Valve Disease Flashcards
Typical sxs of valvular dx?
fatigue dyspnea angina syncope palpitations
Aortic Stenosis definition?
narrowing of aortic outflow tract
Levels of Aortic Stenosis?
Aortic Valve (75%)
Supravalvular
Subvalvular
Aortic Stenosis etiology?
Congenital:
Sxs < 30yo = unicuspid valve
Sxs 30-65 = bicuspid valve
Sxs >65yo = degeneration and sclerosis of valve
Rheumatic valve disease
Course of Aortic Stenosis?
(U) asympt until severe
Death w/i 4 yrs of sxs
Aortic Stenosis sxs?
Early:
fatigue
dyspnea on exertion
Later: dyspnea w/ ADL angina syncope heart failure
Aortic Stenosis physical findings? (3)
1) Systolic ejection murmur - 2nd right ICS
2) Thrill - 2nd right ICS
3) Early systolic ejection click
Aortic Stenosis physical findings when severe?
Late peak systolic ejection murmur
Small pulse pressure
Gradation of murmurs: 1 out of?
6
barley audible to very loud
Aortic Stenosis lab findings:
ECG?
Initially normal
As LV hypertrophy (LVH) develops:
↑ QRS
Left axial deviation
Aortic Stenosis lab findings:
CXR?
Initially normal
LVH shows:
post-stenotic dilation of aorta
Aortic Stenosis lab findings:
Echo?
LVH:
calcified leaflets
Aortic Stenosis management?
Mild: follow
Mod: annual ECG, Echo, CXR
Severe: cardiology
Aortic Stenosis indications for intervention? (4)
1) Sxs: CHF sxs
2) Ejection fraction < 50%
3) CAD
4) Valve opening < 1cm
Hypertrophic Cardiomyopathy (HCM) definition?
Form of subvalvular AS:
Disease cardiac mm w/ severe hypertrophy in ABSENCE of cause for 2º hypertophy
Hypertrophic Cardiomyopathy etiology?
60% FH
Hypertrophic Cardiomyopathy affects LV how?
LV is hypercontractile w/ high wall stress,
Ejects all blood during systole
Hypertrophic Cardiomyopathy sxs?
Similar to AS
Murmur louder when standing or valsalvas (ascending aorts)
Aortic valve not calcified
No ejection sounds
Hypertrophic Cardiomyopathy tx?
Ca2+ channel blockers
β blocker
Aortic Regurgitation (Insufficiency) definition?
leak of blood back thru aortic valve @ diastole
Acute Aortic Regurg etiology? (3)
1) Aortic dissection
2) Latrogenic - cath/surgical
3) Endocarditis
Chronic Aortic Regurg etiology? (4)
1) Rheumatic val dx
2) Bicuspid aortic val
3) Dilated aortic root
4) CT dx (RA, Marfans, Ehler’s)
Aortic Regurg indications for intervention? (3)
1) Symptomatic
2) Asymp w/ EF < 55%
3) LVESD > 55mm, EDD >70mm
Chronic Aortic Regurg progression?
LV overload w/ gradual dilation/hypertrophy
Mild DOE
DOE and rest, orthopnea, noctural dyspnea
Post sxs survival <2yrs
Acute Aortic Regurg progression?
Pulmonary edema
Req’s urgent referral
Aortic Regurg physical findings?
Austin Flint murmur
Watson Waterhammer pulse
Widened pulse pressure
Low diastolic
Austin Flint murmur?
low-pitch diastolic @ apex
similar to diast mitral stenosis murmur
Wide pulse pressure due to?
↑ systolic P and ↓ diastolic P
Watson Waterhammer pulse?
Powerful upstroke, sudden disappearance
hallmark of AR
Aortic Regurg lab findings:
ECG?
LVH
Aortic Regurg lab findings:
CXR?
normal if acute
LVH if chronic
(P) CHF/pulm edema
Aortic Regurg lab findings:
Echo?
LVH
Aortic Regurg management?
Aysmp/mild: follow 6-12mo,
(P) Vasodilators (ACE inhib)
Symp: valve replacement
Mirtal Regurge definition?
leak of blood from LV into L atrium
Acute Mirtal Regurge etiology?
Papillary mm necrosis/rupture from eschemia
Endocarditis
Acute Mirtal Regurge tx?
(U) emergent surgery
Chronic Mirtal Regurge etiology?
Barlow's Synd Inherited MV prolapse Sub-acute endocartitis Rheumatic HD Acquired CT dx (SLE)
Barlow’s Syndrome is?
Common cause of Mirtal Regurge
Degeration of value tissue -> stretched leaflets
(C) w/ Grave’s, Marfan’s, MD
Mirtal Regurge progression?
LV enlarges to accommodate ↑ volume -> SV ↑ -> LA enlarges to accom ↑ vol -> Atrial fibr Pulm HTN RV hypertrophy
Mirtal Regurge sxs?
Dyspnea, fatigue
Arrhythmias
Pulm HTN
Mirtal Regurge physical findings?
High-pitch pansystolic murmur (apex to axilla)
Late:
S3, S4 gallops
JVD
hepatomegaly
Mirtal Regurge lab findings:
EKG?
LAEnlargement
LVH
(P) RVH
Mirtal Regurge lab findings:
CXR?
LAE
LVH
Mirtal Regurge lab findings:
Echo?
LAE
LVH
Hyperdynamic LV wall motion
Mirtal Regurge tx?
Afterload reduction w/ ACE inhib, vasodial
↓ sodium
Valve repair/replace
Mitral Valve Prolapse etiology?
Ballooning of mitral leaflets into LA during systole
Mitral Valve Prolapse physical findings?
mid-late systolic clicks
Mitral Valve Prolapse tx?
(U) benign
(P) β blockers
Mitral Stenosis definition?
Narrowing of mitral valve
Obstructs flow from LA to LV
Mitral Stenosis etiology?
(U) Rheumatic HD
Mitral Stenosis results in?
↑ LA P
↑ pulmonary HTN
Mitral Stenosis progression?
Asymp 20+ yrs post Rheum fever
7yrs between sxs and total disability
Mitral Stenosis sxs?
Plumonary congestion sxs
(U) atrial fibr
Mitral Stenosis physical findings?
Loud S1 w/ opening snap
Mid-dias rumbling murmur followed by pre-syst kick
Late:
loud P2 and RV heave
Mitral Stenosis lab findings:
EKG?
LAE
Late:
RVH
a fib
Mitral Stenosis lab findings:
CXR?
LAE
calcified mitral annulus
Late:
Kerley B lines
RVH
pulm cong
Mitral Stenosis lab findings:
Echo?
DIAGNOSTIC
Thick valves
↓ vale excursion
Mitral Stenosis lab findings:
Angio/Cath?
Giant LA Small LV LA HTN pulm HTN gradient LA to LVEDP
Mitral Stenosis management?
Mild: diauretics
Warfarin for a fib or significant LA enlarg
Valve surgery
Endocarditis sxs?
Viral-like
SOB, persistent cough
New murmur
Skin ∆s
Endocarditis indications for surgery: Class 1
Valve stenosis or regurg HF
Regurge w/ ↑ LVEDP or mod pulm HTN
Resistant organisms
Heart block, abscess, lesion
Endocarditis indications for surgery: Class 2
Recurrent emboli
Persistent veg > 1cm
Anticoag and Thromboembolism (TE) risks?
Older Female DM Malig HTN Alcohol
Tricuspid Valve Regurge etiology?
(U) 2º to RV dysfxn (vol overload, pulm HTN)
Result of LV failure
a/w pulmonary regurge, mechanical interference
