28. Aortic & Pulmonary Valve Disease Flashcards
Which is more common: mitral valve disease or aortic valve disease?
mitral
Aortic valve pathology can be? (3)
Rheumatic, calcific, or bicuspid
What are the athlerosclerotic risk factors for calcific aortic stenosis?
- lipids
- hypertension
- male
- metabolic syndrome
- smoking
- diabetes
- renal failure
- elevated CRP
- hypehemocystenemia
What are the genetic risk factors for calcific aortic stenosis?
- vitamin D receptor
- apolipoprotein A1, B, and E
- Estrogen receptor alpha gene
- notch 1
- ACE
- IL10
- CT growth factor
- chemokine receptor 5 (CCR5)
Once thought a degenerative disease, the mechanism by which a healthy tricuspid aortic valve becomes _____ is now believed to be similar to that of atherosclerosis.
stenotic
Once thought a degenerative disease, the mechanism by which a healthy tricuspid aortic valve becomes stenotic is now believed to be similar to that of ______.
atherosclerosis
The tricuspid aortic valves become stenotic ______, mainly caused by calcium deposits in the valve cusps and not by fusion of the commissures.
in the sixth, seventh, and eighth decades of life
The tricuspid aortic valves become stenotic in the sixth, seventh, and eighth decades of life, mainly caused by ______ in the ______ and not by fusion of the commissures.
calcium deposits; valve cusps
In developed countries, ______ has become a very rare cause of aortic stenosis. When the aortic valve is affected by ______ the mitral valve is almost always affected as well.
rheumatic fever; rheumatic heart disease
In developed countries, rheumatic fever has become a very rare cause of aortic stenosis. When the ____ valve is affected by rheumatic heart disease the _____ valve is almost always affected as well.
aortic; mitral
The ______of the aortic valve serves as the mainstay of diagnosis.
echocardiogram with Doppler interrogation
Valve replacement is recommended for individuals with ______. Such patients have a dire outlook, with 75% dying within 3 years of symptom onset.
symptomatic severe aortic stenosis
______ is recommended for individuals with symptomatic severe aortic stenosis. Such patients have a dire outlook, with 75% dying within 3 years of symptom onset.
Valve replacement
The cardinal symptoms of _____ are angina, syncope and shortness of breath.
severe aortic stenosis
The cardinal symptoms of severe aortic stenosis are ____, _____, and ______.
angina, syncope, and shortness of breath
The _____ is the most common congenital cardiac malformation, occurring in 1% to 2% of the population.
bicuspid aortic valve (BAV)
The bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, occurring in ____% of the population.
1 to 2
After development, bicuspid aortic valve (BAV) is associated with _____, _____, and _____.
aortic dilation, aneurysms, and dissection
After development, _____ is associated with aortic dilation, aneurysms, and dissection .
bicuspid aortic valve (BAV)
______ are the result of abnormal aortic cusp formation during valvulogenesis.
Bicuspid aortic valves (BAVs)
Bicuspid aortic valves (BAVs) are the result of ______ during valvulogenesis.
abnormal aortic cusp formation
In bicuspid aortic valve (BAV), adjacent cusps ______, larger than its counterpart yet smaller than 2 normal cusps combined. BAVs are likely the result of a complex developmental process, not simply the fusion of 2 normal cusps.
fuse to form a single aberrant cusp
Adjacent cusps fuse to form a single aberrant cusp, larger than its counterpart yet smaller than 2 normal cusps combined. BAVs are likely the result of a complex developmental process, not simply ______.
the fusion of 2 normal cusps
In patients with bicuspid aortic valve (BAV), deficient microfibrillar elements result in ______, matrix metalloproteinases (MMPs) release, ______, cell death, and ______.
smooth muscle cell detachment; matrix disruption; loss of structural support and elasticity
In patients with _____, deficient microfibrillar elements result in smooth muscle cell detachment, matrix metalloproteinases (MMPs) release, matrix disruption, cell death, and a loss of structural support and elasticity.
bicuspid aortic valve (BAV)
In patients with bicuspid aortic valve (BAV), deficient microfibrillar elements result in smooth muscle cell detachment, ______, matrix disruption, _____, and a loss of structural support and elasticity.
matrix metalloproteinases (MMPs) release; cell death
Describe how bicuspid aortic valve (BAV) is inherited.
auto dominant with reduced penetrance
males 4:1
Name 3 valvular complications of bicuspid aortic valve (BAV).
- aortic stenosis
- aortic insufficiency
- endocarditis
Name 4 vascular complications of bicuspid aortic valve (BAV).
