Cardiac Murmurs & Valve Probz Flashcards
Heart valves are made up of what type of tissue?
Cartilage (which is why it doesn’t heal well)
What does each problem with a valve reduce?
Cardiac output
What is the function of the chordae tendineae?
They are connective tissue that connect papillary muscle to the mitral & tricuspid valves
Which side of the heart has more frequent damaged valves?
the left side because of the high pressure blood
The AV node sits between what three heart valves? Why is this concerning with valvular disease?
Tricuspid, mitral, and aortic
valve damage could then lead to arrhythmias from AV node conduction problems
How do you get a gallop heart sound?
valves are not closing at the same time
ex: “lub” S1 sound is really sounds like “lub-bub”- mitral and tricuspid valves closing at different times
Rubbing heart sound occur during what part of the cardiac cycle?
Can hear it throughout most of the cycle
What are four types of abnormal heart sounds?
Gallops, Rubs, Clicks, Murmurs
What is a “click” heart sound? when could you hear a click?
it is a sharp snapping sound that is present when valves are opening or closing
From MVP or mechanical valve
What two parts of the heart are you listening to when you ascultate over the right 2nd intercostal space? What valve problem is there with a loud murmur? How about a soft murmur?
Right atrium and aorta
Loud- aortic stenosis
Soft- tricuspid regurgitation
What two heart parts are you listening to over the upper left sternal border? What are the two valve problems you could hear here?
pulmonic artery and left atrium
stenotic pulmonary valve and mitral valve regurgitation
What heart part are you listening to over the lower left sternal border? What two valve problems could you hear here?
right ventricle
stenotic tricuspid valve or regurgitant pulmonic valve
What heart part are you listening to over the apex? what two valve problems could you hear here?
left ventricle
mitral stenosis or aortic regurgitation
“lub” begins the _______ phase and “dub” begins the _____ phase of the cardiac cycle
systolic
diastolic
What is the measurement of a stenotic aortic valve?
less than 1 cm squared in diameter
What are the four systolic heart murmur sounds?
aortic stenosis, pulmonic stenosis, mitral regurg, tricuspid regurg
What are the four diastolic heart murmur sounds?
mitral stenosis, tricuspid stenosis, aortic regurg, pulmonic regurg
What is a thrill heart sound?
its vibration on skin
What are the six stages of grading heart sounds?
1) . not very audible; very faint
2) . barely audible but not easily heard
3) . heard easily but no thrill
4) . loud with a thrill or thrust over pericardium
5) . very loud, heard with stethoscope tilted on chest
6) . extremely loud, heard without stethoscope
what is often the first symptom of decreased cardiac output?
body compensates with increased HR - tachycardia
If a patient has a transmural MI (infarction that involves the whole thickness of the heart muscle), what can happen to the mitral valve?
MI can cause papillary muscle to pull away from the cardiac muscle
this leads to mitral valve prolapse
what are the three most common types of acquired valvular disease?
Rheumatic (more common outside US), Infective, Calcific (degenerative or autoimmune)
What are some late symptoms and signs of decreased CO?
symptoms: peripheral edema, productive cough, dyspnea at rest, severely dec activity
signs: CHF (dyspnea, heart sounds, breath sounds, peripheral edema), EKG ST change
What is left ventricle remodeling that occurs during left ventricular hypertrophy? what can LVH cause?
remodeling is rounding of the Ventricle muscle so that valve leaflets cant meet & we get regurgitation
LVH can cause diastolic dysfunction (which leads to CHF)
Define insufficiency of a valve versus regurgitation?
insufficiency is valve isn’t functioning properly (not opening or closing)
regurgitation is the improper blood flow FROM the insufficiency
What is the most common etiology of mitral regurgitation?
annular dilatation associated with decreased left ventricle function
What are four main etiologies for Aortic insufficiency?
rheumatic
endocarditis
annular dilation (due to connective tissue disorder)
disruption of valve commissures from dissection
what is the most common cause of tricuspid valve disease?
mitral valve disease (increased pulmonary pressures dilate the right ventricle and cause annular dilation of the tricuspid valve); occurs in about 10-50% of people
How do you get pulmonic regurgitation?
From increased pulmonic pressures (can be from MV disease, COPD, other pulmonary disease)
What are the two etiologies for aortic stenosis?
calcific (infective or degenerative) and congenital (bicuspid or unicuspid)
Why do you not want to stent a stenotic valve?
Calcium deposits from the calcification can break off from the valve & travel in the blood (becomes embolus)
What is the medical treatment for valvular problems?
Treat underlying disease for prevention
What size is the mitral valve compared to the aortic valve? what size is a stenotic MV
its twice the size (about 4-5 cm); stenotic size is less than 2 cm
what are two indications for surgery for mitral regurgitation?
symptomatic patient that’s limiting life activities and decreased LV function
What measure of heart function are you losing with Atrial fibrillation?
lose ejection fraction because atria aren’t contracting properly & amount of blood leaving the ventricles is decreased
What are the two types of valve repairs? What are the three replacement options?
repairs: leaflet excision & suturing, annulus ring placement
replacement: prosthetic, mechanical, implantable
What are two possible indications for tricuspid valve repair/replacement?
1) . tricuspid regurg from mitral valve problems
2) . symptoms of severe right heart failure
Four indications of Aortic valve repair or replacement?
Severe aortic stenosis (<1 cm squared)
severe aortic insufficiency
endocarditis
ascending aortic dissections
What is a catheter balloon valvuloplasty used for? it is a definitive therapy for what patient population?
used as a “bridge” procedure until valve surgery
used as definitive therapy in pts who aren’t surgical candidates
What patient population will undergo a TAVR procedure?
non open heart surgical candidate who has severe aortic stenosis (pt cant have bicuspid AV)
