Heart Valves Flashcards
Stenosis VS regurgitaion
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
Systole:
Diastole:
Systole: pulmonic and aortic valves open, and the mitral and tricuspid close
Valvular Flow
Mitral goes to aortic ( left side oxygenated)
Tricuspid goes to Pulmonary ( right unoxygenated )
Valvular stenosis
Narrowing of valve HF occurs
Valvular Regergitation
Incomplete closure of valve from scarring
cause blood to pump twice
dilates and hypertrophy
HF
Casuse of Stenosis
Congential
Rheumatic
Senile
causes of Regergitaion
Rhematic - acute or chronic
Infective- endo, dilated, cardiomyopathy
traumatic - valve rupture, papillar muscle
senile
congenital
8 types of valve disorders
- mitral stenosis .
- mitral regergitaion
- Aortic stenosis
- Aortic Regurgitation
- tricuspid stenosis
- tricuspid regurgitation
- Pulmonary stenosis
- Pulmonary reurgitation
mitral stenosis
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
mitral stenosis
complications
- afib
- EF worsens
- inc RV hypertrophy
- emboli risk
Symptoms:
cough, SOB , orthopnea, pulm HTN
RHF, edema , fatigue, AF, diastolic murmur
CXR: straight L cardiac silloette
Mitral stenosis management
- diauretic
- anticouagulation : DOAC not approved need coumadin
INR: 2.5-3.5 ****
mitral valve replacement needs lifelong anticoags - low NA
- GAS prophylaxis
- ventricular rate control : BB calcium channel blocker , dig with afib
- pulmonary complications complicate this dx ; manage the infection
Mitral Regergition
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
mitral regurgitation
signs and symptoms
most predominate
fatigue and orthopnea
narrow pulse pressure
holosystolic murmur with split s2 and s3
mitral regurg management
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*
Mitral Valve Prolapse
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
mitral valve prolaplse
treatment
beta p blockers
anticoagulation
surgical: mitral clip, MV repair over replacement
Aortic Stenosis
most common valvular HD
Congenital:
radiation
rheumatic fever
Risk:
LDL, DM, smoking, CKD, metabolic syndrome
Aortic Stenosis
Stiffening
LV hypertrophy
compression of coronary arteries
decrease 02
chest pain
low cardiac output
aortic stenosis signs and symptoms
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 **
aortic stenosis management
- no strenuous exercise
- avoid dehydration
- Beta-blocker
- nitrates
- statin
- eval 1-2 yr echo
- coag and platelets
no NOAC, only coumadin
INR** 2.0-3.0
2.5 target
3.0 older generation mechanical valves (mitral)
Anti-coaug and platelets therapy for AS
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
aortic regurgitation
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
tricuspid stenosis
RARE
1. native valve
2. rheumatic HD
3. tricuspid repair
most common in the USA
4. carcinoid tumors
Tricuspid stenosis signs and symptoms
- pulmonary congestion
- fatigue
- hepatomegaly
- very little SOB compared to edema
- diastolic murmur lower L sternal border
Tricuspid findings
RA enlargement
CXR
Domes in diastole
Tricuspid stenosis management
decrease edema
bowel edema; bumex or toresmide
liver enlargement
alderstone inhibitor
Tricuspid regergitaion
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
Tricuspid regurgitation findings
- hepatomegaly
- acities
- Plural Effusion
- increase RA pressure
***holosystolic murmur in left sternal border
pulmonary stenosis
congenital
carcinoid
tumor
endocarditis
mild to moderate asymptomatic
severe: syncope, chest pain, dyspnea
**mid systolic murmur **
pulmonary stenosis findings
R axis deviation
** Assess AV gradient( pressure on each side of the valve) and LV function
> 60 valvotomy for asymptomatic
> 50 with symptoms
pulmonary stenosis management
diauretics
perc ballon valuvolplasty
pulmonary regurgitation
two categories high and low :
high pressure cause:
pulmonary HTN
low-pressure cause ;
dilated pulm annulus
congenital
plaque
valve replacement
pulmonary regurgitaion signs and symptoms
** hallmark finding**
high pitch decrescendo diastolic murmur
1. pulm HTN
2. fatigue
3. abd fullness
4. bloating
5. LE edema
pulm regurgitaion management
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
