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Cardiopulmonary > Valve disease > Flashcards

Valve disease Flashcards

1
Q

pathway of blood through heart

A

1) body –> 2) inferior/superior vena cava –> 3) right atrium –> 4) tricuspid valve –> 5) right ventricle –> 6) pulmonary arteries –> 7) lungs –> 8) pulmonary veins –> 9) left atrium –> 10) mitral or bicuspid valve –> 11) left ventricle –> 12) aortic valve –> 13) aorta –> 14) body.

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2
Q

systole

A

ventricle contract and the atrioventricular valves close and the semilunar valves open

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3
Q

diastole

A

the semilunar valves close and the atrioventricular vales open

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4
Q

Chordae tendineae and Papillary muscles

A

Prevent inversion of valves during
ventricular systole.
Can become damaged from MI
causing back flow “regurgitation”.

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5
Q

what is the most common heart valve disease?

A

aortic stenosis

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6
Q

Mitral Stenosis

A

Primarily occurs in females (66%)
Rheumatic heart disease- Primary Cause
Valve Leaflets don’t opening easily or completely
Decreases area and increases resistance to flow between A-V

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7
Q

Mitral Regurgitation/Incompetence

A

MV does not close completely during systole (Incompetence)
Creates back flow (Regurgitation)
Stroke Volume increase to compensate for back flow
Eccentric hypertrophy to accommodate increased volume
L Atrium dilates due to back pressure

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8
Q

Mitral Regurgitation/Incompetence epidemiology

A

20% people >55y/o have some degree of mitral regurgitation

~1/3 of all cases are caused by rheumatic heart disease.

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9
Q

Mitral Regurgitation/Incompetence signs and symptoms

A

Anxiety and palpitations w/ exercise

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10
Q

Mitral Valve Prolapse

A

LA Dilates
Pulmonary Congestion
left ventricular hypertrophy to compensate

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11
Q

Mitral Valve Prolapse symptoms

A

Dyspnea of Exertion, Murmur

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12
Q

Aortic Stenosis

A

Thickening, calcification, or both

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13
Q

Aortic Stenosis epidemiology

A

~25% of the population >65y/o

Calcific aortic stenosis and congenital bicuspid aortic valve stenosis account for the overwhelming majority of cases

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14
Q

Aortic Stenosis symptoms

A

Volume Overload- LVH to compensate

Dyspnea of Exertion

Suppressed BP Response

Orthopnea

Murmur

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15
Q

Aortic Regurgitation/Incompetence causes

A

Congenital, rheumatic, endocarditis, age, chronic HTN

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16
Q

Aortic Regurgitation/Incompetence volume overload

A

LV Dilates, possible LV & LA Conc Hypertrophy (late stage)

No pulmonary symptoms until very advanced stages

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17
Q

Aortic Regurgitation/Incompetence symptoms

A

Dyspnea of Exertion

Murmur

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18
Q

Exercise Considerations for aortic stenosis

A

Asymptomatic aortic stenosis: intensity should be low and progressed gradually

19
Q

Exercise Considerations for all valve disease

A

Suppressed BP response to exercise, possibly exaggerated HR
Angina may be a symptom but a predictable intensity/workload
Patients with symptomatic valve disease are typically not candidates for exercise programs!

20
Q

Pericarditis

A

Swelling and Irritation of the pericardium

21
Q

Pericarditis causes

A

Viral infections, Bacterial infections (less common), Fungal infections (rare)
May occur due to a heart attack, radiation
therapy and post open heart surgery

22
Q

Pericarditis symptoms

A

Sharp retrosternal pain with radiation to the back (lasting hours), fever,
Pain worsens with deep breathing or coughing
and when laying flat.
Pain is improved while sitting up and leaning forward
Friction rub on auscultation

23
Q

Pericardial Effusion

A

Accumulation of fluid in the pericardial sac.

24
Q

Pericardial Effusion causes

A

Viral infections, Bacterial infections (less common), Fungal infections (rare)
May occur due to a heart attack, radiation
therapy and post open heart surgery

25
Q

Pericardial Effusion symptoms

A

Pressure pain in chest, dysphagia,

dyspnea,

26
Q

Auscultation aortic region

A

Right 2nd intercostal space, parasternal

27
Q

Auscultation pulmonic region

A

Left 2nd intercostal space, parasternal

28
Q

Auscultation tricuspid region

A

Left 4th or 5th intercostal space, parasternal

29
Q

Auscultation mitral region

A

Left 4th or 5th intercostal space, midclavicular

30
Q

Apical Pulse Measurement

A 
Most accurate measurement of heart rate
by clinical examination.
5th intercostal space at the mid clavicular line
Use when irregular rhythms are detected
on exam.
31
Q

S1 “Lub” The first heart sound

A

Closure of the AV valves (Tricuspid and Mitral)
Occurs with ventricular contraction
Marks the approximate beginning of systole.

32
Q

S2 “Dub” The second heart sound

A

Closure of the Semilunar valves
(Aortic and Pulmonic).
Marks the end of systole and the beginning of ventricular relaxation (diastole).

33
Q

Splitting S1

A

Mitral and Triscupid valve sounds (M1 and T1) are slightly asychronous.
Mitral closure may precede tricuspid closure by 20 to 30
msec (0.02 to 0.03 sec.). This is generally normal.

34
Q

Splitting S1 abnormalities

A

Wide splitting of the first sound is almost always abnormal and warrants further medical examination.

35
Q

Splitting S2

A

Two components, aortic (A2) and pulmonic sounds (P2),

(S2) is of shorter duration and higher frequency than S1.

36
Q

Physiologic splitting S2

A

is demonstrated during inspiration in healthy individuals, primarily due to a delayed P2.
Common in children and well condition athletes

37
Q

Persistent splitting S2

A

may occur in supine or recumbent position however, the split should resolve on expiration following sitting, standing, or a Valsalva maneuver.

38
Q

S3 gallop

A

occurs at the beginning of diastole after S2 and is lower in pitch than S1 or S2 as it is not of valvular origin.
Indicative of ventricular failure.
you hear a slosh sound

39
Q

S4 gallop

A

Occurs prior to S1, produced by the sound of blood being forced into a stiff or hypertrophic ventricle.
Indicative of LVH or HCM
you hear a stiff wall

40
Q

Murmur

A

Extra sounds during the cardiac cycle, such as whooshing or swishing made by turbulent blood flow often due to a faulty valve or structural changes in the myocardium.

41
Q

Friction rub

A

Often due to pericarditis or pleuritis (lungs)

Place hand over ear and rub finger over hand, this is what a friction rub sounds like

42
Q

Murmurs should be assessed on the

following characteristics:

A

shape, location, timing, intensity and pitch

43
Q

Murmurs location

A

Determined by the site where the
murmur originates
A, P, T, M listening areas

44
Q

murmurs intensity

A 
Graded on a 6 point scale
Grade 1 = very faint
Grade 2 = quiet but heard immediately
Grade 3 = moderately loud
Grade 4 = loud*
Grade 5 = heard with stethoscope partly off  the chest*
Grade 6 = no stethoscope needed*

Cardiopulmonary (7 decks)

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