Lecture 7 Valves Flashcards
what valve only has 2 leaflets?
mitral
what is the largest heart valve?
tricuspid
3 potential causes to tricuspid stenosis:
rheumatic fever, carcinoid, congenital
Rheumatic fever typically affects the _____, followed by the _____, and ____ valves
mitral, aortic, tricuspid
carcinoid syndrome is secondarty to ____ production from ___ metastasis
serotonin;
liver
carcinoid syndrome can cause ____ sided valvular disease, such as fibrous plaque formation–> _____ and _____
right;
stenosis and regurgitation
symptoms of tricuspid stenosis
excessive fatigue and dyspnea
tricsupid stenosis forward failure: decreased ____ of the LV; thus decreased _____ _____
preload; stroke volume
tricuspid stenosis backward failure: hepatic _____ and peipheral ____
edema, congestion
Tricuspid stenosis:
mid ____ murmur over the ____ _____ _____ border. murmur _____ on inspiration
diastolic; lower left sternal;
increases
triscupid regurgitation:
_____ murmur heard best over the ____ ____ border;
murmur ____ with inspiration
pansystolic; lower sternal;
increases
tricuspid regurg:
liver is ____ and shows systolic ____;
hepatojugular reflux present
enlarged, pulsatations
majority of the tricuspid regurg patients will get ____ ____
atrial fibrillation
pulmonary valve lesions are typically due to ____ reasons
congenital (ie tetralgy of fallot, pulmonary atresia)
mitral stenosis:
decreased flow of blood to the ____ causes decreased cardiac ____ –> symptoms of fatigue, muscle wasting, weakness
LV; output
mitral stenosis:
there is ___ hypertrophy, which can cause fibrillation or mural thrombi. there is also increased ____ _____ resistence
LA;
pulmonary vascular
The classic symptom of mitral stenosis is ____ on ____
dyspnea, exertion
the auscultory triad of mitral stnosis is what?
apical diastolic rumble + increased S1 + opening snap
with severe mitral stenosis, ____ ____ can be seen, due to engorged pulmonary lymphatics
kerley’s lines
what is by far the most common cause of mitral stenosis? what is the timing of the cause?
rheumatic fever, late lesion
echo of mitral stenosis will show ____ enlargment and leaflet ____ secondary to restrictive opening of the valve
LA;
doming
mitral regurg is due to _____ heart disease, ____ rheumatic fever, mitral valve _______; orconnective tissue disease such as ____, _____, or osteogenesis imperfecta
ischemic; early;
prolapse;
ehler’s-danlos, marfan syndrome
mitral regurg:
increased ____ pressure, ____ pressure, and pulmonary vein pressure
LA; pulmonary capillary wedge
mitral regurg:
symptoms include fatigue, dyspnea, decreased ____ toleranace, palpitations, and _____ _____
exercise; atrial fibrillation
if chronic, mitral regurg results in ____ hypertrophy.
LA
if acute mitral regurg, such as ruptured ____ ____ post ____, then the increased in blood to the LA causes acute ____ ____
papillary muscle, MI;
pulmonary edema
patients with mitral regurg have increased susceptibility to ____ ____
bacterial endocarditis
in mitral regurg, the mitral ____ dilates _____
annulus, posteriorly
the normal aortic valve has ___ cusps. it is a ____ valve
3, semilunar
aortic stenosis is due to age-related ____, or early onset ____ if the patient has a _____ valve
calcification, calcification; bicuspid
____ is another cause of aortic stenosis, but it is typically also associated with the ____ valve
rheumatic fever;
mitral
aortic stenosis causes an increase in ____, with secondary impaired ___ emptying during _____
afterload; LV, systole
aortic stenosis causes a ____ _____ hypertrophy
concentric LV
Aortic stenosis: LV Hypertrophy with increased ____ ____ –> increased ___ demand and decreased ____ ____ during diastole. This, ____ can occur during exercise
muscle mass; O2, subendocardial flow; angina
classic symptoms of aortic stenosis: acronym? and what each letter stands for
SAD
syncope, angina, dyspnea
Aortic stenosis can result in sudden death due to _____ ____ or if untreated, can cause gradual ____ _____ _____
ventricular arrhythmia, congestive heart failure
aortic stenosis:
____ ____ murmur heard best in the ____ ____ ____ that radiates to the ____
systolic ejection; right 2nd intercostal space; carotids
An aortic valve area (AVA) less than ____ or an ejection fraction less than ____is considered severe as seen on Echo. What is indicated?
.8 cm squared; 50%
surgery
causes of aortic regurg:
mixed aortic stenosis, aortic root dilatation (______ _____), congenital (____ valve), rheumatic fever, endocarditis
annuloaortic ectasia;
bicuspid
aortic regurgitation is the most common valvular lesion in ____ ___ ____
blunt chest trauma
what 2 rheumatic disease are associated with aortic regurg?
rheumatoid arthritis;
ankylosing spondylitis
Aortic regurg results in volume ____ of the ____. This results in increased _____ and wall stress.
overload, LV;
LV end diastolic pressure
Aortic regurg:
increased LVEDP causes progressive LV ____, eventually leading to ____ ____ of the LV (increased ____ size and increased ____ thickness)
dilatation;
eccentric hypertrophy; CHAMBER*; wall
___ ____ is massive dilatation of the LV
Cor Bovinum
Aortic regurg:
LV failure –> fall in ____ and _____ until CO can not be maintained.
contractility, ejection fraction
Aortic regurg:
______ ischemia from decreased _____ coronary blood flow, increased ventricular pressure, LVH, and increased workload –> ____ despite normal coronaries
subendocardial; diastolic;
angina
Aortic regurg:
____ ____ murmur;
____ pulse pressure due to ____ systolic and _____ diastolic pressure
diastolic blowing;
widened, increased, decreased
Aortic regurg:
____ ____ pulse = bounding and forceful peripheral pulse;
_____ = forceful carotid pulse;
______ = forceful limb pulse
water hammer;
corrigan’s;
watson’s
Aortic regurg: what is de musset’s sign?
what is quincke’s pulse?
bobbing of head with cardiac cycle;
pulsating nail beds
aortic regurg:
austin flint murmur - when regurgitant jet hits the anterior leaflet of the ____ ____, causes closure –> murmur at the ____
mitral valve;
apex
aortic regurg:
_____ sign = systolic and diastolic murmur over the femoral arteries;
____ sign - pistol shot sounds over the large arteries
duroziez’s;
traube’s
____ ____ is unexplained LVH associated with a non-dilated ventricle in the absence of another cardiac or systemic condition
hypertrophic cardiomyopathy (HCM)
HCM:
____ ____ dysfunction, with dynamic ____ outflow obstruction, often at rest
LV diastolic, LV
HCM: often see ____ anterior motion of the ____ valve and ____ regurg
systolic; mitral; mitral
what heart sound is often seen with HCM?
there is also a ____ ____ murmur and a holosystolic murmur of ____ ____
S4
systolic ejection; mitral regurg
HCM:
____ carotid ____ aka ‘______’
bisferiens upstroke; spike and dome
maneuvers to decrease the LV size and make an HCM murmur louder: _____ and ____
maneuvers to increase the LV size and make a murmur softer: ______ and ____
standing, valsalva maneuver;
squatting, handgrip exercise
HCM causes ____ during exercise. It can also cause sudden death in young athletes due to ____ _____. Can also cause CHF symptoms
syncope ;
ventricular arrhythmia
Patients with HCM should restrict ____. If at a high arrythmic risk, they should receive an ____
exercise;
ICD
