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Cardiopulmonary > Cardiac Valve Disease (2) > Flashcards

Cardiac Valve Disease (2) Flashcards

1
Q

What valves are opened during dystole?

A

Tricuspid and mitral valves (heart filling)

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2
Q

What valves are open during systole?

A

Pulmonic and aortic valves (heart emptying)

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3
Q

What happens to the valve when contraction increases?

A

Pressure is greater than downstream pressure and the valve opens

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4
Q

What happens to the valve when contraction ends?

A

Pressure decreases below downstream pressure and the valve closes

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5
Q

What do chordae tendineae and papillary muscles prevent?

A

Inversion of valves during ventricular systole

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6
Q

What can chordae tendineae and papillary muscles become damaged from?

A

MI causing regurgitation

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7
Q

What are the atrio-ventricular valves?

A

Mitral (left)

Tricuspid (right)

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8
Q

What are the semilunar valves?

A

Aortic (left)

Pulmonic (right)

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9
Q

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

A

chordae tendineae and papillary muscles

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10
Q

How can cardiac valve disease be acquired?

A

Gradual fibrosis

Rheumatoid fever

Endocarditis

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11
Q

Where is cardiac valve disease most common?

A

Left side of heart in older adults

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12
Q

Who does mitral stenosis primarily occur in?

A

Females

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13
Q

What is the primary cause of mitral stenosis?

A

Rheumatic heart disease

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14
Q

What is mitral stenosis?

A

When valve leaflets don’t open easily or completely

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15
Q

What does mitral stenosis decrease and increase?

A

Decreases area

Increases resistance to flow between A-V

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16
Q

What are the reasons that mitral stenosis causes pressure overload?

A

LA hypertrophy

Impaired LV filling

Pulmonary hypertension

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17
Q

What may mitral stenosis advance to?

A

Right heart failure

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18
Q

What type of murmur is heard in mitral stenosis?

A

Diastolic murmur

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19
Q

What causes arrhythmias in mitral stenosis?

A

Stretch of left atrium creating multiple foci

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20
Q

Why is there a risk for thrombus in mitral stenosis?

A

Due to pooling in left atrium and increased turbulence

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21
Q

What is medical management for mitral stenosis?

A

Anti-coagulants and anti-arrhythmics

Surgery

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22
Q

What is mitral regurgitation/incompetence?

A

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

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23
Q

Why does stroke volume increase in mitral regurgitation/incompetence?

A

To compensate for back flow

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24
Q

Why does eccentric hypertrophy occur in mitral regurgitation/incompetence?

A

To accommodate for increased volume

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25
Q

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

A

Due to back pressure

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26
Q

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

A

20%

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27
Q

What percent of population have mitral valve prolapse?

A

2-6% (mostly asymptomatic)

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28
Q

When may surgery be required for mitral valve prolapse?

A

If regurgitation is severe

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29
Q

Why is there a volume overload in mitral valve prolapse?

A

Left atrium dilates

Pulmonary congestion

LVH to compensate for

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30
Q

What is the murmur heard in mitral valve prolapse?

A

Holosystolic due to regurgitation into left atrium

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31
Q

How does aortic stenosis occur?

A

Thickening, calcification or both

32
Q

What accounts for the majority of aortic stenosis?

A

Calcified aortic stenosis and congenital bicuspid aortic valve stenosis

33
Q

What are symptoms of aortic stenosis?

A

Volume overload (LVH to compensate)

Suppressed BP response

Orthopnea

Dyspnea on exertion

34
Q

What type of murmur is heard in aortic stenosis?

A

Systolic murmur

35
Q

What are the common causes of aortic regurgitation/incompetence?

A

Congenital

Rheumatic

Endocarditis

Age

Chronic hypertension

36
Q

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

A

LV dilates

37
Q

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

A

LV and LA concentric hypertrophy

38
Q

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

A

Diastolic murmur

39
Q

Who are not candidates for exercise programs?

A

Patients with symptomatic valve disease

40
Q

What makes up the pericardium?

A

Fibrous

Serous

Pericardial space

41
Q

What is the fibrous layer of the pericardium?

A

Outermost layer

42
Q

What is the serous of the pericardium?

A

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

43
Q

What is the pericardial space?

A

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

44
Q

What is the epicardium?

A

Outer layer of connective tissue that covers the heart

45
Q

What is pericarditis?

A

Swelling and irritation of pericardium

46
Q

What is most common cause of pericarditis?

A

Viral infections

47
Q

What may pericarditis occur from?

A

Heart attack, radiation therapy, and post open heart surgery

48
Q

What type of pain is felt in pericarditis?

A

Sharp retrosternal pain with radiation to back (lasts hours)

49
Q

When does pain worsen in pericarditis?

A

Deep breathing or coughing while lying flat

50
Q

When does pain improve in pericarditis?

A

Sitting up and leaning forward

51
Q

What is heard on auscultation with pericarditis?

A

Friction rub

52
Q

What is pericardial effusion?

A

Fluid in pericardial sac

53
Q

What are symptoms of pericardial effusion?

A

Pressure pain in chest, Dysphagia, and Dyspnea

54
Q

What are signs of pericardial effusion?

A

Muffled heart sounds and possible JVD

55
Q

What may pericardial effusion progress to?

A

Cardiac tamponade

56
Q

Where is the aortic region on auscultation of the heart?

A

Right 2nd intercostal space (parasternal)

57
Q

Where is the pulmonic region on auscultation of the heart?

A

Left 2nd intercostal space (parasternal)

58
Q

Where is the tricuspid region on auscultation of the heart?

A

Left 4th or 5th intercostal space (parasternal)

59
Q

Where is the mitral region on auscultation of the heart?

A

Left 4th or 5th intercostal space (midclavicular)

60
Q

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

A

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

61
Q

What is the S1 sound?

A

First heart sound and is closure of AV valves

62
Q

What does S1 occur with?

A

Ventricular contraction

63
Q

What does S1 mark the beginning of?

A

Systole

64
Q

What is the S2 sound?

A

2nd heart sound and closure of semilunar valves

65
Q

What does S2 sound mark the end and beginning of?

A

End of systole and beginning of ventricular relaxation (dystole)

66
Q

What is the difference between the S1 and S2 sound?

A

S2 is shorter duration and higher frequency

67
Q

What is the splitting S1 sound?

A

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

68
Q

What is splitting S2?

A

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

69
Q

What is an S3 (gallop)?

A

Low pitch and occurs after S2

70
Q

What is an S4 (gallop)?

A

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

71
Q

What is a murmur often due to?

A

Faulty valve or structural changes in myocardium

72
Q

How long are murmurs compared to heart sounds?

A

Longer

73
Q

How are murmurs graded?

A

1-6

74
Q

What grades are murmurs that are considered thrills given?

A

4-6

75
Q

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

A

Putting patient in different positions (Valsalva or squatting)

Cardiopulmonary (20 decks)

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