26. Introduction to Valvular Heart Disease Flashcards
Valvular stenosis: causes what kind of load on the upstream chamber?
pressure load –> concentric hypertrophy
valvular stenosis: what kind of load on the downstream chamber?
decreased pressure/underloading
valvular regurg: what kind of load on the upstream chamber?
volume load –> eccentric hypertrophy
intracardiac shunt: what kind of load on the affected chambers?
volume load on the chambers that carry the extra blood.
in aortic stenosis, how does pulmonary venous congestion occur?
aortic stenosis = volume load on LV. get LVH and resulting reduction in compliance. then get LAE and pulmonary congestion due to the decr compliance.
in mitral stenosis, where is the pressure buildup?
in the LA.
how does pulm venous congestion occur in mitral stenosis?
direct backup into the pulmonary venous beds.
with mitral stenosis, what happens to LV pressure and size?
pressure decr, size decr due to underloading
mitral regurg will have what effect on the LV?
volume load and subsequent eccentric hypertrophy
aortic regurg will have what effect on the LV?
volume load and subsequent eccentric hypertrophy
which is worse: aortic regurg or mitral regurg?
aortic regurg due to the extra blood being pumped against the strong aorta vs the compliant LA.
mitral regurg: what kind of load does it inflict on the LV?
both volume and pressure load
with an atrial septal defect, which chambers will enlarge?
Right Ventricle: eccentric. since it is tasked with handling the excess volume
atrial septal defect: what is the most turbulent part of the flow/part that causes murmur?
extra flow through pulmonic valve.
atrial septal defect: where does the 02 step up occur?
right atrium
patent ductus arteriosus: between what two structures?
aorta –> pulm artery
Patent ductus arteriosus: which direction is the shunt?
from L to R because of incr pressure in the aorta compared to the pulm artery
patent ductus arteriosus: causes enlargement of what chambers?
the L ventricle ends up handling the extra flow
Patent ductus arteriosus: where is the oxygen step-up?
in the pulmonary artery
ventricular septal defect: which direction is the shunt?
L to R
ventricular septal defect: what chambers are enlarged?
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)
ventricular septal defect: where is the oxygen stepup?
in the RV or pulm arteries
Tetralogy of Fallot: what are the 4 components?
- VSD
- pulmonic stenosis
- RVH
- overriding aorta
Tetralogy of Fallot: which direction is the shunt?
R to L
Tetralogy: why is the shunt R to L?
because of pulmonary stenosis
Tetralogy: which ventricle is hypertrophied?
RV, eccentric
what is meant by a volume overload?
a requirement for increased volume. could be due to anemia, pregnancy.
why is there widened splitting of S2 with an atrial septal defect?
P2 is delayed because of increased pulmonic flow.
Describe Eisenmenger Syndrome
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.
Eisenmenget Syndrome occurs most frequently with what kind of defect?
VSD
