Exam 1 - Cardio Flashcards
1
Q
What two things make up the Endocardium?
A
Lining of chambers and valves
2
Q
What are the two types of valve dysfunction?
A
Stenosis (blood not getting through), Insufficiency (blood regurgitation back)
3
Q
Which side of the heart are valve disorders more common?
A
Left side of heart
4
Q
If a valve is dysfunctional do other organs try to compensate?
A
Yes. The heart and kidneys (among others) try to compensate for valve dysfunction.
5
Q
Which two valves are effected by stenotic conditions/pathologies?
A
Aortic Valve (left semilunar valve), Mitral Valve (left AV valve)
6
Q
What are three major causes of Valve Stenosis?
A
Congenital (abnormally bicuspid instead of tricuspid), Degeneration (common in older populations), Inflammatory (2º rheumatic heart disease)
7
Q
What two diseases can result in inflammation of heart valves causing Stenotic Valves?
A
Rheumatic fever=post-infectious systemic inflammatory disease/response due to streptococci bacteria, effects joints, skin, CNS, and heart
Rheumatic heart disease=the inflammation associated with rheumatic fever can scar/deform the valves
8
Q
Rheumatic heart diseases can result in what sort of heart valves?
A
Stenotic heart valves
9
Q
Stenotic Valves cause what sort of sound on auscultation?
A
Murmur
10
Q
Which phase does a sound from a stenotic valve occur?
A
Systolic phase
11
Q
Where does one auscultate the aortic valve?
A
Right parasternal 2nd intercostal space
12
Q
What happens to CO and SV volumes from Stenotic Valves?
A
Reduced CO and SV from LV into Aorta
13
Q
How does the heart compensate for decreased flow from Stenotic Aortic Valve?
A
Increased LV contractility in attempt to increase SV and maintain CO
14
Q
What is “Exertional Insufficiency” in Stenotic Aortic Valve disease?
A
When SV and CO are insufficient during exertion but “sufficient” at rest
15
Q
In a Stenotic Aortic Valve what volume changes are present in the LV?
A
Increased volume in end of systole
16
Q
At end of Systole what is the difference in volume in LV from normal in Stenotic Aortic Valve?
A
Increased volume in LV
17
Q
What happens to Systolic BP in Stenotic Aortic Valve?
A
Decreased Systolic BP
18
Q
How does the body compensate for decreased Systolic BP in Stenotic Aortic Valve disease?
A
Body will increase systemic vascular resistance to try to compensate for decrease in CO
19
Q
What happens to LV systolic pressure in Stenotic Aortic Valve disease?
A
Increased systolic pressure in LV due to incomplete emptying of ventricle
20
Q
In Stenotic Aortic Valve what causes increased systolic pressure in LV?
A
Incomplete emptying of LV
21
Q
What happens to Peak Systolic and End Systolic pressures in Stenotic Aortic Valve?
A
Increased, due to incomplete emptying
22
Q
In Stenotic Aortic Valve what happens to the peak systolic pressure gradient between LV and Aorta?
A
Increased
23
Q
What are the four types and pressures of Peak Systolic pressure gradient between LV and Aorta in Stenotic Aortic Valve?
A
Mild=less than 20mmHg
Moderate=20-39
Severe=40-59
Very severe=more than 60
24
Q
Increased LA pressure, increased pulmonary pressure, and pulmonary HTN can lead to what?
A
Pulmonary Edema on left side of heart from Stenotic Aortic Valve
25
Thickening of the LV from working harder in Aortic Valve Stenosis is called
Hypertrophy
26
Hypertrophy of LV in Stenotic Aortic Valve causes wall of LV to be ____ and ____
Thicker and non-complaint
27
LV Hypertrophy causing thicker, non-complaint LV wall will increase ____ pressure
Preload
28
LV Hypertrophy resulting in thick and non-compliant wall can result in coronary circulation _____
Insufficiency/Ischemia
29
LV Hypertrophy resulting in thick and non-compliant wall can result in ____ to heart electrical flow
Ventricular Dysrhythmias
30
If mitral valve is healthy what will it help do in left sided congestive pattern?
Help protect against
31
What is the most common etiology of Mitral/left AV valve Stenosis?
Rheumatic heart disease. Degenerative not as common.
