valve disease

Question 0

types of aortic stenosis (3)

Answer 0

Calcific, bicuspid, rheumatic

Question 1

types of hypertrophy causing valve disease

Answer 1

Concentric hypertrophy –> stenosis (aortic, pulmonic)

Eccentric hypertrophy –> insufficiency/regurgitation (in any of the 4 valves)

Question 2

Symptoms of Aortic stenosis

Answer 2

1. syncope - from ventricular tachycardia, heart block, or vasodilation w/ fixed stroke volume
2. angina - from hypertrophy or CAD
3. CHF
   * * Sx don’t manifest until very late –> rapid progression once start**
   * *Risk of sudden death!**

Question 3

heart sounds/signs of Aortic Stenosis

Answer 3

1. systolic murmur (coarse, high-pitched, late peaking)
2. S4 (from stiff ventricle)
3. small & slow carotid upstroke (compensatory)

Question 4

Causes of Mitral Stenosis

Answer 4

1 Rheumatic fever

• Mitral annular calcification
• single papillary muscle

Question 5

Heart valve stenosis wastes energy bc:

Answer 5

Creates:

1. pressure gradient
2. turbulence

Question 6

problems (pathophys) of mitral stenosis

Answer 6

1. decreased blood flow into L ventricle
   –> underfilled LV
   –> increased LA & RV pressure (P backs up)
   ==> pulmonary venous congestion/HTN
   ** RV failure if pulmonary stenosis!!!
   **Danger: risk of thromboemboli from stasis **

Question 7

Treatment for aortic and mitral stenosis

Answer 7

Aortic: surgical valve replacement right away w/ Sx

Mitral: surgical valve replacement if moderate Sx, or if A-fib.

Question 8

Regurgitant fraction

Answer 8

measure of amount of regurgitation by a valve.

RF = regurgitant volume/total stroke volume

Question 9

causes of aortic regurgitation

Answer 9

Chronic:
- Aortic dilatation, bicuspid valve, Rheumatic heart disease.
Acute:
- endocarditis, aortic dissection.

Question 10

Consequences of stenosis and regurgitation/insufficiency

Answer 10

Stenosis: pressure overload (only chronic)

Regurgitation: volume overload *can be acute OR chronic

Question 11

pathophysiology of chronic compensated aortic insufficiency

Answer 11

• compensated, so no big changes in P & f(x), can last long time*
  1. some backward flow of blood into LV during diastole
  (slowly progressing over time)
  2. body senses “HTN” so dilates systemic vasculature
  3. LV dilates to compensate for increased volume (has high compliance) –> no significant change in LV pressure
  4. total stroke volume increases, so no loss of blood volume to systemic circ.

Question 12

clinical signs of aortic regurgitation

Answer 12

Sx: fatigue, angina, heart pounding

• “Corrigan’s pulse” = rapidly rising, bounding
• S3 (rapid early filling)
• decrescendo diastolic murmur
• • quieter sounds if ACUTE AI bc no compensation!**

Question 13

pathophysiology of DEcompensated Aortic regurgitation

Answer 13

1. Loss of LV compliance –> regurgitated volume > LV volume.
2. increased diastolic LV pressures –> decreased contractile force
3. ejection fraction falls, preload increases
   * * not reversible once EF drops**

Question 14

Pathophysiology of Acute Aortic insufficiency

Answer 14

Normal heart, w/ acute increase in diastolic pressure
–> L heart failure bc can’t maintain EF w/o increasing compliance.
==> major sympathetic response

Question 15

Treatment for aortic insufficiency

Answer 15

Surgery to replace Aortic valve as soon as get symptoms or find LV dysfunction (may be asymptomatic)

Question 16

causes of Mitral Regurgitation

Answer 16

Acute: papillary rupture/stretch or chord perforation

Chronic: Rheumatic fever, dilated LV, Myxomatous degeneration

Question 17

acute vs. chronic Mitral Regurgitation (pathophys.)

Answer 17

Chronic: enlarged V wave, but keeps almost normal LA pressures bc increased compliance & dilation of LA.
Acute: Huge V wave, w/ massively increased LA pressures & pulmonary edema bc cannot handle increased LA volume.

Question 18

Determining severity of regurgitation

Answer 18

1. Compensation –> LA or LV pressures, higher = bad.
   
   • higher BP = more aberrant blood flow*
2. Duration of Regurgitation –> slower HR = more time in diastole & more regurgitation.
3. Size of regurgitant orifice –> larger opening = more regurg (bad).

Question 19

changes in chronic compensated Mitral Regurgitation

Answer 19

• Increased compliance –> increased LV volumes => normal diastolic P
• “very” normal EF (normal amt blood leaving LV, but some goes to LA & some goes to systemic circ.)

Question 20

Chronic decompensated Mitral Regurgitation

Answer 20

• LV compliance drops –> less compensation –> increasing diastolic P
• EDV increases, & ESV even more so –> contractility drops –> EF drops
• • same idea w/ acute MR, but normal LV compliance is not enough to compensate acutely ==> HIGH EF!**

Question 21

Symptoms of Mitral Regurgitation

Answer 21

Acute: pulmonary edema, short decrescendo murmur
Chronic compensated: dyspnea w/ exertion
Chronic DEcompensated: SOB, fatigue
*both chronics: R heart failure, edema, venous distension; holosystolic murmur

Question 22

signs of mitral valve prolapse

Answer 22

S3 & L displaced, diffuse apical impulse (LV dilation)

Question 23

Treatment for mitral regurgitation

Answer 23

Surgery #1 to repair valves, #2 replace if can’t repair.

–> depends on degree of Sx, size of regurg., etc.