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CVPR > CVPR Week 3: Pathophysiology of valvular heart disease > Flashcards

CVPR Week 3: Pathophysiology of valvular heart disease Flashcards

1
Q

Objectives

A
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2
Q

Normal aortic valve: # of cusps

A

3 cusps

right, left and non-coronary

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3
Q

Normal aortic valve: Thickness

A

0.5 - 2mm

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4
Q

Normal aortic valve: Length

A

1.5 - 2 cm

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5
Q

Normal aortic valve: Area

A

3 - 5 cm2

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6
Q

Normal aortic valve: Annulus

A

1.8 - 2.7 cm

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7
Q

Normal aortic valve: Aortic root

A

~ 3.5 cm

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8
Q

Normal aortic valve: Trivial regurgitation

A

0 - 2 %

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9
Q

Normal aortic valve

A
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10
Q

Aortic Stenosis: Valve area

A

when the aortic valve area is 1 cm2 or less

this is severe aortic stenosis

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11
Q

Normal aortic valve: Echocardiograph

A
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12
Q

Normal Mitral Valve: leaflets

A

2 leaflets

Anterior and posterior leaflets

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13
Q

Normal Mitral Valve: leaflet structure

A

Each leaflet is divided into 3 scallops: AL, Mid and PM

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14
Q

Normal Mitral Valve: Leaflets thickness

A

0.7 - 3 mm

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15
Q

Normal Mitral Valve: D shape

A

AntPost < MedLat diameter

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16
Q

Normal Mitral Valve: ​valve area

A

4 - 6 cm2

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17
Q

Normal Mitral Valve: annulus

A

fibromuscular annulus

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18
Q

Normal Mitral Valve: what structures are involved in the action of the valve?

3 listed

A
  • Chordae Tendinae
  • AL and PM Papillary muscles
  • LV walls
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19
Q

Normal Mitral Valve: etiology from dysfunction in what structures?

3 listed

A

Pathology in

  • chordae tendinae
  • AL and PM papillary muscles
  • LV walls

can lead to mitral valve dysfunction

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20
Q

Normal Mitral Valve: Trivial to mild Regurgitation

A

30 - 45 %

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21
Q

Normal Mitral Valve

A
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22
Q

Normal Mitral Valve: Echo

A
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23
Q

Identify

A
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24
Q

Identify phases

A
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25
Q

Identify

A
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26
Q

Types of valvular heart disease

4 listed

A
  • Aortic stenosis
  • Aortic regurgitation
  • Mitral regurgitation
  • Mitral stenosis
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27
Q

Aortic stenosis brief description

A

narrowing of the aortic valve area causing obstruction to LV ejection

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28
Q

Mitral stenosis brief description

A

narrowing of Mitral valve area causing obstruction to LV filling

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29
Q

Aortic regurgitation brief description

A

Backflow from the aorta to the LV

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30
Q

Mitral regurgitation brief description

A

Backflow from the LV to the LA

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31
Q

Aortic stenosis common etiology

A
  • younger than 70 50% congenital bicuspid valve
  • Older than 70 48% degenerative
  • post inflammatory or rheumatic
  • radiation therapy to the chest
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32
Q

Bicuspid aortic valve description

A

A bicuspid aortic valve (BAV) is an aortic valve that only has two leaflets, instead of three. The aortic valve regulates blood flow from the heart into the aorta. The aorta is the major blood vessel that brings oxygen-rich blood to the body.

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33
Q

Pathology of aortic stenosis

A
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34
Q

Aortic Stenosis: Echo

A
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35
Q

Aortic Stenosis: Hemodynamic consequences

6 listed

A
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36
Q

Identify hemodynamic changes in aortic stenosis

A
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37
Q

Pathophysiology of aortic stenosis

A
  • the LV systolic pressure increases to open the aortic valve
  • LV hypertrophy occurs from chronic increased LV pressure
  • LV compliance decreases and so LA pressure and end diastolic pressure increases
  • aortic pressure is decreased from a reduced stroke volume
  • reduced coronary perfusion during diastole
  • so increased oxygen demand and reduced perfusion/supply