32
Which gender develops Mitral/Left AV Valve Stenosis more often?
Female
33
When is the murmur heard with Mitral/Left AV Valve Stenosis?
Diastole
34
What causes the diastolic murmur in Mitral/Left AV Valve Stenosis?
Narrowed AV valve during LV filling
35
Where is the Mitral/Left AV Valve auscultated?
Left 5th intercostal space, along midclavicular line
36
What part of the diastolic phase is Mitral/Left AV Valve Stenosis auscultated?
Mid-to-late diastolic phase
37
What is the primary change in atrial output in Mitral/Left AV Valve Stenosis?
Less atrial output
38
How does the LA try to compensate for Mitral/Left AV Valve Stenosis?
Increased atrial contractility to try to increase output
39
If Mitral/Left AV Valve Stenosis progresses to a severe state how is the SV and CO into the aorta affected?
Reduced SV and CO output
40
How might the LV compensate for severe Mitral/Left AV Valve Stenosis to maintain CO?
Increasing SV output
41
What happens to the end diastolic volume in Mitral/Left AV Valve Stenosis in the LV?
Decreased diastolic volume in LV
42
What happens to the left atrial filling volume in Mitral/Left AV Valve Stenosis?
Increased filling volume
43
What happens to the LA pressure in Mitral/Left AV Valve Stenosis?
Increased LA pressure
44
Increased LA pressure in Mitral/Left AV Valve Stenosis can lead to what type of edema?
Pulmonary edema
45
Increased LA pressure in Mitral/Left AV Valve Stenosis causes what pressure change pulmonary vessels?
Increased pulmonary pressures, leading to pulmonary hypertension and pulmonary edema
46
Pulmonary Hypertension from Mitral/Left AV Valve Stenosis can lead to what type of edema?
Pulmonary Edema
47
What can Mitral/Left AV Valve Stenosis progress to on the right side of the heart?
Right side congestive changes
48
What does severely progressed Mitral/Left AV Valve Stenosis do to SV and CO?
Reduce SV and CO, causing decreased systemic BP
49
Reduced SV and CO from Mitral/Left AV Valve Stenosis will do what to systemic BP?
Decrease systemic BP
50
What is the attempted compensation for severely progressed Mitral/Left AV Valve Stenosis resulting in decreased systemic BP?
Body increasing systemic vascular resistance to "offset" drop in CO
51
What structural changes can occur in the LA in Mitral/Left AV Valve Stenosis?
LA wall dilation/hypertrophy
52
What can happen to the electrical rhythm of the LA in Mitral/Left AV Valve Stenosis?
Atrial Dysrhythmias
53
Dyspnea in Mitral/Left AV Valve Stenosis is due to what?
Pulmonary HTN/congestion (Pulmonary Edema)
54
What effect can Mitral/Left AV Valve Stenosis have on position and breathing?
Orthopnea (difficult to breathe laying down, easier when sitting up). (Also nocturnal dyspnea.)
55
What is a Regurgitation/Insufficient condition mean?
Blood is flowing back from the chamber it came from through a valve that is not completely closing.
56
What are the two valves that a Regurgitation/Insufficient condition can exist in?
Aortic Semilunar Valve, Mitral/Left AV Valve
57
What are two possible broad causes of Aortic Valve Insufficiency/Incompetence?
Congenital, secondary to disease
58
What three types of diseases can cause Aortic Valve Insufficiency/Incompetence?
Rheumatic heart disease, CAD, bacterial endocarditis
59
When is a murmur heard in Aortic Valve Insufficiency/Incompetence?
Diastolic phase
60
Where do you auscultate for Aortic Valve Insufficiency/Incompetence?
2nd intercostal space, right parasternal side
61
What is the primary change in the aorta of SV and CO with Aortic Valve Insufficiency/Incompetence?
Decreased SV and CO.
62
What happens to some of the blood volume in aorta in Aortic Valve Insufficiency/Incompetence?
Backflows into LV
63
How does the LV compensate in Aortic Valve Insufficiency/Incompetence?
Increased LV contraction to try to compensate for "back flow loss"
64
When the LV increased contractibility in Aortic Valve Insufficiency/Incompetence what is the net result of the SV and backflow to LV?
