CARDIO-VALVE DZ Flashcards by JHope .

How does doppler indicate hemodynamics of heart?

RED- shorter waver, higher pitch means coming towards transducer
BLUE- lower pitch away from transducer

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What are the common congenital Aortic stenosis?

Bicuspid aortic valve. Normal valve =3, thickened
Membranous subvalvar= Peds
Fused leaflets w/doming= Peds, valves don’t separate

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What is the common blood flow through valves?

Tricuspid- 3 leaflets.
Pulmonic
Mitral- 2 leaflets
Aortic- 3 leaflets

Tissue Paper My Assests

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Which is MC types in aortic stenosis in Adults?

Acquired

Calcific-MC leaftlets thickened, INC turbulent flow

Hypertrophic subaortic- IV thick, during systole outflow constricted as MSK contracts. constriction not at valve

Rheumatic- strep GAS, Latino/Asia- immigrants mmigrants VC

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What happens pathophys when aortic valve becomes narrow?

Aortic Stenosis
INC ventricular systolic pressure- must overcome valve to maintain CO

LVH- stiffer like a MSK during exercises.

Systole decompensation- EF DEC
LOW pulse pressure- Narrowed,

Late LV failure Overtime/severe- HYPOTENSION

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Overtime what happens to diastole with LVH in AS?

Diastolic dysfunction
CV MSK thickens, requiring more work to distend
AS- rapid deteriotaion and poor prognosis

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Pt present with angina and syncope? What is on your DDX

Aortic stenosis- d/t hypertrophy, INC O2 demand

Angina- Stable, Unstable-occurs w/o damage, O2 demand not met, CP inadequate BF

CHF- HFpEF (d), HFrEF (s)

Lightheadness after exertion

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On PE you notice a soft S2, palpable murmur, and BP pulse difference <40, What do these indicated?

Aortic Stenosis

Systolic murmur- palpable thrills
Soft S2- Aortic valves not closing
Delayed arterial upstroke- systole becomes gradual vs strong in 1/3 of upstroke
Narrow pulse pressure- diastole rises bc Stroke vol dfx
Lung rales- LA pressure rises, blood pushed to lungs if LVH

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Pt has angina and syncope, with S2 diminished? What is next step?

Aortic Stenosis
Echocardiogram KEY
Signs: INC leaflet thick, cant close
INC systole velocity- CV pumping hard to get threw thickness
DEC valve surface area- LVH**
Maybe mosaic colors

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Flow rate is constant regardless of where on echo?

continuity principle
Flow in the LV outflow tract =area flow in aortic valve
If you are given LV outflow, can solve for aortic valve area

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What is Normal aortic valve area?

4 cm2 ; anything less is severe aortic stenosis

Echo provide number-NO CATH needed

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What is purpose of cardiac catheter?

Mainly for Coronaries
CAD/Unstable angina/Acute coronary syndrome/MI

Or to check if coronary are damage b4 Valve replacement w/ aortic stenosis

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What mechanical treatment for aortic stenosis restores normal hemodynamics?

Valve replacement Mechanical- needs anticoagulation d/t clot risk
Heterograft- bovine pig material
Homograft- human
TAVR-transcutaneous aortic valve, metalic stent tube keep vessel open

IF Triad of CHF, angina, Stoke Adam/syncope attacks, and systolic/EF dfx, **then VALVE replace. NOT MEDS

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What mechanical treatment ameliorates the stenosis for 6-12mo?

Balloon valvuloplasty-large ballon placed in valve

IDEAL for-calcific or rheumatic AS for tri-leaflet valves, palliative nonsurgical pts, urgent if needed prior to hip surgery, TAVR work up

Poor prognosis

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What is condition when blood is pumped 2x as great from LV, but leaks back int LV?

Aortic regurgitation

Echo Doppler- uniform color of BF

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What are result of slow LV dilation?

Acute decompensation
Pulmonary congestion
dec time for LV to elarge
Diastole pressure is HIGH

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What occurs in LV systolic failure?

