(MHD) Clinical Valvular Heart Disease Flashcards

1
Q

What is the primary cause of mitral stenosis?

A

Rheumatic fever (rare in the US)

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2
Q

How does rheumatic fever lead to mitral stenosis?

A

It results in “melting” and fusing of the mitral valve apparatus. The leaflets become so rigid that they cannot open or shut

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3
Q

What effect can rheumatic fever have that leads to Mitral Regurgitation?

A

When rheumatic fever results exclusively or predominantly in contraction and fusion of the chordae tendineae, with little fusion of the valvular commissures, dominant MR results

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4
Q

Name the clinical presentations which may result from chronic MS (8)

A
  1. Enlargement of the left atrium and resultant elevation of the left main stem bronchus
  2. Calcification of the left atrial wall
  3. Mural thrombi
  4. Obliterative changes in the pulmonary vascular bed
  5. Dyspnea
  6. Pulmonary Edema
  7. Endocarditis
  8. Compression of the left recurrent laryngeal nerve
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5
Q

A “Hockey-stick” deformity on ultrasound is associated with what cardiac issue?

A

Mitral Stenosis

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6
Q

What operation is the key for mitral stenosis treatment?

A

Balloon valvulopasty

Carried out in symptomatic patients with moderate to severe MS

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7
Q

What is the most common valvular issue?

A

Mitral Valve regurgitation

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8
Q

Degenerate vs Functional Mitral Regurgitation

A

Degenerate: The valve itself has broken down in a way that can be fixed

Functional: The issue is not with the valve itself so much so as with the ventricle. Much tougher fix.

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9
Q

How can ischemia/infarction lead to mitral regurg?

A

Ischemia/Infarction can lead to a failure of papillary muscle contraction, thus allowing for prolapse into the atria and associated insufficiency.

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10
Q

Why might atrial dilation or left ventricular hypertrophy be seen with mitral regurgitation?

A
  1. If the left atrium doesn’t expand in size, you will see RV hypertrophy because blood which is regurgitated into the left atrium backs up and causes a pressure increase for the right ventricle to push through.
  2. Sometimes the atria simply dilates and there are no pressure changes.
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11
Q

Symptoms usually do not develop in patients with chronic MR until __________________. Because of this….

A

The left ventricle fails.

Because of this, we cannot wait for symptoms

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12
Q

_______________ reduction is of particular benefit in the management of mitral valve regurgitation– both the acute and the chronic forms.

A

Afterload reduction

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13
Q

What window defines the optimal timing of valve replacement surgery?

A

If the surgery is done too early, the patient will have a valve for a longer time and as such will have greater risk for longterm prosthetic complications.

If surgery is done too late, the Left Ventricle gets too stretched out and ventricular function is too deteriated.

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14
Q

The patient’s _______ prior to surgery is a good predictor of surgical outcome

A

EF

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15
Q

What kind of valve is normally given to younger patients? Elderly?

A

Younger: mechanical valve

Elder: tissue based valve (porcine, bovine, etc.)

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16
Q

What percentage of patients with mitral valve prolapse show symptoms?

A

Only 5%

17
Q

What is the most common cause of aortic stenosis in adults?

A

Degenerative (senile) calcific AS. The cuspos are immobilized by a deposit of calcium along their flexion lines. Comes with aging.

18
Q

What is a key point regarding the progress of symptoms of aortic stenosis?

A

Aortic stenosis can occur for a very long time without symptoms clearly appearing. Often times, the onset of significant symptoms occurs just prior to a rapid decline and death.

19
Q

Why might patients with aortic stenosis sometimes have a single S2 sound?

A

The calcification and immobility of the aortic valve make it inaudible

20
Q

What sound might a systolic murmur make when aortic stenosis becomes severe?

A

It may make a cooing/musical sound that is associated with a precordial thrill.

21
Q

What is the treatment for an aortic valve stenosis? What treatment will not work as a long term fix?

A

Aortic Valve Replacement is the only true treatment. Balloon aortic valvuloplasty risk restonisis due to scarring in more than half the patients.

22
Q

What causes aortic regurgitation?

A

Aortic regurgitation (AR) may be caused by primary disease of either the aortic valve leaflets (rheumatic fever) or the wall of the aortic root or both.

23
Q

The ability to hear aortic regurgitation indicates that it is at what stage?

A

Moderate to severe

24
Q

Treatment of aortic regurgitation (symptomatic patients? asymptomatic patients?)

A

symptomatic patients: AVR

asymptomatic patients: usually drugs (nifedipine)

25
Q

What is the most commonly used aortic valve replacement type?

A

Bi-leaflet tilting disc

26
Q

The most common cause of tricuspid regurgitation is…

A

Dilatation of the right ventricle and of the tricuspid annulus, which may be complications of right ventricular failure of any cause.

27
Q

The response of a murmor to __________ helps aid in establishing it as tricuspid regurgitation.

A

Respiration

28
Q

Tricuspid Regurgitation in the abscence of ____________ ______________ usually does not require surgical treatment

A

the absence of pulmonary hypertension

29
Q

What type of aortic valves are more likely to become stenosed?

A

Bicuspid aortic valve

30
Q

What are the (3) concerning symptoms of aortic stenosis?

A
  1. Angina
  2. Syncope
  3. HF