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CVPR 312 Cardiac Pathophysiology > CVPR 312 Valve Disease > Flashcards

CVPR 312 Valve Disease Flashcards

1
Q

“LUB” sound. What does this mean?

A
  • AV valve closes (beginning of systole)

- 1st heart sound

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2
Q

“DUB” sound. What does this mean?

A
  • Semilunar Valve closure (End of systole)

- 2nd heart sound

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3
Q

2/3 of patients with valve disease are?

A

Acquired stenosis

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4
Q

Rheumatic Fever - develops in _____ of all Group A, ß hemolytic streptococci infections.

A

0.3 - 3 %

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5
Q

Autoimmune disease in nature in which the heart valves are likely to be damaged.

A

Rheumatic Fever

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6
Q

In the diagnosis of Rheumatic Fever, what is the Jones criteria?

A

2 major manifestations, or

1 major & 2 minor manifestations.

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7
Q

5 major manifestations of Rheumatic Fever?

A
  1. ) Migratory Polyarthritis
  2. ) Carditis
  3. ) Subcutaneous Nodules
  4. ) Erythema Marginatum
  5. ) Sydenham’s chorea
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8
Q

Sydenham’s chorea

A

(neurologic syndrome-dancing movements of muscles)

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9
Q

Erythema Marginatum

A

reddening of the skin with center areas faded.

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10
Q

Migratory Polyarthritis

A

Migratory arthritis occurs when pain spreads from one joint to another. In this type of arthritis, the first joint may start to feel better before pain starts in a different joint.

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11
Q

The chance of relapse is much ________after initial attack; antibodies against strep & patients own tissues are just waiting to be triggered into action

A

Higher

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12
Q

Rheumatic Fever mortality rate ?

A

1%

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13
Q

Acute Pericarditis

A

seepage of serum and fibrin into pericardial cavity

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14
Q

Acute Myocarditis

A

Ashcoff Bodies

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15
Q

Endocarditis

A

acute valve damage
- Edema of valve leaflet
- Fibrin/platelet deposition along edge of
valve

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16
Q

Ashcoff Bodies

A

nodules found in the hearts of individuals with rheumatic fever. They result from inflammation in the heart muscle and are characteristic of rheumatic heart disease.

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17
Q

(Anitschkow cells)

A

large macrophages

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18
Q

Rheumatic Heart Disease (RHD)

A

RHD is a complication of recurrent attacks of RF.

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19
Q

A single episode of RF usually leaves what behind?

A

little residual deformity

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20
Q

From Inflammatory Stage to

Healing Stage, the patient may be impacted by the following:

A
  • Fusion of Commisure
  • Funneling of AV valves
  • Calcification
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21
Q

What percentage of infections progress to RF ?

A

3%

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22
Q

What percentage of patients with Rheumatic Fever suffer from mitral valve involvement as well?

A

70%

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23
Q

What percentage of patients with Rheumatic Fever have combined mitral and aortic valve involvement ?

A

25 %

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24
Q

Mitral valve involvement > in ?

