26. Introduction to Valvular Heart Disease

Question 1

Valvular stenosis: causes what kind of load on the upstream chamber?

Answer 1

pressure load –> concentric hypertrophy

Question 2

valvular stenosis: what kind of load on the downstream chamber?

Answer 2

decreased pressure/underloading

Question 3

valvular regurg: what kind of load on the upstream chamber?

Answer 3

volume load –> eccentric hypertrophy

Question 4

intracardiac shunt: what kind of load on the affected chambers?

Answer 4

volume load on the chambers that carry the extra blood.

Question 5

in aortic stenosis, how does pulmonary venous congestion occur?

Answer 5

aortic stenosis = volume load on LV. get LVH and resulting reduction in compliance. then get LAE and pulmonary congestion due to the decr compliance.

Question 6

in mitral stenosis, where is the pressure buildup?

Answer 6

in the LA.

Question 7

how does pulm venous congestion occur in mitral stenosis?

Answer 7

direct backup into the pulmonary venous beds.

Question 8

with mitral stenosis, what happens to LV pressure and size?

Answer 8

pressure decr, size decr due to underloading

Question 9

mitral regurg will have what effect on the LV?

Answer 9

volume load and subsequent eccentric hypertrophy

Question 10

aortic regurg will have what effect on the LV?

Answer 10

volume load and subsequent eccentric hypertrophy

Question 11

which is worse: aortic regurg or mitral regurg?

Answer 11

aortic regurg due to the extra blood being pumped against the strong aorta vs the compliant LA.

Question 12

mitral regurg: what kind of load does it inflict on the LV?

Answer 12

both volume and pressure load

Question 13

with an atrial septal defect, which chambers will enlarge?

Answer 13

Right Ventricle: eccentric. since it is tasked with handling the excess volume

Question 14

atrial septal defect: what is the most turbulent part of the flow/part that causes murmur?

Answer 14

extra flow through pulmonic valve.

Question 15

atrial septal defect: where does the 02 step up occur?

Answer 15

right atrium

Question 16

patent ductus arteriosus: between what two structures?

Answer 16

aorta –> pulm artery

Question 17

Patent ductus arteriosus: which direction is the shunt?

Answer 17

from L to R because of incr pressure in the aorta compared to the pulm artery

Question 18

patent ductus arteriosus: causes enlargement of what chambers?

Answer 18

the L ventricle ends up handling the extra flow

Question 19

Patent ductus arteriosus: where is the oxygen step-up?

Answer 19

in the pulmonary artery

Question 20

ventricular septal defect: which direction is the shunt?

Answer 20

L to R

Question 21

ventricular septal defect: what chambers are enlarged?

Answer 21

LV, and possibly RV depending on how high up in the membrane the defect is located. If very high up, the RV may never see the extra flow (may go directly into pulm arteries)

Question 22

ventricular septal defect: where is the oxygen stepup?

Answer 22

in the RV or pulm arteries

Question 23

Tetralogy of Fallot: what are the 4 components?

Answer 23

• VSD
• pulmonic stenosis
• RVH
• overriding aorta

Question 24

Tetralogy of Fallot: which direction is the shunt?

Answer 24

R to L

Question 25

Tetralogy: why is the shunt R to L?

Answer 25

because of pulmonary stenosis

Question 26

Tetralogy: which ventricle is hypertrophied?

Answer 26

RV, eccentric

Question 27

what is meant by a volume overload?

Answer 27

a requirement for increased volume. could be due to anemia, pregnancy.

Question 28

why is there widened splitting of S2 with an atrial septal defect?

Answer 28

P2 is delayed because of increased pulmonic flow.

Question 29

Describe Eisenmenger Syndrome

Answer 29

shunt reverses itself.
with long-standing L to R shunt, pulm arteries react to inc flow by constricting –> pulm hypertension, increased R sided heart pressures. if constricted enough, shunt direction will reverse.

Question 30

Eisenmenget Syndrome occurs most frequently with what kind of defect?

Answer 30

VSD