Cardiovascular Module #6 Flashcards
What are the 2 types of valvular dysfnction?
Stenotic
Insufficiency
Which side of the of heart is it more common to have valve disorders?
Left Side
What happens in stenotic conditions?
Narrowing of the orifice of the valve which restricts blood flow throught
What are the causes of aortic valve (left semilunar) sentosis?
Congenital = abnromal formation of the valve (have bicuspid valve instead of normal tricuspid valve)
Degenerative Changes
Inflammatory secondary to rheumatic heart disease
What are the primary mechanical effects on the cardiac pump?
Reduced outflow of left ventricle = incomplete empyting of L ventricle/increased end-systolic LV pressure
What are the secondary mechanical effects on the cardiac pump?
Hypertrophy of L ventricle as compensation to increased workload
What are the output changes seen in aortic valve stenosis?
↓SV/↓CO
↓systolic BP
↓pulse pressure
What are the cardiac pressure/congestion changes seen in aortic valve stenosis?
↑ left atrial pressure (↑ PCWP)
pulmonary HTN
↑ pulmonary pressures –> edema
What are the symptoms of aortic valve stenosis?
Dyspnea on exertion (DOE)
Syncope
Angina Symptoms
Can progress to heart failure
When would you hear the heart murmur w/ aortic valve stenosis?
Systolic
What is the cause of mitral (L AV valve) stenosis?
Rheumatic Heart Disease
What are the primary mechanic effects on the cardiac pump seen in mitral stenosis?
Reduced outflow of L atria = incomplete emptying of L atria/increased LA pressures
What are the secondary mechanical effects on the cadiac pump seen in mitral stenosis?
L atria dilation d/t incomplete emptying of L atria
Hypertrophy as compensation to increased workload
What are the output changes seen w/ mitral stenosis?
Potential exertional insufficiency of ↓SV/↓CO
**heart is able to compensate during rest, but you see defect during exercise when you would need to pump faster
What are the cardiac pressure/congestion changes you see w/ mitral stenosis?
↑ left atrial pressure (↑ PCWP)
pulmonary HTN
↑ pulmonary pressures –> edema, right ventricular congestion/failure
What kind of symptoms do you see w/ mitral stenosis?
Prominent pulmonary symptoms/complications d/t pulmonary HTN/edema:
Dyspnea on Exertion Orthopnea (difficult breathing laying down/easier sitting up) Nocturnal Dyspnea
Non-angina type chest discomfort (atypical chest pain)
When do you hear the heart murmur w/ mitral stenosis?
Diastolic
**narrowed AV valve during ventricular filling
Generally what is the problem in regurgitation conditions?
Insufficiency or incompetence
Inability of valve to completely close allows back-flow of blood
What are the primary mechanical effects on the cardiac pump in aortic valve insufficiency/incompetence?
During ventricular relaxation (diastole) blood from aorta “back-flows” into L ventricle –> increased end-diastolic filling volumes of L ventricle
What are the primary output changes seen in aortic valve insufficiency/incompetence?
↑ SV/CO to accommodate for “back-flow loss”
What are the primary pressure changes seen in aortic valve insufficiency/incompetence?
“spread out”↑ systolic BP
↓ diastolic BP
↑ pulse pressure
What are the secondary mechanic effects seen in aortic valve insufficiency/incompetence?
L Ventricle Dilation (to compensate/maintain SV/CO volumes)
L Ventricle Hypertrophy (to compensate for increased workload w/ larger SV/CO)
What are the secondary cardiac pressure/congestion changes?
↑ pulmonary pressure and edema
Clinically what are the symptoms seen with aortic valve insufficiency/incompetence?
Angina type discomfort
Dyspnea on Exertion
Bounding peripheral pulses (d/t pulse pressure changes)
When do you hear the murmur associated w/ aortic valve insufficiency/incompetence?
Diastolic
What are the primary mechanical effects on the cardiac pump in mitral insufficiency/incompetence?
Back flow of blood into L atria during ventricular contraction (systole)…leads to:
increased L atrial volumes/pressures
left atrial dilation/hypertrophy
viscous cycle as atrial dilation may
enlarge mitral valve even more
Eventually compensation fails to maintain CO and heart failure occurs
When do you hear the murmur in mitral valve insufficiency/incompetence?
Systolic
What is the most common valve disorder in the US?
Mitral Valve Prolapse Syndrome
What happens in mitral valve prolapse syndrome?
Enlarged cusps of mitral valve prolapse back (billow back) into L atrium during systole
May develop mitral valve regurgitation
What are the symptoms of mitral valve prolapse syndrome?
Have large continuum of presentation/prognosis –> no symptoms - symptoms (most have good prognosis w/o symptoms/complications)
Might hear mid-systolic click or systolic murmur
What causes tricuspid (R AV valve) insufficiency/incompetence?
Congenital
Secondary to pulmonary HTN pathologies
What are the mechanical effects on the cardiac pump in tricuspid insufficiency/incompetence?
Pulmonary HTN/congenital regurgitation causes back flow into R atria, leads to:
increased R atrial pressures -->
increased venous pressures
(increased CVP)
increased atrial volumes/pressures
--> R ventricular volumes/pressures
R ventricular hypertrophy/dilation to
compensate/maintain CO
What are some of the symptoms seen w/ tricuspid (R AV) insufficiency/incompetence?
Distended Jugular Veins
Lower extremity/generalized edema
When do you hear the heart murmur w/ tricuspid (R AV) insufficiency/incompetence?
Systolic
