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Physiology > Lecture 14: Cardiac valve disorders > Flashcards

Lecture 14: Cardiac valve disorders Flashcards

1
Q

Pathophysiology of aortic regurgitation - PV loop

A

Low pressure filling

Tremendous preload, diastolic volume doubles

Filling is prolonged (filling from two spots)

Big stroke volume

Slightly enhanced contractility

See figure

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2
Q

What happens to semilunar valves during ventricular systole?

A

Opening of semilunar valves

Ventricles contract and force the valves to open by pushing blood through

See figure

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3
Q

Aortic valve

A

See figure

Systole: cusps forced open

Diastole: blood gets caught in valves, and they close

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4
Q

What type of murmur occurs in mitral regurgitation

A

Holosystolic high pitched murmur extending from S1 to S2

Constant intensity throughout

Heard best at the apex, often radiates to the left axilla

Exaggerated with exertion

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5
Q

What might you hear in the lungs in a person with mitral stenosis?

A

Rales (crackles)

Due to fluid getting pushed into the lungs

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6
Q

Etiology of mitral stenosis

A

1) Most commonly occurs a decade after rheumatic fever.
2) Calcification.
3) Congenital.
4) Rarely occurs with lupus (autoimmune) or rheumatoid arthritis.

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7
Q

Sound of murmur in aortic stenosis

A

Harsh and rough

Crescendo and decrescendo

If the valves ares still malleable, an early ‘clink’ will be heard

A fourth heart sound (S4) is common

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8
Q

What happens if heart failure is present in mitral regurgitation?

A

Third heart sound

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9
Q

Symptoms of aortic stenosis

A

1) Angina Pectoris (chest pain): Increased demand for coronary blood due to hypertrophy and afterload. Compression of coronary vessels and the aortic ‘jetstream’ have also been implicated.
2) Syncope (fainting): Due to decreased cerebral flow.
3) Congestive heart failure: Due to persistent afterload.

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10
Q

Why do palpitations occur in people with mitral stenosis?

A

Usually the results of atrial arrhythmias, such as atrial fibrillation.

The enlarged atrium is the major risk for this, which occurs due to the high atrial pressure.

Dilated atria = electrical path length is longer than usual = increased chance that something will go wrong with transmission of electrical current

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11
Q

What does aortic stenosis cause?

A

Systolic murmur

Increased pressure required by LV = myocardial hypertrophy

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12
Q

Symptoms of aortic regurgitation?

A

Shortness of breath

LV is preloaded from the LA and the aorta = increased volume load on the heart

Pressure builds up in the lungs

Pulmonary congestion and edema

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13
Q

Aortic regurgitation anatomy

A

Retracted fibrotic valve cusps = incompetent aortic valve

Dilated and hypertrophied left ventricle (eccentric hypertrophy)

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14
Q

Symptoms of mitral stenosis

A

1) Shortness of breath, hemoptysis (coughing of blood or blood stained mucous from respiratory system), and orthopnea (shortness of breath when lying flat)
2) Palpitations
3) Neurological symptoms:

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15
Q

Other physician findings in aortic regurgitation

A

Widened pulse pressure with hyperdynamic pulses.

Pulsating carotid impulses and nailbeds, sometimes uvula.

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16
Q

What is another word for mitral prolapse? When is it diagnosed?

A

Floppy mitral valve

Often diagnosed in adulthood, since manifestations can take years to manifest.

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17
Q

Where is a murmur from aortic best heard?

A

Base of the heart (2nd ICS)

Can project up the carotid

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18
Q

What determines blood flow in the heart?

A

Changes in pressure

Cause valves to open and close

Blood moves from high pressure to low pressure (gradient)

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19
Q

What are cardiac murmurs? Cause?

A

Abnormal sounds created by the heart.

Can be caused by pericardial rub, fluid overload (due to renal or heart failure), and valve disease (most common)

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20
Q

What can result if a valve failures to close?

A

Regurgitation

Incompetency

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21
Q

Why do neurological symptoms occur in people with mitral stenosis?

A

Usually the result of embolic events caused by the atrial arrhythmias.

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22
Q

Pathophysiology of mitral regurgitation - PV loop

A

Ventricle gets dilated, filled with same blood

Big preload (EDV)

Big filling curve

Isovolumetric filling and contraction are lost

See figure

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23
Q

What kind of murmur does mitral valve prolapse produce?

A

Presents as mid-systolic clicks, or late systolic murmur.

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24
Q

What is valve stenosis?

A

Valve fails to open

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25
Q

What characteristics are common in left-sided murmurs?

A

Pulmonary congestion and dyspnea

26
Q

Symptoms of mitral regurgitation

A

1) Shortness of breath, orthopnea, nocturnal dyspnea: Due to pulmonary congestion and edema.
2) Palpitations: Atrial enlargement predisposes to atrial arrhythmias.

27
Q

How to know if aortic regurgitation has lead to heart failure?

A

Third heart sound

28
Q

What happens to AV valves during diastole?

A

Opening of the AV valves

Blood returning to the heart travels through the atria and forces the AV valves open

The atria contract forcing addition of blood into the ventricles

See figure

29
Q

Pathophysiology of mitral stenosis - wiggers lewis

A

Higher LA pressures

Separation between pressures during diastole

30
Q

Type of murmur in mitral stenosis

A

Diastolic rumble over the apex

Worsened after exertion

May have opening snap

31
Q

Aortic Stenosis anatomy

A

Valve can be either a tricuspid aortic valve that has thickened and become stenotic, or a bicuspid valve, which results from the fusion of two leaflets of the valve during development

Hypertrophy of left ventricle (concentric hypertrophy)

Post-stenotic dilation of ascending aorta

Calcified aortic valve

See figure

32
Q

What causes valve disorders?