Chronic decompensation

EF- ejection fraction DEC

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Pt c/c weakness, palpitations, CP, orthopnea, wide pulse pressure? What other findings on exam?

AORTIC REGURGITATION

HIGH PITCHED early **diastolic decresendo murmur -Blood falling back after systole.
HEARD at LSB and apex - Heard at Mitral and Aortic

Systolic flow murmur-Aortic, turbulent has valve closes

CHF- EF <40, CP, edema, orthopnea ascites, fatigue, SOB, weak

Palpitations TYPEs

INC SV- valve is loose, so can pump out alot, felt LLD
Atrial Fibrillation- arrhythmia, people feel irregular rapid beats

Large upstroke volume

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PT has history of Marfans in Family? What other cause of Chronic aortic regurgitation?

Hypertension

Aortic root dilatation

Arteriosclerosis-valve vessels stiffened

Aortic stenosis-

VRProsthesis: leaflet vs. perivalvular d/t difficult sewing or stent around valve

Endocarditis- infection of the aortic valve; common in IVDU
RA, SLE-rare

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Baby Joe was born with bicuspid aortic valve? What are risk of his conditions?

Aortic Regurgitation Chronic II

Other etiology
○ VSD (ventricular septal defects)
● Sinus of Valsalva aneurysm (rare)-MC graudal distended
● Aortitis
● Rheumatic Fever rare 
● Syphilis - rare

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Pt was in a car accident and hit his steering wheel. c/o fatigue, SOB, CP, and palpitation. PE- you hear a absent S1 CXR- Normal heart size? What could be a complication?

ACUTE-Aortic Regurgitation
● Aortic Dissection
● Endocarditis
● Valve prosthesis - clot formation
● Rupture of sinus of Valsalva aneurysm
● Rheumatic fever-rare

What is natural progression of Aortic REgurg?

Long period w/o symptoms
Blood falls back to LV in diastole
Gradual LVH w/ normal stroke volume via dilation
Symptoms mean rapid deterioration- LVSEF very symptomatic
ACUTE decomp- pulmonary congestion
CHRONIC decomp- LV systolic failure, EF DEC

What encourages forward ejection rather than backward flow?

Treatment of AR
Afterload reduction
None very helpful
CHF-diuretics
Antibiotics needed preop some cases, Dirty surgery

When is surgery beneficial for Aortic regurgitation?

ACUTE OR SEVERE AR EMERGENCY
Endocarditis
Chronic AR- based on: 1. SX 2. Sys dFX/EF 3. Inc LV dilation

What is sound defect in S1 at Mitral valve, which Rheumatic and fibrocalcific changes may damage this valve?

Mitral Stenosis-RARE | Mitral and Tricuspid 1st- Mitral most bc LV bigger/louder

What leads to RHF and LA enlargement?

``` MITRAL STENOSIS Blood backs up into LA due to narrow mitral valve LA pressure rises Lungs back flow/congested 2nd Pulmonary HTN ```

Pt c/c CP, edema, SOB, sx fo CHF w/ palpitations PE CV *Loud S1, narrow pulse pressure Lung- Rales What are DDX?

MITRAL STENOSIS | KEY * LOUD S1 at Mital

Pt c/c CP, edema, SOB, sx fo CHF w/ palpitations PE CV *Loud S1, narrow pulse pressure Lung- Rales What are other findings

LOUD S1 Opening snap Diastolic murmur- blood still in chamber Narrow pulse pressure Rales- Pulmonary HTN: RV lift, LOUD P2, JVPressure INC, v waves**

Pt has LOUD S1 with pulmonary rales. What is next step?

ECG Signs: LA abnormal, RVH, Atrial Fib CXR Echo w/Doppler

What are hallmarks of Mitral stenosis on CXR

Large L pushes L bronchus Large Pulmonary artery in RV Small LV

Echo shows leaflets fused tips, thick, and shorten chords. What is DX and what other findings?

``` MITRAL STENOSIS Leaflets flexible, still domes Leaflets calcified Pressure half-time in doppler Pulmonary HTN ```

?Is catherization diagnosis needed for all Mitral Stenois?

