SM 142 Valvular Heart Disease: Regurgitant

Question 1

Is Mitral Stenosis a Systolic or Diastolic murmur?

Answer 1

Diastolic

Question 2

Is Mitral Regurgitation a Systolic or Diastolic murmur?

Answer 2

Systolic

Question 3

Is Aortic Stenosis a Systolic or Diastolic murmur?

Answer 3

Systolic

Question 4

Is Aortic Regurgitation a Systolic or Diastolic murmur?

Answer 4

Primarily Diastolic but also Systolic

Question 5

Why is Aortic Regurgitation both a Diastolic and Systolic murmur?

Answer 5

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

Question 6

Under Aortic Regurgitation, how does SV change and what is significant about this?

Answer 6

Total SV = SV from LA + Regurgitant SV from Aorta, leads to increased preload

Question 7

How does increased EDV alter the LV during Aortic Regurgitation?

Answer 7

Increased Volume = Increased Preload = Dilation of the LV

Question 8

What can be used to measure the extent of Aortic Regurgitation?

Answer 8

LVEDV + Preload, which increase due to backflow over incompetent Aortic Valve

Question 9

How does Aortic Stenosis affect Afterload and Preload?

Answer 9

Aortic Stenosis = Increased Afterload + Normal Preload

Question 10

How does Mitral Regurgitation affect Afterload and Preload?

Answer 10

Mitral Regurgitation = Increased Preload (due to extra volume from regurg being pumped back in) + Normal Afterload

Question 11

How does Aortic Regurgitation affect Afterload and Preload?

Answer 11

Aortic Regurgitation = Increased Preload (due to extra volume from regurg being pumped back in) + Increased Afterload (due to extra volume)

Question 12

Why does afterload increase in Aortic Regurgitation?

Answer 12

Increased stretch of the LV leads to increased forced resisting contraction = increased afterload

Question 13

Why does Mitral Regurgitation not increase Afterload?

Answer 13

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

Question 14

What can cause LV Dilation?

Answer 14

Increased Preload/EDV

Question 15

What can cause LV Hypertrophy?

Answer 15

Increased Afterload

Question 16

How does Mitral Regurgitation affect the Left side of the heart?

Answer 16

Since blood is pumped back into the LA, the LA dilates

Question 17

How does Aortic Regurgitation affect the Left side of the heart?

Answer 17

Increased Preload + Increased Afterload = LV Dilation and LV Hypertrophy + Aortic Dilation

Question 18

Which valve defect affects the Aorta and how?

Answer 18

Aortic Regurgitation leads to a dilated Aorta due to increased blood flow across the Aortic Valve

Question 19

What does Aortic Valve damage lead to?

Answer 19

Aortic Regurgitation since it is no longer structurally viable

Question 20

What murmur presents with altered pulse pressure, and how?

Answer 20

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

Question 21

Why does Aortic Regurgitation lead to a decrescendo murmur?

Answer 21

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

Question 22

When is the optimal time to operate on Aortic Regurgitation?

Answer 22

When patients have worse symptoms, LV dysfunction, and LV/Aorta dilation

Question 23

How is Aortic Regurgitation operated on?

Answer 23

If no Aorta enlargement, just replace the Aortic Valve; if the Aorta is enlarged, replace the Aortic Valve + enlarged portion of the Aorta

Question 24

What are the two main causes of Mitral Regurgitation?

Answer 24

Primary Valve disease = Primary cause; Primary Muscle disease = Secondary cause

Question 25

What can cause Mitral Regurgitation via Primary Valve disease?

Answer 25

Rheumatic + Bacterial Infection + Mitral Valve Prolapse

Question 26

What does Mitral Regurgitation do to the right side of the heart?

Answer 26

Mitral Regurgitation causes congestion spanning pulmonary to systemic venous areas

Question 27

How does Mitral Regurg effect Cardiac Output?

Answer 27

Low Cardiac Output

Question 28

How does LV Dysfunction manifest from Mitral Regurg?

Answer 28

Volume Overload = Dilation

Question 29

How does Arial Fibrillation + Systemic Embolism form from Mitral Regurg?

Answer 29

Mitral Regurg promotes stretching of the Left Atrium, causing fibrosis which alters conductivity, causes Atrial Fibrillation -> Embolism formation

Question 30

What causes Mitral Valve prolapse?

Answer 30

Leaflet thickening and enlargement

Question 31

How does Mitral Regurg alter the LA filling curve?

Answer 31

Leads to a more prominent V wave due to incompetent valve allowing blood to return into the Left Atrium

Question 32

How does Mitral Regurg present on physical exam?

Answer 32

Holosystolic Apical murmur

Question 33

How is Mitral Regurg operated on?

Answer 33

Unlike other valvular defects, the valve can be repaired with optimum outcome before the onset of symptoms

Question 34

How is Mitral Regurg repaired?

Answer 34

Slice out parts of the leaflet and make the valve tighter with an Annuloplastic ring

Question 35

How are secondary causes of Mitral regurg treated?

Answer 35

Secondary Cause = Muscle disease such as ischemia + cardiomyopathy, so treat the disease

Question 36

Which form of Mitral Regurg precipitates from damage to the Left Ventricle?

Answer 36

Secondary Mitral Regurgitation, because the muscles are affected and not the valves themselves

Question 37

What is the target for Primary Mitral Regurg?

Answer 37

The Mitral Valve

Question 38

What is the target for Secodary Mitral Regurg?

Answer 38

The Ventricle

Question 39

How are Primary MR and LV dysfunction related?

Answer 39

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

Question 40

Is valve surgery curative?

Answer 40

No, just prolongs lifespan

Question 41

How dos Aortic Valve disease affect the LV?

Answer 41

In both Aortic Stenosis + Aortic Regurg, afterload increases leading to LV Hypertrophy

Question 42

How does valvular heart disease vary with age?

Answer 42

Valvular Heart Disease increases with age

Question 43

Generally, when should valvular stenosis be operated on?

Answer 43

Once symptoms develop

Question 44

Generally, when should valvular regurgitation be operated on?

Answer 44

Symptoms develop + LV dysfunction/dilation