A

Infection

Post-infection

Inflammatory disorders

Ischemic disorders

Congenital disorders

33
Q

Eitology of mitral regurgitation

A

1) Acute causes: rupture of a chordae or damage to a papillary muscle from ischemia, trauma, or infective endocarditis.
2) Rheumatic heart disease.
3) Myxomatous degeneration (ie. Mitral valve prolapse).
4) Calcification of the annulus.
5) Congenital

34
Q

Pathophysiology of aortic stenosis: Wiggers-Lewis

A

Big separation of LV pressure and aortic pressure (LV pressure needs to increase to get the blood through the stenotic aortic valve)

Shortening of pulse pressure

QRS complex is wider (hypertrophy)

Phonocardiogram shows systolic murmur

35
Q

What is the Gallaverdin phenomenon?

A

If aortic stenosis is heard at the apex of the heart, it can be confused with mitral regurgitation

36
Q

What causes shortness of breath, hemoptysis and orthopnea in people with mitral stenosis

A

Backpressure to the lungs is very severe, which elevates pulmonary capillary pressures.

37
Q

Pathophysiology of mitral stenosis - PV loop

A

Can’t get blood into the ventricle = restricted filling

38
Q

Rheumatic aortic stenosis - how?

A

Fibrosis and calcification following a strep infection

39
Q

Pathophysiology of mitral regurgitation - wiggers lewis

A

High LA pressure

Aortic pressure is normal

See figure

40
Q

Possible etiologies of aortic stenosis

A

Congenital

Rheumatic

Degenerative

41
Q

What is the ethology of aortic regurgitation?

A

Cups abnormalities: Endocarditis, Rheumatic disease (post infection), Ankylosing spondylitis (systemic inflammatory disease), Congenital malformation

Aortic disease: Aneurysm (blood filled bulge on a vessel), Marfan’s (genetic disease in which connective tissue deteriorates around the aorta and the valve opens), Systemic inflammatory disease, Trauma, Dissection

42
Q

Phonograms for common murmurs

A

See figure

43
Q

Valve anatomy

A

See figure

44
Q

Anatomy of mitral stenosis

A

Small mitral orifice (cusps calcified together)

Atria are not strong enough to push blood through the valve = atria dilate

Enlarged thickened left atrium

Small left ventricle

Thickened matted chordae tendinae

See figure

45
Q

Where do valve disorders often occur?

A

Occur more frequently on the left side of the heart

Right valve disorders occur in people who use IV drugs (bacterial deposits)

46
Q

Congenital aortic stenosis - anatomy of valve, when does it present?

A

Unicuspid or bicuspid valve

Can present early in life or in 5th-6th decade

47
Q

What do valve disorders result from

A

If there is failure of a valve opening or closing

48
Q

What does mitral valve prolapse lead to?

A

Occasionally, MVP causes symptomatic regurgitation which increases the risk of infective endocarditis and requires surgical repair.

49
Q

Degenerative aortic stenosis - how? when? Risk factors?

A

Calcification of a valve

Usually in 7th decade of life

Risk factors are the same as atherosclerosis

50
Q

Wiggers/Lewis diagram

A

Illustrates the relationship between cardiac pressures, volumes, ECG and heart sounds throughout the cardiac cycle

See figure

51
Q

Types of artificial valve replacements

A

1) caged ball valve
2) tilting disc valve
3) single leaflet valve
4) bileaflet valve

See figure

52
Q

Anatomy of mitral regurgitation

A

Incompetent mitral valve

Retracted shortened mitral valve cusps

Enlarged left atrial appendage

Ruptured chordae tendinae

Enlarged left ventricle

Enlarged left atrium

53
Q

What type of murmur in aortic stenosis? When does it occur?

A

Systolic murmur

Begins after S1 and ends before S2

54
Q

What happens to AV valves during ventricular systole?

A

Closing of AV valves

Ventricles contract, forcing blood against AV valves

AV valves close (first heart sound)

Papillary muscles contract to stabilize the valves

See figure

55
Q

What kind of murmur does aortic regurgitation produce

A

Diastolic murmur in aortic area

Sometimes at apex (austin flint murmur)

Described as blowing and often faint

56
Q

Where is the apical impulse in a person with mitral regurgitation?

A

Laterally displaced and hyper dynamic

57
Q

What does aortic regurgitation cause?

A

Diastolic murmur

Increased volume load on LV = dilation

58
Q

How is mitral valve prolapse diagnosed?

A

Often diagnosed by echocardiogram before symptoms.

59
Q

Pathophysiology of aortic stenosis: PV loop

A

Hypertophied LV

Curve is shifted up, the heart is filling under higher pressure

Loop is more narrow (ventricle is hard to fill)

Need to generate big pressure during isovolumetric contraction

Not as much blood is injected into the aorta, so the end systolic volume is higher

Shift in contractility due to SNS stimulation

See figure

60
Q

Pathophysiology of aortic regurgitation - wiggers Lewis

A

Diastolic pressure in aorta is low (ejected blood is leaking back into atria)

Widening of pulse pressure

Phonocardiogram: diastolic murmur (always), sometimes accompanied by small systolic murmur

61
Q

What happens to semilunar valves during diastole?

A

Closing of semilunar valves

Ventricles relax, intraventricular pressure falls and blood flows back from the arteries, filing the cusps of the semilunar valves, forcing them to close

See figure

Physiology (19 decks)

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