Cardio Mod 6 Flashcards
which side of the heart is valve dysfunction more common
left side
2 types of valve dysfunction
- stenotic
2. insufficiency
3 etiologies of aortic valve stenosis
- congenital - abnormal bicuspid formation
- degenerative changes - more common in older population - deposits on valves that make it hard to open
- inflammatory - secondary to rheumatic heart dz
what two inflammatory conditions can cause aortic stenosis?
- rheumatic fever - post-infectious systemic inflammatory disease/reponse due to step - effects joints, skin, CNS and heart
- rheumatic heart dz - the inflammation associated with rheumatic fever can scar/deform the valves
primary effects of aortic valve stenosis
- reduced outflow of left ventricle
- increased end systolic LV volume/pressure (incomplete emptying of LV)
- output changes: decr SV/decr CO - (heart tries to compensate)
- decr systolic BP, potential decr pulse pressure (decr amplitude of pulse = pulse parvus)
secondary effects of aortic valve stenosis
- hypertrophy of left ventricle as compensation to increased workload
- –may cause coronary circulation insufficiency
- –coronary capillary density insufficient for myocardial hypertrophy
- –may lead to ischemia and potential dysrhythmias
- cardiac pressure/congestion changes - incr left atrial pressure, incr pulm pressures, pulm HTN = pulm edema
- all of this may progress to MI/heart failure
classic symptoms of aortic valve stenosis
syncope with exertion
angina
DOE as it progresses to heart failure
where is the heart murmur heard in aortic valve stenosis - systolic or diastolic?
systolic
where do you auscultate the aortic valve
right parasternal 2nd ICS
etiologies of mitral valve stenosis
-what population does it affect more?
- rheumatic heart dz most common cause
- degenerative not as common
females>males
primary effects of mitral valve stenosis
- reduced outflow of left atria
- increased LA volume/pressures (incomplete emptying of left atria)
- output changes: decr SV/decr CO - heart compensates to try and maintain normal SV and CO; exertional insufficiency of decre SV/CO
secondary effects of mitral valve stenosis
- left atria dilation due to incomplete emptying of left atria/hypertrophy as compensation to increased workload
- cardiac pressure/congestion changes - incr left atrial pressure, incr pulm pressure, pum HTN, leads to edema can eventually lead to RVF
- increased A wave due to pulmonary congestion
- atrial wall changes may lead to ischemia and potential atrial dysrhythmias - blood flow stasis of Aflutter/fib will add risk of thrombi formation
- all can lead to MI/heart failure
s/s of mitral valve stenosis
- progressive dyspnea due to pulmonary HTN/congestion
(also orthopnea, PND) - non angina chest discomfort
- right sided heart failure due to pulmonary HTN/congestion
where is the heart murmur heard in mitral valve stenosis - systolic or diastolic
diastolic
aortic valve insufficiency etiologies
- congenital
- secondary to disease pathology (rheumatic heart dz, bacterial endocarditis, CAD)
- CT disorders and other systemic dz
primary effects of aortic valve insufficiency
- during ventricular relaxation blood from aorta back flows into left ventricle
- increased end diastolic filling volumes of left ventricles
- output changes: incr SV/CO to accomodate for back flow loss; incr systolic BP, decr diastolic BP, incr pulse pressure (wide pulse pressure)
secondary effects of aortic valve insufficiency
- dilation and hypertrophy of left ventricle to compensate for SV/CO volumes and workload
- cardiac pressure/congestion changes - potential for incr pulm pressure and edema
- potential for dysrhythmias and associated complications due to wall changes
- heart failure occurs as compensation mechanisms can’t maintain CO
s/s of aortic valve insufficiency
- bounding peripheral pulses from increased pulse pressure changes
- DOE, orthopnea, PND, angina chest pain
- progressive symptoms that may develop over decades
when is the heart murmur heart in aortic valve insufficiency - systolic or diastolic
diastolic
mitral valve insufficiency etiologies
- rheumatic heart dz, endocarditis
- mitral valve prolapse progressing to regurgitation
- other: CAD, congestive cardiomyopathy, systemic CT disorders
effects on heart with mitral valve insufficiency
- increased left atrial volumes/pressures: back flow of blood into left atria during ventricular contraction which leads to left atrial dilation/hypertrophy; viscous cycle as atrial dilation may enlarge mitral valve opening more
- increased ventricular fililng columes/pressures due to increased filling volumes from atria - hypertrophy and dilation of left ventricle follows
- increased atrial pressures also may lead to congestive back up into pulmonary circulation - incr pulm pressure, pulm HTN/edema
- eventually compensation fails to maintain CO and heart failure occurs
s/s of mitral valve insufficiency
DOE - progresses to heart failure
where is the heart murmur hear in mitral valve insufficiency
systolic
where do you auscultate the mitral valve?
left 5th ICS space along the midclavicular line
what is the most common valve disorder in the US
mitral valve prolapse syndrome
what is mitral valve prolapse syndrome
enlarged cusps of mitral valve prolaps back into left atrium during systole
pathogenesis of mitral valve prolapse syndrome
- abnormal connective tissue accumulation/degeneration in the valves cause enlargements
- the cusps will billow back into the atria
- chordae tendineae become stretched/elongated as cusps billow back
- eventually cusps may not be able to fully close and mitral valve regurgitation develops
s/s of mitral valve prolapse syndrome
may or may not be symptomatic
what is the heart sound heard in mitral valve prolapse syndrome
mid systolic click or systolic murmur
prognosis of mitral valve prolapse syndrome
good without complications
severe consequences of mitral valve prolapse syndrome
- rupture of chordae tendinae, emboli formation, ventricular failure
- infective endocarditis, stroke, death
etiologies of tricuspid valve insufficiency
- congenital
2. secondary results of pulm HTN pathologies
mechanical effects on cardiac pump with tricuspid valve insufficiency
- pulm HTN/congenital regurgitation causes back flow into right atria
- increased right atrial pressures creates increased venous pressures
- distended jugular veins and lower extremity/generalized edema
- increased atrial volumes/pressures progress to increased right ventricular volumes/pressures
- right ventricular hypertorphy/dilation compensate to maintain cardiac output - compensation eventually fails and right sided heart failure occurs
where is the heart murmur heart in tricuspid valve insufficiency - systolic or diastolic
systolic
where is the tricuspid valve heard
left 5th intercostal space along parasternal line
