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NU 735 Fall Clinical > Heart Valves > Flashcards

Heart Valves Flashcards

1
Q

Stenosis VS regurgitaion

A

If the valve does not open during systole, murmur is related to stenosis: pulmonic or aortic valve.

regurgitation valve should close during systole: mitral or tricuspid

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2
Q

Systole:

Diastole:

A

Systole: pulmonic and aortic valves open, and the mitral and tricuspid close

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3
Q

Valvular Flow

A

Mitral goes to aortic ( left side oxygenated)
Tricuspid goes to Pulmonary ( right unoxygenated )

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4
Q

Valvular stenosis

A

Narrowing of valve HF occurs

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5
Q

Valvular Regergitation

A

Incomplete closure of valve from scarring
cause blood to pump twice
dilates and hypertrophy
HF

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6
Q
A
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7
Q

Casuse of Stenosis

A

Congential
Rheumatic
Senile

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8
Q

causes of Regergitaion

A

Rhematic - acute or chronic
Infective- endo, dilated, cardiomyopathy
traumatic - valve rupture, papillar muscle
senile
congenital

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9
Q

8 types of valve disorders

A
  1. mitral stenosis .
  2. mitral regergitaion
  3. Aortic stenosis
  4. Aortic Regurgitation
  5. tricuspid stenosis
  6. tricuspid regurgitation
  7. Pulmonary stenosis
  8. Pulmonary reurgitation
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10
Q

mitral stenosis

A

usually from rheumatic HD
geriatric and HD patients
congenital
**hallmark elevated AV gradient
severe- you will see inc in PVR and PAP at rest and rising during exercise , inc RV pressure cause pulm HTN

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11
Q

mitral stenosis
complications

A
  1. afib
  2. EF worsens
  3. inc RV hypertrophy
  4. emboli risk
    Symptoms:
    cough, SOB , orthopnea, pulm HTN
    RHF, edema , fatigue, AF, diastolic murmur
    CXR: straight L cardiac silloette
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12
Q

Mitral stenosis management

A
  1. diauretic
  2. anticouagulation : DOAC not approved need coumadin
    INR: 2.5-3.5 ****
    mitral valve replacement needs lifelong anticoags
  3. low NA
  4. GAS prophylaxis
  5. ventricular rate control : BB calcium channel blocker , dig with afib
  6. pulmonary complications complicate this dx ; manage the infection
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13
Q

Mitral Regergition

A

back flow of blood
Pulm congestion
L atrial dilation
dec blood into LV
dec CO
inc LA pressure
inc LA hypertrophy
inc in PA pressure
Inc in RV pressure

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14
Q

mitral regurgitation
signs and symptoms

A

most predominate
fatigue and orthopnea
narrow pulse pressure
holosystolic murmur with split s2 and s3

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15
Q

mitral regurg management

A

NSR avoid isometric exercise
Digoxin
vasodilators
treat underling HF
BIV pacer
anticouaglation
surg repair
beta block , ace and diuretic with severe heart condition could backfire with ICM*

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16
Q

Mitral Valve Prolapse

A

Floppy valve
the primary cause is MR
more common women 15-30
benign
men > 50 more severe (surgery her)
congenital; Marfan syndrome
elhlers-donlos, osteogenesis imprefecta

mid to late systolic click
inverted T wave 2,3 and AVF

17
Q

mitral valve prolaplse
treatment

A

beta p blockers
anticoagulation
surgical: mitral clip, MV repair over replacement

18
Q

Aortic Stenosis

A

most common valvular HD
Congenital:
radiation
rheumatic fever
Risk:
LDL, DM, smoking, CKD, metabolic syndrome

19
Q

Aortic Stenosis

A

Stiffening
LV hypertrophy
compression of coronary arteries
decrease 02
chest pain
low cardiac output

20
Q

aortic stenosis signs and symptoms

A

cardinal symptoms
exertional dyspnea
angina
syncope

*mid systolic murmur
a slow rise in apical pulse
narrow pulse pressure

Pulsus parus et tardus; carotid pulse rises slowly to delay peak aculstate s2 while palpate is latent ( severe as)

*****AS murmer= mid systolic murmer after s1 increawse in intensity peak during ejection **

21
Q

aortic stenosis management

A
  1. no strenuous exercise
  2. avoid dehydration
  3. Beta-blocker
  4. nitrates
  5. statin
  6. eval 1-2 yr echo
  7. coag and platelets
    no NOAC, only coumadin
    INR** 2.0-3.0
    2.5 target
    3.0 older generation mechanical valves (mitral)
22
Q

Anti-coaug and platelets therapy for AS

A

Afib= coumadin 2.0-3.0
target 2.5
bioprosthetic coumadin 3-6 months and Asa
no risk factor then asa
TAVAR = 6 months of Plavix and lifelong asa
Surgical= > 65 bioprestetics

23
Q

aortic regurgitation

A

failure of the valve to close causes backflow of blood into to L ventricle
1. LV hypertrophy
2. pulm edema
3. treat underlying cause
ECHO
AVR
vasoactive agents

24
Q
A
25
Q

tricuspid stenosis

A

RARE
1. native valve
2. rheumatic HD
3. tricuspid repair
most common in the USA
4. carcinoid tumors

26
Q

Tricuspid stenosis signs and symptoms

A
  1. pulmonary congestion
  2. fatigue
  3. hepatomegaly
  4. very little SOB compared to edema
  5. diastolic murmur lower L sternal border
27
Q

Tricuspid findings

A

RA enlargement
CXR
Domes in diastole

28
Q

Tricuspid stenosis management

A

decrease edema
bowel edema; bumex or toresmide
liver enlargement
alderstone inhibitor

29
Q

Tricuspid regergitaion

A

Primary:
1. RF
2. prolapse
3. endo fibrosis
4. radiation

Secondary:
1. MI
2. trauma
3. HF
4. MV regurg
5. pacemaker wires
80% of patients have secondary reasons

30
Q

Tricuspid regurgitation findings

A
  1. hepatomegaly
  2. acities
  3. Plural Effusion
  4. increase RA pressure
    ***holosystolic murmur in left sternal border
31
Q

pulmonary stenosis

A

congenital
carcinoid
tumor
endocarditis
mild to moderate asymptomatic
severe: syncope, chest pain, dyspnea
**mid systolic murmur **

32
Q

pulmonary stenosis findings

A

R axis deviation
** Assess AV gradient( pressure on each side of the valve) and LV function
> 60 valvotomy for asymptomatic
> 50 with symptoms

33
Q

pulmonary stenosis management

A

diauretics
perc ballon valuvolplasty

34
Q

pulmonary regurgitation

A

two categories high and low :
high pressure cause:
pulmonary HTN
low-pressure cause ;
dilated pulm annulus
congenital
plaque
valve replacement

35
Q

pulmonary regurgitaion signs and symptoms

A

** hallmark finding**
high pitch decrescendo diastolic murmur
1. pulm HTN
2. fatigue
3. abd fullness
4. bloating
5. LE edema

36
Q

pulm regurgitaion management

A

no specific therapy
treat pulm HTN
vasodilator therapy
diuretics
Low PVR- repairs of carcinoid tetralogy of Fallot
high- PVP replace with bioproprestitic
** flow lan, viagra, nitrox oxide**
for pulm htn

37
Q
A

NU 735 Fall Clinical (40 decks)

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