Increased SV into aorta but some SV returning to LV
65
What is the diastolic volume result in LV due to Aortic Valve Insufficiency/Incompetence?
Increased end diastolic volume in LV
66
What are the pressure changes in systolic, diastolic, and pulse pressure seen in Aortic Valve Insufficiency/Incompetence?
Systolic up, Diastolic down, increased pulse pressure "widens"
67
What is the cause of increased Systolic BP in Aortic Valve Insufficiency/Incompetence?
Increased SV
68
What is the cause of decreased Diastolic BP in Aortic Valve Insufficiency/Incompetence?
Back flow of blood into LV
69
What happens with the end diastolic pressure of the LV in Aortic Valve Insufficiency/Incompetence?
Increased LV end diastolic pressure
70
What can Aortic Valve Insufficiency/Incompetence progress to?
Left sided congestion pattern
71
What sort of edema is seen in Aortic Valve Insufficiency/Incompetence?
Pulmonary Edema, from pulmonary HTN
72
What are the LV structural changes in Aortic Valve Insufficiency/Incompetence?
Dilation/hypertrophy of LV
73
What causes LV dilation (not hypertrophy) in Aortic Valve Insufficiency/Incompetence?
To compensation/main SV and CO volumes the LV dilates
74
What can LV dilation cause damage to in Aortic Valve Insufficiency/Incompetence?
Further valve damage making the problem even worse
75
What causes LV hypertrophy (not dilation) in Aortic Valve Insufficiency/Incompetence?
Increased workload and larger SV/CO
76
What electrical problems can be seen with Aortic Valve Insufficiency/Incompetence?
Ventricular dysrhythmias
77
What sort of pulse changes/feeling are found in Aortic Valve Insufficiency/Incompetence?
Bounding Peripheral Pulses, due to increased pulse pressure
78
In what condition is Bounding Peripheral Pulses found in?
Aortic Valve Insufficiency/Incompetence
79
What are the etiologies of Mitral (Left AV Valve) Insufficiency/Incompetence?
Rheumatic heart disease, endocarditis, Mitral Valve prolapse progressing into regurgitation, CAD, congestive cardiomyopathy, systemic CT disorders
80
Mitral Valve Prolapse progressing into mitral valve regurgitation is caused by...
Mitral (Left AV Valve) Insufficiency/Incompetence
81
What phase is a murmur heard in Mitral (Left AV Valve) Insufficiency/Incompetence?
Through Systolic phase
82
Where do you auscultate for Mitral (Left AV Valve) Insufficiency/Incompetence?
5th intercostal space along midclavicular line
83
What is primary change of SV and CO into aorta in Mitral (Left AV Valve) Insufficiency/Incompetence?
Decreased SV and decreased CO
84
What causes decreased SV and CO into aorta in Mitral (Left AV Valve) Insufficiency/Incompetence?
Due to backflow of blood from LV into LA during ventricular contraction
85
What is the heart's compensation for decreased SV and decreased CO into aorta in Mitral (Left AV Valve) Insufficiency/Incompetence?
Increased LV contractility in attempt to increased SV and CO
86
What happens to end diastolic volume of LA in Mitral (Left AV Valve) Insufficiency/Incompetence?
Increased end diastolic volume in LA
87
How does an increased end diastolic volume in the LA cause the LA to compensate in Mitral (Left AV Valve) Insufficiency/Incompetence?
Increased LA "kick" to increase blood flow to LV, which increases LV end diastolic volume
88
What is the change in systemic BP seen in Mitral (Left AV Valve) Insufficiency/Incompetence?
Decreased systemic blood pressure
89
How does the body compensate for decreased systemic BP in Mitral (Left AV Valve) Insufficiency/Incompetence?
Increased systemic vascular resistance to off set decreased CO
90
What is the change in left atrial filling pressure found in Mitral (Left AV Valve) Insufficiency/Incompetence?
Increased LA filling pressure
91
What is the change in end diastolic pressure of LV in Mitral (Left AV Valve) Insufficiency/Incompetence?
Increased end diastolic pressure in LV
92
What can Mitral (Left AV Valve) Insufficiency/Incompetence progress to?
Progress to left side congestive pattern
93
What is Left Atrium hypertrophy/dilation due to in Mitral (Left AV Valve) Insufficiency/Incompetence?
