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FA CARDIO 3 > Cardiac Valvular Dz 1 > Flashcards

Cardiac Valvular Dz 1 Flashcards

1
Q

connects LA to LV

A

mitral valve

opens during diastole

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2
Q

connects LV to aorta

A

aortic valve

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3
Q

connects RA to RV

A

tricuspid valve

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4
Q

connects RV to pulmonic artery

A

pulmonic valve

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5
Q

primary means to non-invasively study cardiac function and valvular disease

A

Transthoracic Echocardiography

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6
Q

sound waves in TTE used to (4 results)

A
  1. images of heart structures
  2. direction and velocity of blood flow
  3. filling of heart and perfusion of myocardium
  4. pressure gradient
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7
Q

indications for TTE

A

valvular disease, syncope, DOE

heart failure and pulmonary HTN

infective endocarditis

evaluation of TIA/Stroke

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8
Q

TEE

A

posterior structures of heart

esp. good for LA, L atrial appendage, mitral valve, aorta

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9
Q

indications for TEE

A
  1. infective endocarditis (esp PVE)
  2. aortic dissection
  3. Detection of LA mass or thrombus
  4. when pt factors preclude TTE
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10
Q

valvular heart disease

etiologies

A

congenital or acquired

due to rheumatic fever, now due to degeneration of the valve

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11
Q

Rheumatic heart disease

A

immune mediated illness affects multiple systems

initiated by untreated streptococcal infection

antibodies against strep proteins cross react with protein self antigens

attack heart, joints, vessels to produce inflammation

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12
Q

myocarditis secondary to rheumatic fever

A

may result in severe ventricular dilation

all three layers of heart may be effected

results in poor LV contractility and deformation of valvular apparatus

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13
Q

effect of poor LV contractility

myocarditis

A

HFrEF (syncope, DOE)

can’t move blood forward so back up into lungs

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14
Q

effect of deforming valvular apparatus

myocarditis

A

regurgitation

valve is stretched apart

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15
Q

acute rheumatic fever will also cause valve leaflets…

A

to become red and swollen with small sterile vegetations

inflammatory changes heal with fibrosis

causes stenosis and regurgitation in same valve

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16
Q

fibrosis of valvular disease causes

A

fibrosis of leaflets (hard)

fusion of leaflet commissures

contracting valve leaflets

shortening chordae

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17
Q

s/s of acute rheumatic fever

A
  1. febrile illness
  2. arthritis
  3. carditis
  4. skin lesions
  5. chorea
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18
Q

febrile illness in acute rheumatic fever

A

history of suggestive strep pharyngitis

mc in kids 4-10 yrs of age, M=F

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19
Q

arthritis in acute rheumatic fever

A

migratory poly arthritis of mid-large joints (hips, elbows, knees)

lasting about 4 weeks, responsive with ASA

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20
Q

carditis in acute rheumatic fever

A

pericardial friction rub

new heart murmurs

any heart valve - aortic> mitral> R heart

visible on ECHO

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21
Q

treatment of rheumatic fever

A

Penicillin to eradicate the strep

prophylaxis PCN injections for 10+ yrs to prevent recurrent strep infections

ASA used for treatment of severe and pericarditis

22
Q

epidemiology of aortic stenosis

A

more common in men

more common in older patients

more common in comorbid dyslipidemia

23
Q

pathophys of aortic stenosis

A

degenerative

wear/tear + deposition of calcium causes leaflets to become more rigid and fuse at commissures

24
Q

when does aortic stenosis become symptomatic?

A

60-70s with bicuspid AORTIC

70-80s with tricuspid aortic

bc the trileaflet allow blood to move thru easier so more degeneration must take place

25
Q

etiologies of aortic stenosis (3)

A
  1. congenital abnormal valve with superimposed calcification
  2. calcification and degeneration of normal valve
  3. rheumatic disease
26
Q

aortic sclerosis

A

thickened valve leaflets without stenosis

27
Q

aortic stenosis

A

measurable outflow obstruction and reduced valve area

28
Q

hemodynamics of AS

A

valve damage leads to LV outflow obstruction

ventricle increases speed and strength of contraction to compensate (increased AFTERload)

LV hypertrophy = stiffness = diastolic dysfunction

eventually DILATION occurs = systolic dysfunction

29
Q

moderate stenosis is a valve

A

1.0-1.5 cm

30
Q

critical aortic gradient/stenosis

A

> 40 mmHg and <1.0 cm

31
Q

symptomatic AS when?

