Cardio Mod 6

Question 1

which side of the heart is valve dysfunction more common

Answer 1

left side

Question 2

2 types of valve dysfunction

Answer 2

1. stenotic

2. insufficiency

Question 3

3 etiologies of aortic valve stenosis

Answer 3

1. congenital - abnormal bicuspid formation
2. degenerative changes - more common in older population - deposits on valves that make it hard to open
3. inflammatory - secondary to rheumatic heart dz

Question 4

what two inflammatory conditions can cause aortic stenosis?

Answer 4

1. rheumatic fever - post-infectious systemic inflammatory disease/reponse due to step - effects joints, skin, CNS and heart
2. rheumatic heart dz - the inflammation associated with rheumatic fever can scar/deform the valves

Question 5

primary effects of aortic valve stenosis

Answer 5

1. reduced outflow of left ventricle
2. increased end systolic LV volume/pressure (incomplete emptying of LV)
3. output changes: decr SV/decr CO - (heart tries to compensate)
4. decr systolic BP, potential decr pulse pressure (decr amplitude of pulse = pulse parvus)

Question 6

secondary effects of aortic valve stenosis

Answer 6

• 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

Question 7

classic symptoms of aortic valve stenosis

Answer 7

syncope with exertion
angina
DOE as it progresses to heart failure

Question 8

where is the heart murmur heard in aortic valve stenosis - systolic or diastolic?

Answer 8

systolic

Question 9

where do you auscultate the aortic valve

Answer 9

right parasternal 2nd ICS

Question 10

etiologies of mitral valve stenosis

-what population does it affect more?

Answer 10

1. rheumatic heart dz most common cause
2. degenerative not as common

females>males

Question 11

primary effects of mitral valve stenosis

Answer 11

1. reduced outflow of left atria
2. increased LA volume/pressures (incomplete emptying of left atria)
3. output changes: decr SV/decr CO - heart compensates to try and maintain normal SV and CO; exertional insufficiency of decre SV/CO

Question 12

secondary effects of mitral valve stenosis

Answer 12

1. left atria dilation due to incomplete emptying of left atria/hypertrophy as compensation to increased workload
2. cardiac pressure/congestion changes - incr left atrial pressure, incr pulm pressure, pum HTN, leads to edema can eventually lead to RVF
3. increased A wave due to pulmonary congestion
4. atrial wall changes may lead to ischemia and potential atrial dysrhythmias - blood flow stasis of Aflutter/fib will add risk of thrombi formation
5. all can lead to MI/heart failure

Question 13

s/s of mitral valve stenosis

Answer 13

1. progressive dyspnea due to pulmonary HTN/congestion
   (also orthopnea, PND)
2. non angina chest discomfort
3. right sided heart failure due to pulmonary HTN/congestion

Question 14

where is the heart murmur heard in mitral valve stenosis - systolic or diastolic

Answer 14

diastolic

Question 15

aortic valve insufficiency etiologies

Answer 15

1. congenital
2. secondary to disease pathology (rheumatic heart dz, bacterial endocarditis, CAD)
3. CT disorders and other systemic dz

Question 16

primary effects of aortic valve insufficiency

Answer 16

1. during ventricular relaxation blood from aorta back flows into left ventricle
2. increased end diastolic filling volumes of left ventricles
3. output changes: incr SV/CO to accomodate for back flow loss; incr systolic BP, decr diastolic BP, incr pulse pressure (wide pulse pressure)

Question 17

secondary effects of aortic valve insufficiency

Answer 17

1. dilation and hypertrophy of left ventricle to compensate for SV/CO volumes and workload
2. cardiac pressure/congestion changes - potential for incr pulm pressure and edema
3. potential for dysrhythmias and associated complications due to wall changes
4. heart failure occurs as compensation mechanisms can’t maintain CO

Question 18

s/s of aortic valve insufficiency

Answer 18

1. bounding peripheral pulses from increased pulse pressure changes
2. DOE, orthopnea, PND, angina chest pain
3. progressive symptoms that may develop over decades

Question 19

when is the heart murmur heart in aortic valve insufficiency - systolic or diastolic

Answer 19

diastolic

Question 20

mitral valve insufficiency etiologies

Answer 20

1. rheumatic heart dz, endocarditis
2. mitral valve prolapse progressing to regurgitation
3. other: CAD, congestive cardiomyopathy, systemic CT disorders

Question 21

effects on heart with mitral valve insufficiency

Answer 21

1. 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
2. increased ventricular fililng columes/pressures due to increased filling volumes from atria - hypertrophy and dilation of left ventricle follows
3. increased atrial pressures also may lead to congestive back up into pulmonary circulation - incr pulm pressure, pulm HTN/edema
4. eventually compensation fails to maintain CO and heart failure occurs

Question 22

s/s of mitral valve insufficiency

Answer 22

DOE - progresses to heart failure

Question 23

where is the heart murmur hear in mitral valve insufficiency

Answer 23

systolic

Question 24

where do you auscultate the mitral valve?

Answer 24

left 5th ICS space along the midclavicular line

Question 25

what is the most common valve disorder in the US

Answer 25

mitral valve prolapse syndrome

Question 26

what is mitral valve prolapse syndrome

Answer 26

enlarged cusps of mitral valve prolaps back into left atrium during systole

Question 27

pathogenesis of mitral valve prolapse syndrome

Answer 27

1. abnormal connective tissue accumulation/degeneration in the valves cause enlargements
2. the cusps will billow back into the atria
3. chordae tendineae become stretched/elongated as cusps billow back
4. eventually cusps may not be able to fully close and mitral valve regurgitation develops

Question 28

s/s of mitral valve prolapse syndrome

Answer 28

may or may not be symptomatic

Question 29

what is the heart sound heard in mitral valve prolapse syndrome

Answer 29

mid systolic click or systolic murmur

Question 30

prognosis of mitral valve prolapse syndrome

Answer 30

good without complications

Question 31

severe consequences of mitral valve prolapse syndrome

Answer 31

1. rupture of chordae tendinae, emboli formation, ventricular failure
2. infective endocarditis, stroke, death

Question 32

etiologies of tricuspid valve insufficiency

Answer 32

1. congenital

2. secondary results of pulm HTN pathologies

Question 33

mechanical effects on cardiac pump with tricuspid valve insufficiency

Answer 33

1. 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
2. compensation eventually fails and right sided heart failure occurs

Question 34

where is the heart murmur heart in tricuspid valve insufficiency - systolic or diastolic

Answer 34

systolic

Question 35

where is the tricuspid valve heard

Answer 35

left 5th intercostal space along parasternal line