SM 142 Valvular Heart Disease: Regurgitant Flashcards
Is Mitral Stenosis a Systolic or Diastolic murmur?
Diastolic
Is Mitral Regurgitation a Systolic or Diastolic murmur?
Systolic
Is Aortic Stenosis a Systolic or Diastolic murmur?
Systolic
Is Aortic Regurgitation a Systolic or Diastolic murmur?
Primarily Diastolic but also Systolic
Why is Aortic Regurgitation both a Diastolic and Systolic murmur?
Diastolic murmur due to the inflow of blood through an incompetent Aortic Valve + Systolic murmur due to increased volume in the LV pushing more blood over the AV
Under Aortic Regurgitation, how does SV change and what is significant about this?
Total SV = SV from LA + Regurgitant SV from Aorta, leads to increased preload
How does increased EDV alter the LV during Aortic Regurgitation?
Increased Volume = Increased Preload = Dilation of the LV
What can be used to measure the extent of Aortic Regurgitation?
LVEDV + Preload, which increase due to backflow over incompetent Aortic Valve
How does Aortic Stenosis affect Afterload and Preload?
Aortic Stenosis = Increased Afterload + Normal Preload
How does Mitral Regurgitation affect Afterload and Preload?
Mitral Regurgitation = Increased Preload (due to extra volume from regurg being pumped back in) + Normal Afterload
How does Aortic Regurgitation affect Afterload and Preload?
Aortic Regurgitation = Increased Preload (due to extra volume from regurg being pumped back in) + Increased Afterload (due to extra volume)
Why does afterload increase in Aortic Regurgitation?
Increased stretch of the LV leads to increased forced resisting contraction = increased afterload
Why does Mitral Regurgitation not increase Afterload?
The increased volume is pumped back into the low pressure LA leading to Dilation + Fibrosis w/ no change in afterload, as opposed to Aortic Regurg where volume cannot be pumped into the high pressure Aorta
What can cause LV Dilation?
Increased Preload/EDV
What can cause LV Hypertrophy?
Increased Afterload
How does Mitral Regurgitation affect the Left side of the heart?
Since blood is pumped back into the LA, the LA dilates
How does Aortic Regurgitation affect the Left side of the heart?
Increased Preload + Increased Afterload = LV Dilation and LV Hypertrophy + Aortic Dilation
Which valve defect affects the Aorta and how?
Aortic Regurgitation leads to a dilated Aorta due to increased blood flow across the Aortic Valve
What does Aortic Valve damage lead to?
Aortic Regurgitation since it is no longer structurally viable
What murmur presents with altered pulse pressure, and how?
Aortic Regurgitation leads to widened Pulse Pressure due to more blood pumped out as well as more blood sucked back in and a Decrescendo murmur
Why does Aortic Regurgitation lead to a decrescendo murmur?
LV experiences increased LVEDV after regurgitant blood fills the Ventricle, so pressure on ejection is high, while regurgitation sucks blood back in leading to a decrescendo in pressure and sound
When is the optimal time to operate on Aortic Regurgitation?
When patients have worse symptoms, LV dysfunction, and LV/Aorta dilation
How is Aortic Regurgitation operated on?
If no Aorta enlargement, just replace the Aortic Valve; if the Aorta is enlarged, replace the Aortic Valve + enlarged portion of the Aorta
What are the two main causes of Mitral Regurgitation?
Primary Valve disease = Primary cause; Primary Muscle disease = Secondary cause
What can cause Mitral Regurgitation via Primary Valve disease?
Rheumatic + Bacterial Infection + Mitral Valve Prolapse
What does Mitral Regurgitation do to the right side of the heart?
Mitral Regurgitation causes congestion spanning pulmonary to systemic venous areas
How does Mitral Regurg effect Cardiac Output?
Low Cardiac Output
How does LV Dysfunction manifest from Mitral Regurg?
Volume Overload = Dilation
How does Arial Fibrillation + Systemic Embolism form from Mitral Regurg?
Mitral Regurg promotes stretching of the Left Atrium, causing fibrosis which alters conductivity, causes Atrial Fibrillation -> Embolism formation
What causes Mitral Valve prolapse?
Leaflet thickening and enlargement
How does Mitral Regurg alter the LA filling curve?
Leads to a more prominent V wave due to incompetent valve allowing blood to return into the Left Atrium
How does Mitral Regurg present on physical exam?
Holosystolic Apical murmur
How is Mitral Regurg operated on?
Unlike other valvular defects, the valve can be repaired with optimum outcome before the onset of symptoms
How is Mitral Regurg repaired?
Slice out parts of the leaflet and make the valve tighter with an Annuloplastic ring
How are secondary causes of Mitral regurg treated?
Secondary Cause = Muscle disease such as ischemia + cardiomyopathy, so treat the disease
Which form of Mitral Regurg precipitates from damage to the Left Ventricle?
Secondary Mitral Regurgitation, because the muscles are affected and not the valves themselves
What is the target for Primary Mitral Regurg?
The Mitral Valve
What is the target for Secodary Mitral Regurg?
The Ventricle
How are Primary MR and LV dysfunction related?
Primary MR can result in LV Dysfunction due to increased EDV + LV Dysfunction can impair the ability to open valves (not the valves themselves) causing Secondary MR
Is valve surgery curative?
No, just prolongs lifespan
How dos Aortic Valve disease affect the LV?
In both Aortic Stenosis + Aortic Regurg, afterload increases leading to LV Hypertrophy
How does valvular heart disease vary with age?
Valvular Heart Disease increases with age
Generally, when should valvular stenosis be operated on?
Once symptoms develop
Generally, when should valvular regurgitation be operated on?
Symptoms develop + LV dysfunction/dilation