also

*

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38
Q

Coronary blood flow in Aortic stenosis

A
  • reduced end-diastolic volume
  • ventricular is less compliant
  • ventricle end-diastolic pressure is increased
  • aortic diastolic pressure is decreased so the epicardial pressure gradient is decreased and therefore the coronary blood flow is decreased and eventually leads to myocardial ischemia
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39
Q

the thicker the heart muscle is…

A

, the less compliant it becomes

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40
Q

Pressure-volume loop of compensated aortic stenosis

6 listed

A
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41
Q

End-systolic pressure curve in compensated aortic stenosis

A

shifted to left

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42
Q

Pressure-volume loop of decompensated aortic stenosis

6 listed

A

now the ventricle doesnt eject normally and so the LVES volume is increased because LV contractility has decreased as a result of myocardial ischemia from chronic pressure overload and LV systolic dysfunction

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43
Q

difference between compensated and decompensated aortic stenosis

A
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44
Q

Symptoms of aortic stenosis

45
Q

Characteristic symptoms of aortic stenosis

A
  • Angina
  • Syncope (exercise related too!) (exercise related syncope)
  • Heart failure
46
Q

Aortic stenosis murmur

A

the later the intensity murmur peaks the worse it is

47
Q

auscultation of aortic stenosis

48
Q

Aortic stenosis best heard

A

right sternal border 2nd intercostal with the diaphragm

49
Q

Aortic stenosis severity sound

A

the later the murmur peaks the more severe the stenosis

50
Q

Treatment of aortic stenosis

A

TAVR is evolving

51
Q

Aortic regurgitation mechanisms

4 listed

A
  • Primary disease of the leaflets
  • Aortic root diseases
  • Acute processes
  • Chronic processes
52
Q

Aortic regurgitation mechanisms: Primary disease of leaflets causes

3 listed

A
  • Aging
  • Infection
  • Inflammation
53
Q

Aortic regurgitation mechanisms: Aortic root diseases

3 listed

A
  • Dilation
  • Aneurysm
  • Dissection
54
Q

Aortic regurgitation mechanisms: Acute processes causes

3 listed

A
  • Infective endocarditis
  • Dissection of the aorta
  • Traumatic injury
55
Q

Aortic regurgitation mechanisms: Chronic processes causes

5 listed

A
  • Bicuspid aortic valve
  • aortic root dilation
  • Previous endocarditis
  • Rheumatic disease
  • Connective tissue diseases
56
Q

Aortic regurgitation echo: holes in the leaflets on this echo

A

quadricuspid valve on this

57
Q

Endocarditis

A

Endocarditis is an infection of the endocardium, which is the inner lining of your heart chambers and heart valves.Endocarditis generally occurs when bacteria, fungi or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart.

58
Q

Marfans aortic regurgitation

59
Q

Hemodynamics of chronic aortic regurgitation

6 listed

60
Q

Describe hemodynamic changes of chronic aortic regurgitation

6 listed

61
Q

Aortic regurgitation murmur

A

decrescendo diastolic murmur & an associated flow related systolic murmur

62
Q

Acute Aortic regurgitation

A
  • large regurgitant volume coming to a non-adapting, non-dilating, non-accommodating ventricle so it can only dilate minimally, get a rapid increase in end-diastolic pressure translating into high atrial pressure, high pulmonary capillary pressure and pulmonary edema which is the mean pathophysiology of acute aortic regurgitation from such a sudden onset of end-diastolic volume.
  • As the ventricle responds by increasing HR and contractility but diastolic filling period is decreased but there is a further decrease of CO and eventually leads to relative ischemia and myocardial dysfunction
  • Both combined lead to heart failure
63
Q

Hemodynamics of Acute Aortic regurgitation

64
Q

Describe the hemodynamic changes of Acute Aortic regurgitation

65
Q

Effect of Aortic regurgitation on oxygen consumption

A

so have increased demand and reduction in supply

66
Q

Describe changes of PV loop in Hemodynamics of chronic compensated Aortic regurgitation

67
Q

Describe changes of PV loop in Hemodynamics of chronic decompensated Aortic regurgitation