NO Gradient between LA (PA wedge) and LV in diastole ● Not needed for evaluating presence or severity ● Performed only for: ○ Preoperative exclusion of CAD if sufficient age or risk factors

What is common onset of Mitral stenosis?

``` Pt doesn't recall h/o rheumatic fever Long latency Insidious constriction of activity CP- Abrupt atrial fib ○ Hemodynamic decompensation ○ Systemic emboli ```

What is the ideal treatment for Mitral Stenosis?

Prevent recurrent rheumatic fever- PROPHAXLIS Diuretics Anticoagulatin-ASA d/t risk of A. Fib

Describe surgery measure for Mitral Stenosis

Balloon -commissurotomy if anatomy OK Surgical open heart surgery to repair mitral valve Valve replacement

What is main cause of Mitral Regurgitation?

#1MC- CAD Dz, STEM/MI 2. LV dialatin 3. Endocarditis-RF rare 4. Prolaspe 5. Connected tissue, inflam-rare 6. Congenital defects- rare

What acute soft tissue ruptures cause Mitral regurgitation?

Chordal ruptures- endocarditis, myxomatous (prolapse) Papillary rupture-MI, trauma Papillary ischemia- d/t circumflex block They shorten can close enough

What occurs when blood regurgitates into left atrium in systole?

FROM MITRAL VALVE REGURGITATION ● LV enlarges- amount of blood is 2x more- flows back into LA ● Acute decompensation: congestion:○ INC LA pressure → acute CHF ● Chronic decompensation: LV systolic failure → muscle tires out → ejection fraction drops

Pt c/c CP, weakness, SOB, w/ fever PE- edema, s/s of Left CHF. holosystolic murmur, PMI+ at apex? What is DX?

MITRAL Regurgitation edema 2/2 RHF Late systolic if starts mid systole d/t papillary damage, prolapse after click

ON ECG, Pt has L atria abnormality and LVH? What is on DDX and what other findings?

MITRAL REGURGITATION Findings: ***MC-A. fib

What are findings for MR pt on CXR?

**LA enlargement ← initial finding ○ LV enlargement ○ CHF

What is workup will ROTH spots show up? What is it indicative of?

ECHO **Roth spots** from endocarditis Other findings ■ Quant-Volume of left atrium filled ■ Quanit- Orifice area, analogous to aortic stenosis ○ Etiology- chronic fevers, weight loss, ○ LV function+

What workup can you see a Large V wave indicative of MR?

``` Cardiac catheterization- Etiology, CAD Large “V” wave ○ Angiographic presence of MR ○ LV size and contractility ○ Hemodynamic effects: output, pressures ```

What treatment can be used for MR due to endocarditis?

○ Endocarditis ABX prophylaxis, TREAT ○ Vasodilator- Afterload reduction ○ CHF TX ○ Arrhythmias TX

What is important with surgical tx of MR?

Valve repair/replace- shorten/reattach chords 1. fix B4 the ejection fraction becomes abnormal EF could gets worse post surgery d/t decompensation Cath ring-MITRAclip

What is the result of RV failure or dialation?

TRICUSPID REGURITATION

What is MCC of RV failure?

LV failure ``` Pulmonary HTN 2/2- MC 1. lung dz 2. Mitral dz 3. Eisenmenger synddrome- ESvolume overload. EX-Atrial or ventricle defect ```

What group of people are at risk of Tricuspid Regurge?

IV drug users- endocardiitis of tricuspid valve | COPD pts, RF- very rare

Pt has edema, ascites, and fatige with exercises? What is ddX

R CHF Tricuspid regurgitation NO Pulmonary congestion

What are PE finding of Tricuspid Regurgitation

Palpate Large V waves jugular veins during systole** NO murmur audible*** Fever, chills, wt loss- Endo SOB- COPD pt

What is ideal treatment of Tricsupid REgurg?

Treat Endo, LVH COPD TX Diuretics

What is most important in surgery for Tricuspid Regurg?

TX- underlying MITRAL valve condition prior-KEY Tricuspid annuloplasty ring Valve replacement