Structural Heart Disease. Flashcards
main job in the body is create one-way flow in the heart.
Cardiac valves
(a) Tricuspid valve (between the right atrium and right ventricle) has three leaflets.
(b) Pulmonary valve (between the right ventricle and the pulmonary artery) has three leaflets.
(c) Mitral valve (between the left atrium and the left ventricle) has TWO leaflets.
(d) Aortic valve (between the left ventricle and the aorta) has three leaflets.
(2) Papillary muscles: Are muscles located in the ventricles of the heart. They attach to the cusps of the atrioventricular valves (Tricuspid and Mitral valves) via the chordae tendineae and contract to prevent inversion or prolapse of these valves on systole.
4 Valves in the Heart: Anatomy
Structural Heart Disease
Another name for leaking heart valve. Occurs when
blood flows back through the valve as the leaflets are closing, or leaks
through the leaflets when they should be completely closed.
Regurgitation: Pathophysiology
Structural Heart Disease.
Is a term for a valve that doesn’t open properly. The flaps of
the valve thicken, stiffen, or fuse together. Thus the heart has to work
harder to pump blood through the valve.
Stenosis: Pathophysiology
Structural Heart Disease.
The most important one is congenital bicuspid
Aortic valve (born with only two leaflets instead of three, usually one fuses with another during fetal development and can lead to aortic aneurysm formation).
Congenital issues: Pathophysiology
Structural Heart Disease.
(a) Back flow of blood from the left ventricle back into the left atrium during systole.
(b) Caused by MI (due to infracting the papillary muscle), rheumatic heart disease, endocarditis, dilated cardiomyopathy, and mitral annulus calcification (due to aging).
(c) Commonly caused by rheumatic heart disease.
(d) Symptoms: Can cause Exertional dyspnea, fatigue, chest pain,
palpitations, or be asymptomatic.
Physical Examination:
1) Causes a Pan Systolic murmur heard best at the apex with
radiation into the left axilla.
2) Hyperdynamic LV
3)*** Possible S3
4) Possible atrial fibrillation due to dilation of the Left atrium.
Mitral Regurgitation: Pathophysiology
Structural Heart Disease.
(a)*** “floppy” mitral valve
(b) Often referred to as “degenerative” mitral valve disease.
(c) With _______ you have the valves protruding back into the left atrium during ventricular systole.
(d) Over time this prolapse can continue to degenerate and turn into mitral regurgitation.
(e) More common in women
(f) Symptoms: Usually asymptomatic, but can cause non-specific chest pain, dyspnea, fatigue, palpitations.
(g)*** Physical Examination: Mid-Systolic click
Mitral Valve Prolapse: Pathophysiology
Structural Heart Disease.
(a) Primarily caused by rheumatic heart disease.
(b) Rheumatic _____ results in thickening of the leaflets, fusion of the mitral commissures, retraction, thickening and fusion of the chordae, and calcium deposits on the valve.
(c) Symptoms: May be asymptomatic, or fatigue, DOE, chest pain,
palpitations.
(d) Physical Examination: Low pitched DIASTOLIC murmur (also called a diastolic rumbling murmur).
Mitral Stenosis: Pathophysiology
Structural Heart Disease.
(a) Usually caused by progressive valvular calcification and degeneration with age > 65.
(b) More common in men
(c) ***Congenitally caused by a bicuspid aortic valve.
(d) Symptoms: Angina, Exertional syncope, CHF, cardiac arrhythmias, sudden cardiac death.
Physical Examination:
1) Systolic crescendo – decrescendo murmur throughout systole
with radiation to the right carotid artery.
2) Parasternal heave (which is an upward push on your hand when
you palpate the precordium, suggesting the presence of
ventricular hypertrophy).
3) Thrill (is a vibratory sensation on your hand) in the aortic
position.
Aortic Stenosis: Pathophysiology
Structural Heart Disease.
(a) Causes blood to flow from the Aorta back into the left ventricle during diastole.
(b) Caused by congenital bicuspid valves, rheumatic heart disease,
endocarditis, and hypertension.
(c) Symptoms: Usually asymptomatic until middle age, Fatigue, Exertional dyspnea, Paroxysmal nocturnal dyspnea, cardiac arrhythmias, CHF, chest pain.
Physical Examination:
1)*** Soft aortic DIASTOLIC murmur
2) Wide pulse pressure
3) Pulmonary edema
Aortic Regurgitation: Pathophysiology
Structural Heart Disease.
(1) ***Echocardiography is gold standard for diagnosis as well as looking for endocarditis.
(2) EKG my reveal LVH with AS
(3) EKG may reveal arrhythmia
Labs/Studies/EKG: Structural Heart Disease.
(1) Treat symptomatically (if in CHF use diuresis, if have a cardiac
arrhythmia then treat accordingly).
(2) ***Surgical repair is the definitive treatment for valvular heart disease with
either tissue or mechanic valve replacement.
Treatment: Structural Heart Disease.
(1) Good history and physical examination to include vitals.
(2) Need to rule out endocarditis if still on your differential.
(3) Evaluate for signs of CHF
(4) Evaluate for signs of cardiac arrhythmia
(5) Evaluate for signs of being unstable (which would suggest more of an acute issue).
(6) Echocardiography to evaluate the valve
Initial Care: Structural Heart Disease.
(1) Cardiac Arrhythmias
(2) Acute CHF
(3) Pulmonary edema
(4) Syncope
(5) AMI
(6) Sudden cardiac death
Complications: Structural Heart Disease
Any new murmur must be referred to MO, MEDADVICE if
asymptomatic, MEDEVAC if symptomatic or unstable.
Disposition: Structural Heart Disease