- aortic dilation
- aneurism formation
- aortic dissection
- associations with coarctation, PDA, and coronary anomalies
What is syncope?
fainting
What is coarctation?
narrowing
What is PDA?
persistent ductus arteriosus
_______ is one of the more common forms of congenital heart disease. Most of the patients are children however patients may come to medical attention during adolescence or adulthood.
Stenosis of the pulmonic valve
In recent years, ______ has largely replaced surgical valvotomy except in patients with dysplastic valves.
percutaneous balloon valvuloplasty
In recent years, percutaneous balloon valvuloplasty has largely replaced surgical valvotomy except in patients with _____.
dysplastic valves
What is aortic stenosis?
a tight aortic valve- blood can’t flow through well
What are some of the major causes of aortic stenosis?
- a bicuspid aortic valve
- age related calcification
- Rheumatic fever
What is a bicuspid aortic valve?
a congenital defect where the aortic valve only has 2 cups
Why is a bicuspid aortic valve bad?
the valves can get damaged more quickly
What are the risk factors for a calcified aortic valve?
- smoking
- HTN
- hyperlipidemia
- diabetes
What valve is more commonly affected by Rheumatic fever?
the aortic valve
What does the acronym SAD, for the s/s of aortic valve stenosis, stand for?
syncope
angina
dyspnea
What is Pulsus Parvus et tardis?
a small or weak pulse that is slow to rise
Where do you palpate the PMI (point of maximal impulse)?
in the 5th intercostal space, similar to where the mitral valve is auscultated
How can the PMI give information about the LV in aortic valve stenosis?
if the PMI is more medial towards the sternum, it is indicative of LVH bc there is growth of the myocardium
What does MAHA stand for?
microangiopathic hemolytic anemia
Why does MAHA occur in aortic valve stenosis?
RBCs are lysed as they are pumped through the stiffened valve
What auscultative finding is present in aortic valve stenosis?
a systolic ejection murmur at the R upper sternal border
Why do aortic stenosis pts get angina?
- they also have CAD (blockage = chest pain)
2. they also have LVH (increased O2 demand that it’s not getting = chest pain)
What is aortic regurgitation?
an insufficient, floppy aortic valve that causes blood to flow back into the L ventricle
What causes aortic regurgitation?
- a widening or anerismal change of the aortic annulus (3a syphilis, Marfans, Ehlers-Danlos Syndrome)
- endocarditis
- Rheumatic fever
What are the s/s of aortic regurgitation?
- fatigue
- syncope
- SOB
- palpitations
What is wide pulse pressure? When does it present?
a large difference in systolic - diastolic pressure
How can the PMI give information about the LV in aortic valve regurgitation?
the LV is dilated, and this is shown by a displaced PMI laterally and inferiorly
What extra heart sound can be heard in aortic valve regurg?
S3 (early diastolic murmur along the L sternal border)
What is S1?
the closing of the mitral and tricuspid valves
What is S2?
the closing of the aortic and pulmonic valves
What happens btw S1 and S2?
systole
What happens btw S2 and S1?
diastole
What is a murmur btw S1 and S2 called?
systolic murmurs (aortic stenosis or pulmonic stenosis; tricuspid regurgitation or mitral regurgitation)
What is a murmur btw S2 and S1 called?
diastolic murmur (aortic regurg or pulmonic regurg; tricuspid stenosis or mitral stenosis)
The ____ sided valve problems are much more common than ____ sided valve problems.
left > right
What is a murmur?
the sounds of turbulent blood flow
What is an ejection sound/click?
valve leaflets moving quickly and then shooting open quickly
What is the shape/description of an aortic stenosis murmur?
it occurs just after S1 and is a crescendo-decrescendo or diamond shape with an ejection click
Aortic stenosis is a _____ _____ murmur that commonly radiates to _____.
systolic ejection; the carotids
What is the shape/description of a pulmonic stenosis murmur?
it occurs just after S1 and is a crescendo-decrescendo or diamond shape without an ejection click
What is the difference btw an aortic and pulmonic stenosis murmur?
the location; pulmonic doesn’t have an ejection click nor does it radiate to the carotids
Mitral regurgitation is a ______ murmur.
holocystolic/pancystolic
What does holocystolic/pancystolic mean?
it lasts through all of systole to S2
Describe the mitral regurgitation murmur and its shape.
starts right at S1, goes all the way to S2, and intensity stays the same throughout (flat); radiates to the axilla
What happens to the L atrium in mitral regurg?
it becomes more compliant in order to accommodate the increased blood volume
Describe a tricuspid regurgitation murmur.
a holocystolic, flat murmur in the tricuspid area that does not radiate to the axilla