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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
Q

Aortic valve involvement >

26
Q

Mitral Valve Stenosis Etiology?

A
  • Rheumatic heart disease if Female

- Congenital

27
Q

Time frame for developing severe Mitral valve stenosis after Acute Rheumatic Fever (ARF) ?

A

Minimum of 2 yrs

28
Q

With MItral Valve Stenosis pressures elevate in the: LA, Pulmonary tree, and Right Heart which lead to ?

A

Pulmonary Edema & RV Hhypertrophy

29
Q

Atrial Contraction represents what percentage of C.O?

30
Q

Mitral stenosis is the only valvular defect which does not affect what ?

A

LVEDP or LV muscle mass

31
Q

During ventricular filling (diastole), LAP exceeds LVP gnerated by what?

32
Q

Treatment for a patient with mitral valve stenosis who is Asymptomatic ?

A

Just follow that patient

33
Q

Treatment for a patient with mitral valve stenosis who is Symptomatic ?

A
  • Balloon Valvuloplasty
  • Open commissurotomy
  • Valve replacement
    Mechanical
    Bio-prosthetic
34
Q

CBP concerns for a patient with Mitral Valve Stenosis?

A
  • Hypervolemic
  • Bicaval cannulation
  • CLP required for myocardial protection
  • Dearing should not be excessive,
    the heart is normal size.
35
Q

Chronic MR patient LA presentation ?

A

↑ LA pressures /slow LA adaptation = ↑ compliance
↑ PA pressure & PAWP

LV Dilation

  • Enable ↑ SV to enable forward flow
  • ↑ LVEDP (mild)
36
Q

Acute MR patient LA presentation ?

A

LA is non-compliant

  • Rapid change in LA pressure = rapid ↑ in pulmonary congestion
  • Pulmonary Edema present
37
Q

Chronic MR patient LV presentation ?

A

LV Dilation

  • Enable ↑ SV to enable forward flow
  • ↑ LVEDP (mild)
38
Q

Acute MR patient LV presentation ?

A

The LV has not had time to distend and hypertrophy which creates a decrease in forward flow.
** EMERGENT CASES ****

39
Q

During ventricular contractions (systole), the left ventricle eject blood back into ?

A

LA & Aorta, thereby increasing the LAP

particularly the V wave

40
Q

CPB considerations with patients who suffer from CHRONIC MR?

A
  • 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
Q

CPB considerations with patients who suffer from ACUTE MR?

A
  • Hypovolemic due to resuscitation efforts.
  • Bicaval cannulation
  • Venous air is normal due to retraction.
  • Warm induction for myocardial protection.
  • De-airing is critical
42
Q

Mitral valve prolapse AKA

A

Floppy valve syndrome. It allows backflow of blood into the LA causing progressive enlargement.

43
Q

3 - 5% of the population with 97% being asymptomatic describes what disease ?

A

Mitral valve prolapse

44
Q

Mitral valve prolapse presents in pts between 20 - 40 y/o. It is most common in ?

45
Q

Etiology of Aortic Valve Disease ?

A
  • RHD
  • Congenital AV Disease
  • Stenotic from birth
  • Bicuspid Aortic Valve (Most Common in CHD) - Idiopathic Calcific Aortic Stenosis
46
Q

During ventricular ejection, LVP exceeds AP in patients with ?

A

Aortic Valve Stenosis

47
Q

Hemodynamic Changes of AS ?

A
  • LV hypertrophy (LVH)
  • Elevation of LVEDP
  • LV dilation
48
Q

LV dilation may occur when contractile state of myocardium becomes depressed

A

LVEDP continues to rise
LA pressure rises
PA pressure rises
Eventual RV failure

49
Q

CPB concerns with patients who have Aortic Valve Stenosis ?

A
  • Hypovolemic with ↑SVR
  • Single 2-Stage cannulation
  • Venting though the Right Superior Pulmonary Vein
  • Higher Cardioplegia requirements
50
Q

Degenerative valvular changes with ________ (repeated mechanical stress) and/or atherosclerosis

51
Q

Calcific Aortic Stenosis Common with

A

congenitally unicuspid (rare) or bicuspid valves (1%)

52
Q

Calcific Aortic Stenosis is frequently ?

A

Asymptomatic

53
Q

Aortic Valve Stenosis causes increased pressures across the valve and an increase in?

A

proximal chamber

54
Q

Etiology of Aortic Valve Regurgitation ?

A 
Rheumatic Heart Disease
Infective Endocarditis
Trauma
Tear of the ascending aorta
Bicuspid valve
Aortic Root Disease
55
Q

Aortic Root Disease can be a result of the following syndromes?

A

Marfan’s
Cystic Medial Necrosis
Syphilitic aortitis
HTN

56
Q

Describe the hemodynamics during Aortic Valve Regugitation ?

A 
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
Q

Chronic AI patient presentation ?

A
  • Gradual LV volume overload
  • Gradual increase in LVEDP
  • LV stroke volume increases by compensatory dilation
  • LVH
58
Q

Acute AI patient presentation ?

A
  • Sudden LV volume overload
  • Rapid increase in LVEDP
  • May exceed LA pressures and cause MV pre-closure
59
Q

CPB concerns with patients who have Chronic AI ?

A
  • 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
Q

Effective C.O. =

A

Q - LV vent Q

61
Q

Types of Valvular Replacement ?

A
  • Biological Prosthetic

- Artificial Prosthetic

62
Q

4 Complications of Valvular Replacement

A
  • Mechanical Deterioration
  • Infective endocarditis
  • Paravalvular leak
  • Clot Formation

CVPR 312 Cardiac Pathophysiology (15 decks)

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