Valve Disease

Question 1

What is the order of the blood flow through the valves?

Answer 1

tricuspid–> pulmonary–> mitral–> aortic

Question 2

Tricuspid Valve: Location

Answer 2

between right atrium and right ventricle

Question 3

Pulmonary Valve: Location

Answer 3

exiting valve between right ventricle and pulmonary artery

Question 4

Mitral Valve: Location

Answer 4

between left atrium and left ventricle

Question 5

Aortic Valve: Location

Answer 5

exiting valve between left ventricle and aorta

Question 6

While three of the valves have 3 “leaflets”, which one only has 2 “leaflets”?

Answer 6

mitral valve

Question 7

When do the tricuspid and aortic valves open and close?

Answer 7

• open during systole
  -allow blood flow from the contracting ventricles out of the heart
  -close with diastole
  -can tell you about symptomology if these valves are damaged

Question 8

Valve Abnormalities (5)

Answer 8

wear and tear
calcification
pannus
endocarditis
thrombus

Question 9

Valve Abnormalities

Answer 9

leads to stenosis or regurgitation

stenosis: very tight and hard for the blood to get through
regurgitation: very loose and the blood flows backward with increased pressure

Question 10

Stenosis often affects what valve?

Answer 10

aortic

Question 11

Regurgitation usually affects what valve?

Answer 11

mitral

Question 12

Aortic Stenosis: Definition

Answer 12

blood is unable to flow freely from the left ventricle to the aorta

Question 13

Aortic Stenosis: Symptoms (4)

Answer 13

often asymptomatic
syncope
light headedness
chest pain
pulmonary edema
-sound/look like:
rhonchi, crackles,
cough, pulmonary
congestion

Question 14

Mitral Regurgitation: Definition

Answer 14

blood leaking back through the mitral valve into the left atrium (aka mitral valve insufficiency)
can be acute or chronic

Question 15

Mitral Regurgitation: Symptoms (2)

Answer 15

fatigue
SOB

Question 16

Infective Endocarditis (IE)

Answer 16

infection on the valve itself or you get vegetations on the valve
these pieces of vegetation can actually break off during contraction and travel to other places
-lungs
-brain or somewhere
else in the body
-can become SEPTIC
EMBOLI

Question 17

IE commonly affects which valve?

Answer 17

tricuspid

Question 18

IE: Risk Factors (3)

Answer 18

prosthetic valve
pacemaker-associated
IV drug abuse (IVDA)

Question 19

IE: Symptoms

Answer 19

fever
chills
anorexia
weight loss
myalgias: pain in muscles
arthralgias: joint pain
heart murmur

-depending on which valve is affected, signs of ischemia or infarction of the extremities, spleen, kidney, bowel, or brain may be the initial CM of IE
-septic emboli can lodge in a cerebral artery or arteriole and cause an ischemic stroke. NEUROLOGICAL symptoms from embolic stroke occur in up to 40% of pts. with IE
-Pts. may also present with meningitis, seizures, encephalopathy, or abscesses of the brain

Question 20

Septic Emboli in IE: Patho

Answer 20

microorganisms travel into the heart, adhere to damaged endothelial tissue, and attract WBCs and platelets, which release cytokines and coagulation factors–> stimulation of the coagulation cascade results in fibrin deposition, and development of a vegetation–> fragments of vegetations can embolize into the circulation—-> carried by the bloodstream, they can initiate infection or ischemia in remote tissues

Question 21

Vegetations are most commonly found on _____

Answer 21

valve leaflets

Question 22

IE: Septic Emboli: Classic CM (5)

Answer 22

-petechiae
-splinter hemorrhages
(linear streaks in the
nailbeds)
-Janeway lesions
(erythematous,
nontender lesions on the
palms and soles)
-Osler’s nodes
(subcutaneous nodules
in the pulp of the
fingertips)
-Roth spots
(oval retinal
hemorrhages with pale
centers)

Question 23

IE in IV Drug Abusers

Answer 23

-the veins are portal of entry, and S. aureus, the flora of the skin, most commonly causes bacteremia
-S. aureus travels from the peripheral vein into the inferior vena cava and into the right side of the heart
-the tricuspid valve is most often affected in IV drug users (blood flow goes through this valve first)
-septic emboli can enter the pulmonary artery–> lungs