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