2B: Pathology of Heart Valve Disease

Question 0

What is S2?

Answer 0

The second heart sound is “shorter” and usually higher frequency than S1– indicates the end of ventricular systole and beginning of ventricular diastole.
***CLOSURE OF the SEMILUNAR VALVES

Question 1

What is S1?

Answer 1

The first heart sound & associated w/ closure of the mitral valve & tricuspid valves at the onset of ventricular contraction

Question 2

What is S3?

Answer 2

The 3rd Heart sound is associated with the rapid passive filling phase of ventricular diastole

Question 3

What is S4?

Answer 3

The 4th Heart sound is associated w/ ATRIAL CONTRACTION

Question 4

What are heart murmurs? and their cause?

Answer 4

• Abnormal heart sounds because of VALVE PROBLEMS
• When heart strikes obstructions, flow becomes turbulent.
• Common in YOUNG CHILDREN (& Some elderly)
• Cause? Heart walls are THIN and vibrate w/ rushing blood.

Question 5

What are Incompetent heart murmurs?

Answer 5

Hear the swishing sound

Question 6

What are Stenotic Heart Murmurs?

Answer 6

Hear the high pitch or click

Question 7

What is a valvular stenosis?

Answer 7

When a valve does not open properly

Question 8

What is Valvular regurgitation/ Incompetence/ insufficiency? And end result of valve dysfunction?

Answer 8

-When a valve does not close properly resulting in BACK-FLOW (regurgitation) of blood.

End result of valve dysfunction? MYOCARDIAL HYPERTROPHY
***(mechanism intended to increase the pumping capability of the heart)

Question 9

When does Valvular heart disease occur ?

Answer 9

• As a result of rheumatic fever, may be secondary to various other inflammatory processes
• occurs with prosthetic valves (can be the site of thrombus formation or infectious endocarditis)

Question 10

What is Rheumatic Fever?

Answer 10

-Multisystem inflammatory disorder w/ major cardiac manifestations & sequelae, most often affecting children ( 5 & 15 yrs)

*****Occurs 1-4 weeks after an episode of tonsillitis or other infections caused by group A Beta hemolytic strep.

-Can lead to endocarditis—> valvular damage

Question 11

Which valve is most commonly involved w/ Rheumatic heart disease?

Answer 11

Mitral valve

Question 12

What is rheumatic heart disease

?

Answer 12

Late sequelae, occurring many years after the episode of rheumatic fever, are grouped under the term rheumatic heart disease

Question 13

What is Mitral Stenosis?

Answer 13

Impairment of blood flow from the L. atrium to the left ventricle;
Result:
1) LESS VENTRICULAR FILLING
2) Decreased SV and CO

Question 14

What are the clinical manifestations of Mitral Stenosis?

Answer 14

Increased LA pressure & hypertrophy, LV hypertrophy, and increased risk of atrial dysrhythmias

Question 15

What are the causes of Mitral Stenosis?

Answer 15

1) Rheumatic Fever
- limits valves ability to open and close
- may have mitral valve stenosis and regurgitation
2) Congenital heart defect
- narrowed mitral valve & develops stenosis early.
- Heart surgery required

Question 16

What is Mitral Insufficiency (PROLAPSE)?

Answer 16

*****Some blood ejected during ventricular systole is forced into the L. atrium (instead of the aorta). Blood is leaking in the wrong direction.

Result: decreased SV and CO, increased LV hypertrophy
-MOST frequent heart valve problem

Question 17

What are the causes of Mitral Insufficiency (PROLAPSE)?

Answer 17

1) Rheumatic fever
2) Infective endocarditis
3) Wear an tear on the valve
4) Prior heart attack
5) Untreated high BP
6) Congenital Heart defects

Question 18

What is AORTIC Stenosis?

Answer 18

• Diminished blood flow from the left ventricle into the aorta
• Results: Decreased SV and CO also faint pulses
• LV hypertrophy(thick wall) develops which increases myocardial oxygen demand

Question 19

What are the main causes of Aortic Stenosis?

Answer 19

1) Birth defects of aortic valve
2) Defective valve– only 1 cusp (should have 3)
3) A bicuspid aortic valve w. progressive wear & tear
2) Rheumatic heart disease
3) Age related degenerative change

Question 20

What is degenerative calcific aortic stenosis?

Answer 20

• Occurs with persons older than 60.

- Normal aortic valve as an age related degenerative change

Question 21

What is aortic insufficiency?

Answer 21

BLood ejected during Ventricular Systole flows back into L. ventricle during ventricular diastole
- Increased ESV, decreased SV and CO and LV hypertrophy.

Question 22

What are cause of aortic insufficiency?

Answer 22

1) congenital heart defect
2) deterioration of the valve w/ age
3) infective endocarditis
4) rheumatic fever