68
Q

Murmurs of Aortic regurgitation

69
Q

Treatment of aortic regurgitation

4 listed

A
  • medical therapy
  • Valve replacement
  • Aortic root repair with spare of native valve
  • Aortic root repair with valve replacement
70
Q

Treatment of aortic regurgitation: Medical therapy

A

Afterload reduction with CCBs (Nifedipine), ACEI (lisinopril) or ARBs (losartan)

71
Q

Treatment of aortic regurgitation: Valve replacement

2 listed

A
  • Bioprosthetic valve
  • Mechanical valve
72
Q

Treatment of aortic regurgitation: Aortic root repair

2 listed

A

Aortic root repair with spare of the native valve or with a valve replacement

73
Q

Mitral Regurgitation etiology

A
  • 60% degenerative
  • 20% Ischemic
  • 20% other including Rheumatic fever and endocarditis
74
Q

Pathology of mitral valve prolapse

75
Q

Acute mitral regurgitation by Echo

76
Q

Chronic mitral regurgitation by Echo

77
Q

Hemodynamics of mitral regurgitation

6 listed

78
Q

Describe the hemodynamic changes of mitral regurgitation

79
Q

Pathophysiology of mitral regurgitation

7 listed

80
Q

PV Loop of Acute Mitral Regurgitation

81
Q

Describe PV Loop changes of Acute Mitral Regurgitation

82
Q

PV Loop of chronic compensated Mitral Regurgitation

9 listed

83
Q

Describe PV Loop changes of chronic compensated Mitral Regurgitation

84
Q

Pathophysiology of chronic decompensated Mitral Regurgitation

8 listed

85
Q

The murmur of Mitral regurgitation

86
Q

Auscultation of Mitral Regurgitation

87
Q

Treatment of Mitral Regurgitation

3 listed

A
  • Surgical repair
  • Percutaneous Repair
  • Valve replacement
88
Q

Treatment of Mitral Regurgitation: Surgical Repair

2 listed

A
  • Quadrangular resection
  • Mitral annuloplasty
89
Q

Treatment of Mitral Regurgitation: Percutaneous repair

A

Mitral valve clip

90
Q

Treatment of Mitral Regurgitation: Valve Replacement

2 listed

A
  • Bioprosthetic valve
  • Mechanical valve
91
Q

Mitral Stenosis: Etiology

2 listed

A

>95% Rheumatic Fever

Congenital, infection, tumor, throbus or drugs <5%

92
Q

Mitral Stenosis Pathophysiology

4 listed

93
Q

Mitral Stenosis by Echo

94
Q

Hemodynamics of mitral stenosis

7 listed

95
Q

Describe Hemodynamics changes of mitral stenosis

7 listed

96
Q

Pathophysiology of Mitral stenosis

97
Q

PV Loop of mitral stenosis

4 listed

98
Q

Describe PV Loop changes of mitral stenosis

99
Q

Auscultation of Mitral stenosis

100
Q

Treatment of mitral stenosis

3 listed

A
  • Temporary Medical Rx
  • Percutaneous repair
  • Valve replacement
101
Q

Treatment of mitral stenosis: Temporary Medical Rx

2 listed

A

Atrial fibrillation/flutter

  • Warfarin
  • A-V nodal blockers
102
Q

Treatment of mitral stenosis: Percutaneous repair

A

MV balloon valvuloplasty

103
Q

Treatment of mitral stenosis: Valve replacement

2 listed

A
  • bioprosthetic valve
  • Mechanical valve
104
Q

Summary of valvular heart disease

4 listed

105
Q

Aortic stenosis summary

2 listed

A

Obstruction to LV ejection (systole)

↑ afterload = LV pressure overload

106
Q

Aortic regurgitation summary

A
  • Backflow from aorta to LV (diastole)
  • ↑ LV preload and afterload = LV volume + pressure overload
107
Q

Mitral regurgitation summary

2 listed

A
  • Backflow from LV to LA (systole)
  • ↓ LV afterload & ↑ LV + LA preload = LV + LA volume overload
108
Q

Mitral stenosis summary

2 listed

A
  • Obstruction to LV filling (diastole)
  • ↓ LV preload & ↑ LA preload & afterload = LA volume + pressure overload

CVPR (93 decks)

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