Cardiac Valve Disease (2) Flashcards by Koden Tietjen

What valves are opened during dystole?

Tricuspid and mitral valves (heart filling)

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What valves are open during systole?

Pulmonic and aortic valves (heart emptying)

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What happens to the valve when contraction increases?

Pressure is greater than downstream pressure and the valve opens

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What happens to the valve when contraction ends?

Pressure decreases below downstream pressure and the valve closes

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What do chordae tendineae and papillary muscles prevent?

Inversion of valves during ventricular systole

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What can chordae tendineae and papillary muscles become damaged from?

MI causing regurgitation

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What are the atrio-ventricular valves?

Mitral (left)

Tricuspid (right)

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What are the semilunar valves?

Aortic (left)

Pulmonic (right)

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What do the semilunar valves not have that the atrio-ventricular valves do?

chordae tendineae and papillary muscles

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How can cardiac valve disease be acquired?

Gradual fibrosis

Rheumatoid fever

Endocarditis

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Where is cardiac valve disease most common?

Left side of heart in older adults

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Who does mitral stenosis primarily occur in?

Females

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What is the primary cause of mitral stenosis?

Rheumatic heart disease

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What is mitral stenosis?

When valve leaflets don’t open easily or completely

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What does mitral stenosis decrease and increase?

Decreases area

Increases resistance to flow between A-V

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What are the reasons that mitral stenosis causes pressure overload?

LA hypertrophy

Impaired LV filling

Pulmonary hypertension

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What may mitral stenosis advance to?

Right heart failure

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What type of murmur is heard in mitral stenosis?

Diastolic murmur

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What causes arrhythmias in mitral stenosis?

Stretch of left atrium creating multiple foci

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Why is there a risk for thrombus in mitral stenosis?

Due to pooling in left atrium and increased turbulence

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What is medical management for mitral stenosis?

Anti-coagulants and anti-arrhythmics

Surgery

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What is mitral regurgitation/incompetence?

Mitral valve does not close completely during systole and creates back flow

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Why does stroke volume increase in mitral regurgitation/incompetence?

To compensate for back flow

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Why does eccentric hypertrophy occur in mitral regurgitation/incompetence?

To accommodate for increased volume

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Why does the left atrium dilate in mitral regurgitation/incompetence?

Due to back pressure

What percent of people >55 y/o have some degree of mitral regurgitation?

20%

What percent of population have mitral valve prolapse?

2-6% (mostly asymptomatic)

When may surgery be required for mitral valve prolapse?

If regurgitation is severe

Why is there a volume overload in mitral valve prolapse?

Left atrium dilates Pulmonary congestion LVH to compensate for

What is the murmur heard in mitral valve prolapse?

Holosystolic due to regurgitation into left atrium

How does aortic stenosis occur?

Thickening, calcification or both

What accounts for the majority of aortic stenosis?

Calcified aortic stenosis and congenital bicuspid aortic valve stenosis

What are symptoms of aortic stenosis?

Volume overload (LVH to compensate) Suppressed BP response Orthopnea Dyspnea on exertion

What type of murmur is heard in aortic stenosis?

Systolic murmur

What are the common causes of aortic regurgitation/incompetence?

Congenital Rheumatic Endocarditis Age Chronic hypertension

What occurs due to volume overload in aortic regurgitation/incompetence?

LV dilates

What is possible in the late stages of aortic regurgitation/incompetence?

LV and LA concentric hypertrophy

What type of murmur is heard in aortic regurgitation/incompetence?

Diastolic murmur

Who are not candidates for exercise programs?

Patients with symptomatic valve disease

What makes up the pericardium?

Fibrous Serous Pericardial space

What is the fibrous layer of the pericardium?

Outermost layer

What is the serous of the pericardium?

Lines the inner surface of the fibrous pericardium (parietal) and is reflected onto the heart as the visceral layer (epicardium)

What is the pericardial space?

Potential space formed by the sac that is filled with fluid that lubricates the heart and reduces friction during movement

What is the epicardium?

Outer layer of connective tissue that covers the heart

What is pericarditis?

Swelling and irritation of pericardium

What is most common cause of pericarditis?

Viral infections

What may pericarditis occur from?

Heart attack, radiation therapy, and post open heart surgery

What type of pain is felt in pericarditis?

Sharp retrosternal pain with radiation to back (lasts hours)

When does pain worsen in pericarditis?

Deep breathing or coughing while lying flat

When does pain improve in pericarditis?

Sitting up and leaning forward

What is heard on auscultation with pericarditis?

Friction rub

What is pericardial effusion?

Fluid in pericardial sac

What are symptoms of pericardial effusion?

Pressure pain in chest, Dysphagia, and Dyspnea

What are signs of pericardial effusion?

Muffled heart sounds and possible JVD

What may pericardial effusion progress to?

Cardiac tamponade

Where is the aortic region on auscultation of the heart?

Right 2nd intercostal space (parasternal)

Where is the pulmonic region on auscultation of the heart?

Left 2nd intercostal space (parasternal)

Where is the tricuspid region on auscultation of the heart?

Left 4th or 5th intercostal space (parasternal)

Where is the mitral region on auscultation of the heart?

Left 4th or 5th intercostal space (midclavicular)

What is the most accurate measurement of HR by clinical exam?

Apical pulse measurement (5th intercostal space at mid clavicular line)

What is the S1 sound?

First heart sound and is closure of AV valves

What does S1 occur with?

Ventricular contraction

What does S1 mark the beginning of?

Systole

What is the S2 sound?

2nd heart sound and closure of semilunar valves

What does S2 sound mark the end and beginning of?

End of systole and beginning of ventricular relaxation (dystole)

What is the difference between the S1 and S2 sound?

S2 is shorter duration and higher frequency

What is the splitting S1 sound?

Mitral and tricuspid valves are slightly asynchronous (wide splitting is abnormal)

What is splitting S2?

When splitting does not resolve in expiration following sitting, standing, or a valsalva

What is an S3 (gallop)?

Low pitch and occurs after S2

What is an S4 (gallop)?

Produced by sound of blood being forced into stiff ventricles (occurs before S1)

What is a murmur often due to?

Faulty valve or structural changes in myocardium

How long are murmurs compared to heart sounds?

Longer

How are murmurs graded?

1-6

What grades are murmurs that are considered thrills given?

4-6

How can you distinguish between different murmurs if they sound similar?

Putting patient in different positions (Valsalva or squatting)