A

women

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25
Aortic valve involvement >
Men
26
Mitral Valve Stenosis Etiology?
- Rheumatic heart disease if Female | - Congenital
27
Time frame for developing severe Mitral valve stenosis after Acute Rheumatic Fever (ARF) ?
Minimum of 2 yrs
28
With MItral Valve Stenosis pressures elevate in the: LA, Pulmonary tree, and Right Heart which lead to ?
Pulmonary Edema & RV Hhypertrophy
29
Atrial Contraction represents what percentage of C.O?
30%
30
Mitral stenosis is the only valvular defect which does not affect what ?
LVEDP or LV muscle mass
31
During ventricular filling (diastole), LAP exceeds LVP gnerated by what?
Stenosis
32
Treatment for a patient with mitral valve stenosis who is Asymptomatic ?
Just follow that patient
33
Treatment for a patient with mitral valve stenosis who is Symptomatic ?
- Balloon Valvuloplasty - Open commissurotomy - Valve replacement Mechanical Bio-prosthetic
34
CBP concerns for a patient with Mitral Valve Stenosis?
- Hypervolemic - Bicaval cannulation - CLP required for myocardial protection - Dearing should not be excessive, the heart is normal size.
35
Chronic MR patient LA presentation ?
↑ LA pressures /slow LA adaptation = ↑ compliance ↑ PA pressure & PAWP LV Dilation - Enable ↑ SV to enable forward flow - ↑ LVEDP (mild)
36
Acute MR patient LA presentation ?
LA is non-compliant - Rapid change in LA pressure = rapid ↑ in pulmonary congestion - Pulmonary Edema present
37
Chronic MR patient LV presentation ?
LV Dilation - Enable ↑ SV to enable forward flow - ↑ LVEDP (mild)
38
Acute MR patient LV presentation ?
The LV has not had time to distend and hypertrophy which creates a decrease in forward flow. **** EMERGENT CASES ******
39
During ventricular contractions (systole), the left ventricle eject blood back into ?
LA & Aorta, thereby increasing the LAP | particularly the V wave
40
CPB considerations with patients who suffer from CHRONIC MR?
- Hypervolemic - Bicaval cannulation - Venous air is normal due to retraction. - Increased needs of Myocardial protection due to LVH, even more with co-existing CAD. - De-airing is critical
41
CPB considerations with patients who suffer from ACUTE MR?
- Hypovolemic due to resuscitation efforts. - Bicaval cannulation - Venous air is normal due to retraction. - Warm induction for myocardial protection. - De-airing is critical
42
Mitral valve prolapse AKA
Floppy valve syndrome. It allows backflow of blood into the LA causing progressive enlargement.
43
3 - 5% of the population with 97% being asymptomatic describes what disease ?
Mitral valve prolapse
44
Mitral valve prolapse presents in pts between 20 - 40 y/o. It is most common in ?
Women
45
Etiology of Aortic Valve Disease ?
- RHD - Congenital AV Disease - Stenotic from birth - Bicuspid Aortic Valve (Most Common in CHD) - Idiopathic Calcific Aortic Stenosis
46
During ventricular ejection, LVP exceeds AP in patients with ?
Aortic Valve Stenosis
47
Hemodynamic Changes of AS ?
- LV hypertrophy (LVH) - Elevation of LVEDP - LV dilation
48
LV dilation may occur when contractile state of myocardium becomes depressed
LVEDP continues to rise LA pressure rises PA pressure rises Eventual RV failure
49
CPB concerns with patients who have Aortic Valve Stenosis ?
- Hypovolemic with ↑SVR - Single 2-Stage cannulation - Venting though the Right Superior Pulmonary Vein - Higher Cardioplegia requirements
50
Degenerative valvular changes with ________ (repeated mechanical stress) and/or atherosclerosis
age
51
Calcific Aortic Stenosis Common with
congenitally unicuspid (rare) or bicuspid valves (1%)
52
Calcific Aortic Stenosis is frequently ?
Asymptomatic
53
Aortic Valve Stenosis causes increased pressures across the valve and an increase in?
proximal chamber
54
Etiology of Aortic Valve Regurgitation ?
``` Rheumatic Heart Disease Infective Endocarditis Trauma Tear of the ascending aorta Bicuspid valve Aortic Root Disease ```
55
Aortic Root Disease can be a result of the following syndromes?
Marfan’s Cystic Medial Necrosis Syphilitic aortitis HTN
56
Describe the hemodynamics during Aortic Valve Regugitation ?
``` During ventricular relaxation, blood flows backwards from the Ao into the LV. Aortic systolic pressure increases, Aortic diastolic pressure decreases, pulse pressure increases, and LAP increases. ```
57
Chronic AI patient presentation ?
- Gradual LV volume overload - Gradual increase in LVEDP - LV stroke volume increases by compensatory dilation - LVH
58
Acute AI patient presentation ?
- Sudden LV volume overload - Rapid increase in LVEDP - May exceed LA pressures and cause MV pre-closure
59
CPB concerns with patients who have Chronic AI ?
- Hypervolemic - Single 2-Stage Venous - CPB initiation slowly t prevent distention - Increased need for CLP due to LVH (Antegrade CLP may be ineffective) (Ostial Delivery maybe required.) - De-airing is critical
60
Effective C.O. =
Q - LV vent Q
61
Types of Valvular Replacement ?
- Biological Prosthetic | - Artificial Prosthetic
62
4 Complications of Valvular Replacement
- Mechanical Deterioration - Infective endocarditis - Paravalvular leak - Clot Formation

CVPR 312 Cardiac Pathophysiology (15 decks)

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