Cardiac Valve Disfunction Flashcards
When is systole in relation to heart sounds?
Between the first and second heart sounds
What is valve stenosis?
Narrowing of the valve
What is the result of valve stenosis?
A pressure gradient across the valve and high pressure in the chamber behind the valve
What is valve incompetence?
When valve doesn’t close properly and blood leaks
What is the result of valve incompetence?
Increased EDV
What causes a murmur?
Turbulence around a stenosed or incompetent valve
What causes valvular heart disease?
rheumatic fever, degenerative conditions
What is the result of valvular heart disease?
cardiac compensation (ventricular enlargment) that eventually fails
What interventions are used to treat valvular heart disease?
Valve replacements, valve repair, balloon valvotomy, stent valves
What happens in aortic stenosis?
fibrosis or calcification causes a progressive narrowing of the aortic valve
What is the size reduction of the aortic valve in aortic stenosis?
2.5cm squared down to 0.7cm squared
What is the pressure gradient across the valve in severe aortic stenosis?
50mmHg - LVP of 170/80
Who does aortic stenosis mostly effect?
The elderly
What are the symptoms of aortic stenosis?
SOB, chest pain, black outs
What is the left ventricular response to aortic stenosis?
Concentric hypertrophy, leads to less compliance, leads to increased LVEDP, leads to increased LAP, can eventually lead to cardiac failure
Are the left ventricular changes reversible?
Yes - after surgery
When is surgery given for atrial stenosis?
When symptoms appear
What type of murmur is heard for aortic stenosis?
An ejection systolic murmur - get louder as gradient increases - best heard at upper right sternal edge
What are the two ways that aortic regurgitation can occur?
damage of leaflets or dilation of aortic root
How are leaflets damaged?
Endocarditis or rhemuatic fever
How is the aortic root dilated?
Marfan’s syndrome, aortic dissection, collagen vascular disorders, syphillis
What happens in aortic regurgitation?
Blood leaks back into the ventricle during diastole, LV has to pump greater SV, leads to an increased EDV and increased ejection fraction, reduced aortic pressure in diastole means there is a wide pulse pressure
What eventually happens in aortic regurgitation?
LV function decreases - eccentric hypertrophy - decompensation - leads to irreversible changes
What kind of murmur is heard for aortic regurgitation?
A diastolic murmur - can’t hear second heart sound because valve isn’t closing properly
What are the causes of mitral valve regurgitation?
myxomatous degenration, ruptured chordae tendinae, endocarditis, myocardial infarct that effect papillary muscle, rheumatic fever, collagen vascular disease, cardiomyopathy
What happens in mitral regurgitation?
Blood flows back in left atrium, left ventricle has to pump greater stroke volume, increased LVEDV, increase LAP, atrial fibrillation, pulmonary oedema
What murmur is heard in mitral regurgitation?
A pan systolic murmur
What causes mitral stenosis?
Almost always rheumatic fever
What happens in mitral stenosis?
reduced filling of the LV, increased LAP and LAV, atrial fibrillation, pulmonary congestion
