood flows backward (regurgitation)

Question 4

Congenital Valvular heart disease

Answer 4

can affect all four valves (or just one) and cause either stenosis or insufficiency

Question 5

Acquired Valvular heart disease types

Answer 5

Degenerative
Rheumatic
Infective endocarditis

Question 6

degenerative Acquired Valvular heart disease

Answer 6

Due to damage over time from mechanical stress, most common cause is hypertension

Question 7

Rheumatic Acquired Valvular heart disease

Answer 7

Gradual fibrotic changes, calcification of valve cusps. The mitral valve is most commonly affected – this is why it is important to treat rheumatic fever

Question 8

Infective endocarditis Acquired Valvular heart disease

Answer 8

Infectious organisms destroy the valve, so they become vegetative
Streptococcal infections are a common cause

Question 9

Which side is more commonly effected?

Answer 9

Left side because of the greater pressures on the left side of the heart

Question 10

risk factor for valvular disease: Age

Answer 10

fibrotic thickening occurs in the mitral and aortic valves. The aorta is stiffer because of increasing systolic BP and stress on mitral valve.

Question 11

Valvular heart disease risk factors

Answer 11

HTN
Marfans syndrome
murmur
age

Question 12

Marfans syndrome

Answer 12

connective tissue disorder that affects the heart and other areas of the body

Question 13

Left-sided valve damage signs

Answer 13

→ dyspnea, fatigue, ↑ pulmonary artery pressure, ↓cardiac output

Question 14

Signs of Mitral Stenosis

Answer 14

Left Side
oDiastolic murmur
oAtrial fibrillation
oPalpitations
oJVD
oPitting edema
oHemoptysis
oCough/ Dysphagia
oHoarseness
oOrthopnea

Question 15

Signs of Mitral valve insufficiency

Answer 15

Left Side
o	paroxysmal nocturnal dyspnea – they sit up at night cause they can’t breath 
o	Orthopnea
o	Palpitations
o	S3 & /or S4 heart sounds 
o	Possible diminished lung sounds/ crackles
o	Systolic murmur
o	Atrial fibrillation

Question 16

Signs of Aortic Stenosis

Answer 16

Left Side
o	Angina
o	Syncope
o	Decreased SVR (systemic vascular resistance) 
o	S3 & /or S4
o	Systolic murmur
o	Narrowed pulse pressure

Question 17

Signs of Aortic insufficiency

Answer 17

Left Side
o	Angina
o	S3 sounds
o	Diastolic murmur
o	Widened pulse pressure

Question 18

Signs of Right side damage

Answer 18

dyspnea, fatigue, ↑ right artrial pressure, peripheral edema, JVD & hepatomegaly (kind of like right sided HF, it is backing up into the periphery)

Question 19

Signs of Tricuspid stenosis

Answer 19

Right Side
o Atrial dysrhythmias
o Diastolic murmur
o Decreased cardiac output

Question 20

Signs of Tricuspid insufficiency

Answer 20

Right Side
o Conduction delays – you will see changes in the ECG
o SVT
o Systolic murmur

Question 21

Signs of Pulmonic Stenosis

Answer 21

Right side
from the heart to the lungs
o Cyanosis
o Systolic murmur

Question 22

Signs of Pulmonic Insufficiency

Answer 22

Right side

o Diastolic murmur

Question 23

Valvular heart disease dx

Answer 23

chest x-ray
12 lead EKG
Echocardiogram
Stress test
Radionuclide studies
Angiography

Question 24

Chest x-ray

Answer 24

shows chamber enlargement, pulmonary congestion, and valve calcification

Question 25

12-lead EKG

Answer 25

shows chamber hypertrophy

Question 26

Echocardiogram

Answer 26

shows chamber size, hypertrophy, specific valve dysfunction (because we can see the flow), ejection function, and amount of regurgitant flow
non-invasive

Question 27

Radionuclide studies

Answer 27

determine ejection fraction during activity and rest

Question 28

Angiography

Answer 28

is a cardiac catherization reveals chamber pressures, ejection fraction, regurgitation, and pressure gradients

Question 29

Valvular heart disease medications

Answer 29

diuretics, afterload-reducing agents (ACEinhibitors, beta blockers, calcium channel blockers), inotropic agents, anticoagulants

Question 30

Inotropic agents

Answer 30

digoxin (Lanoxin), dopamine, dobutamine hydrochloride, to increase contractility and thereby improve cardiac output

Question 31

Valvular heart disease surgical interventions

Answer 31

Percuaneous balloon valvuloplasty
valve repair
commissurotomy (relieve stenosis on leaflets)
annuloplasty ring insertion – gives stability
Prosthetic valve replacement

Question 32

Percuaneous balloon valvuloplasty

Answer 32

procedure can open aortic or mitral valves affected by stenosis. A catheter (done in the cath lab) is inserted through the femoral artery and advanced to the heart. A balloon is inflated at the stenosis to help open and improve leaflet mobility of the valve

Question 33

Prosthetic valve replacement

Answer 33

can be mechanical or tissue. Mechanical valves last longer but they do require anticoagulation. Tissue valves (human tissue from a cadaver) lasts about 10 to 15 years.