Due to increased end diastolic volumes in LA
94
What is the vicious cycle that can happen in Mitral (Left AV Valve) Insufficiency/Incompetence ?
Dilation of LA can enlarge valve opening even more
95
What is the most common valve disorder in the US?
Mitral Valve Prolapse Syndrome
96
What happens to the mitral valves during systole in Mitral Valve Prolapse Syndrome?
Enlarged valves prolapse back into LA during systole
97
What causes enlargement of the mitral valves in Mitral Valve Prolapse Syndrome?
Degeneration of the leaflets or accumulation of abnormal connective tissue
98
What happens to the valve leaflets in Mitral Valve Prolapse Syndrome?
Billow back into LA
99
What happens to the Chordae Tendinae as cusps billow into LA in Mitral Valve Prolapse Syndrome?
Become stretched/elongated
100
What beings when mitral cusps cannot fully close in Mitral Valve Prolapse Syndrome?
Mitral Valve regurgitation develops
101
Is Mitral Valve Prolapse Syndrome always sympatomatic?
No. Large continuum of symptoms
102
What two things might a routine exam reveal about heart sounds?
Mid-systolic click or systolic murmur
103
What is the prognosis for Mitral Valve Prolapse Syndrome in most cases?
Good outcome and good prognosis
104
What are some severe outcomes in Mitral Valve Prolapse Syndrome?
Rupture of chordae tendinae, emboli formation, ventricular failure, infective endocarditis, stroke, death
105
What are the two broad causes of Tricuspid (right AV valve) insufficiency/incompetence?
Congenital (enlarged RV), Secondary result of Pulmonary HTN pathologies
106
What phase is a murmur heard in Tricuspid (right AV valve) insufficiency/incompetence?
Systolic
107
Where do you auscultate to hear the systolic murmur in Tricuspid (right AV valve) insufficiency/incompetence?
Left 5th intercostal space, along para-sternal line
108
When/how long is the murmur heard in Tricuspid (right AV valve) insufficiency/incompetence?
Throughout the systolic phase
109
What are the primary changes in cardiac output in Tricuspid (right AV valve) insufficiency/incompetence?
Decreased SV and decreased CO into Pulmonary Trunk
110
What causes the decreased SV and decreased CO into the Pulmonary Trunk in Tricuspid (right AV valve) insufficiency/incompetence?
Due to backflow of blood into into RA during ventricular contraction
111
What is the attempted compensation of the heart in Tricuspid (right AV valve) insufficiency/incompetence?
Increased RV contractility to try to increased SV and CO
112
What happens to the end diastolic volume of the RA in Tricuspid (right AV valve) insufficiency/incompetence?
Increased end diastolic volume in RA
113
What does the increased diastolic volume in the RA cause the atrial kick to do in Tricuspid (right AV valve) insufficiency/incompetence?
Increased atrial kick in attempt to force more blood into RV
114
What happens to end diastolic pressure of RA in Tricuspid (right AV valve) insufficiency/incompetence?
Increased end diastolic pressure of RA
115
What can Tricuspid (right AV valve) insufficiency/incompetence progress into?
Right sided congestive pattern
116
Tricuspid (right AV valve) insufficiency/incompetence can cause a right sided congestive pattern. What happens to the CVP, RA pressure, and venous pressure?
All increase
117
What happens to RA structure in Tricuspid (right AV valve) insufficiency/incompetence?
RA dilation/hypertrophy
118
What happens to venous pressure in Tricuspid (right AV valve) insufficiency/incompetence?
Increases. Results in jugular vein distention and lower extremity/generalized edema.
119
Distended jugular veins and lower/generalized edema is found in which condition?
Tricuspid (right AV valve) insufficiency/incompetence
120
Which condition causes increased venous pressure?
Tricuspid (right AV valve) insufficiency/incompetence
121
Widened pulse pressure ("bounding pulse") most consistent with which valve disorder?
Aortic Regurgitation
122
Narrowed pulse pressure ("Weaker pulse") most consistent with which three valve disorders?
Sortic Stenosis, Mitral Valve Stenosis, and Mitral Valve Regurgitation
123
Increased CVP and venous distention is most consistent with which valve disorder?
Tricuspid/Right AV Valve Regurgitation