A

occurs when valve decreases to <1.0 cm

initial symptoms are non specific

dyspnea on exertion, exertional dizziness, exertional angina

32
Q

Symptoms of AS and why? (3)

A
  1. angina (decreased diastole = decreased coronary filling)
  2. syncope (outflow decreased, results in decreased perfusion)
  3. dyspnea/HF (backing up into pulmonary circuit)
33
Q

AS murmur/ PE

A

harsh, blowing crescendo decrescendo murmur, best heard at RUSB, 2nd ICS, radiates to neck

s4 gallop

apical pulse, diminished and delayed carotid

34
Q

diagnosis of AS

A

ECHO

determine cause, calculate area and gradient to understand severity

35
Q

AS treatment

A

once symptomatic it is surgical treatment

can give low dose diuretics and ACEI

avoid activity, daily weight and HF s/s

36
Q

pharm CI for AS

A

low dose BB (can be Used from some) reduce contractility and should avoid in HF and AS

vasodilators (reduce coronary perfusion) - hydrazine, nonDHP CCB, NTG

37
Q

surgical treatment of AS (list)

A

AVR w/ prosthetic or mechanical valve +/- CABG

TAVR

balloon aortic valvuloplasty

38
Q

TAVR

A

transcatheter replacement of valve, used in patients with high risk of open heart surgery

balloon tipped catheter goes in, pushes open valve and mechanical one is placed

39
Q

Aortic regurgitation etiologies (Leaftlet issue) (5)

A

rheumatic heart disease

congenital abnormaliteit

infective endocarditis

medications (diet med(

connective tissue disorder

40
Q

Aortic regurgitation etiologies (apparatus distortion)

A

dilation

cardiomyopathy, AS, or aortic root

41
Q

aortic regurgitation hemodynamics

A

LV dilation and hypertrophy @ same time

blood leaks back into LV during aorta so ventricle dilates and hypertrophies to move thru large volumes

causes myocyte damage which causes systolic failure therefore backing up into lungs

42
Q

AR symtpoms

A

largely asymptomatic due to LV compensation

normal to increased EF

  1. symptoms of increased LV filling pressures (Palpitations, pounding HB, atypical chest pain)
  2. reduced CO causes fatigue and weakness
  3. LV dysfunction = PND, orthopnea, DOE

ANgina due to oxygen demand of hypertrophy LV and decreased flow

43
Q

SIGNS of AR

A

blowing, high pitched diastolic decrescendo murmur (LLSB)

widened pulse pressure

arterial pulse bounding

S3 gallop

44
Q

AR treatment

A

monitoring of LV function and size via serial echo (6mo-1yr)

vasodilators (ACEI or nifetapine)

CI BB due to their prolongation of diastole (increased amount of blood regurged)

45
Q

valve surgery is indicated for:

A
  1. ALL symptomatic AR
  2. AR and systolic dysfunction (EF < 55%)
  3. AR and enlarging LV (>55 mm end systolic)

ascending aorta may also req. graft replacement (aortic root)

46
Q

acute AR causes

A

infective endocarditis

ascending aortic dissection

47
Q

pathophys of ACUTE AR

A

LV unable to dilate accommodate regurgitant volume

immediate reduction of effective CO, causing rapid pulmonary congestion

48
Q

symptoms of acute AR

A

pulmonary edema

crackles/rales (Wet lungs)

HoTN

AMS

Dypsnea

cyanosis

oliguria

49
Q

signs of acute AR

A

S3

cardiogenic shock

low pitched, short diastolic murmur

diagnose with ECHO

50
Q

acute AR treatment

A

vasopressors and inotropic support until valve replacement can be performed

FA CARDIO 3 (5 decks)

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