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Cardiology Exam 2 > Valve Disease > Flashcards

Valve Disease Flashcards

1
Q

5 Causes of Mitral Stenosis

A
  • Congenital
  • Systemic inflammatory diseases - SLE, rheumatoid arthritis, carcinoid syndrome
  • Pseudomitral stenosis - anatomically normally but outside thing blocking - vegetation or tumor
  • Mitral Annular Calcification - esp in elderly
  • Rheumatic valvular disease
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2
Q

Gorlin Formula

A
  • Pressure gradient = SQROOT (CO/ MVA x DFP x 44.3)
  • MVA - mitral valve area
  • DFP - diastolic filling time; so high DFP if low HR and vice versa
  • Pressure gradient inc/ worse if… inc CO, inc HR or smaller mitral valve area)
  • Pressure gradient dec/better if… dec CO, dec HR or larger mitral valve area
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3
Q

Pre-Capillary v. Post-Capillary Block (+ symptoms associated w/ ea)

A
  • “Post-capillary block” - L atrial pressure rises to overcome blockage –> pressure gradient b/n L atrium and L ventricle; back up to inc pulmonary pressure which inc hydrostatic pressure in pulmonary capillaries –> inc interstitial fluid so pulmonary edema
  • Dyspnea
  • SOB when supine b/c inc preload (orthopnea)
  • Cough
  • Chest pain
  • “Pre-capillary block” -body compensates by constricting pre-capillary beds which causes inc pressures in R heart (greater afterload/resistance to overcome) –> hypertrophy
  • Peripheral edema
  • Fatigue (b/c less CO)
  • Hoarsness b/c pulmonary artery dilated so compresses recurrent laryngeal
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4
Q

Sounds of Mitral Stenosis v. Aortic Stenosis

A

MITRAL

  • Diastolic rumble (low pitch) - b/c pressure is high in atria, turbulent flow as soon as mitral opens (then gone as pressure equalizes b/n chambers PAUSE) - then reoccurs at end of diastole w/ atrial kick if worse then persists–> Holodiastolic rumble (low pitch)
  • Opening snap (high pitch) - when mitral opens and reaches elastic limits; gets earlier as stenosis worsens

AORTIC

  • Systolic ejection murmur from turbulent slow across valve (in systole); crescendo-decrescendo; as it gets wrose peak becomes later and A2 becomes later
  • S4 - turbulence from atrial kick b/c ventricle so stiff
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5
Q

Valve Regurg/Stenosis Meds

A

Diuretics (dec vol)

Digoxin/ionotropes in aortic stenosis (inc contractility to overcome blockage)

Vasodilators (except for aortic stenosis b/c will further dec CO)

Rate controllers in mitral stenosis

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6
Q

Surgical Options

A

Replace valve - mechanical requires blood thinners/damages RBCs & bio less durable/calcification
new TAVR for aortic valve replacement - done by cath alone

Repair mitral valve or clip mitral valve leaflets together in mitral regurgitation (get rid of extra)

Percutaneous Balloon Valvuloplasty in mitral or aortic stenosis

IABP (inflates in diastole/deflates in systole) for mitral regurg but not aortic regurg

Can replace aortic root if that is the problem in aortic regurgitation

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7
Q

Acute v. Chronic Response to Mitral Regurgitation

A
  • ACUTELY … no compensatory change in compliance so inc in L atrium pressure –> back up –> pulmonary edema
  • CHRONICALLY- compensatory inc in L chamber compliance/ eccentric L ventricle hypertrophy (elongated - dilated) so that change in vol creates less change in pressure and maintain same forward SV into aorta
    • End diastolic pressure volume curve shifts right and down
  • BUT VISCIOUS CYCLE… as ventricle enlarges the annula becomes dilated so worse regurgitation
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8
Q

Sounds in Mitral Regurgitation v Aortic Regurgitation

A

MITRAL

  • Pan or holo-SYSTOLIC murmur - starts when mitral closes and lasts all of systole (b/n S1 and S2)
  • If severe… early diastolic rumble - build up in atria –> turbulence once mitral opens (S3)

AORTIC

  • Decresendo DIASTOLIC murmur starting w/ A2 (decresendo as retrograde flow dec)
  • Systolic ejection murmur may be present b/c more vol to eject
  • Flint murmur - low diastolic murmur like mitral stenosis b/c back flow impairs mitral valve
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9
Q

Mitral Valve Prolapse (cause and complications)

A
  • Myxomatous degeneration of mitral valve w/ redundant leaflets (too long for diameter of L ventricle)
  • Means fibrous valve replaced w/ gel-like, unstructured substance; THICK and parachute like
  • Mid to late systolic click (when leaflets reach elastic limits in atrium); Can be followed by late systolic mitral regurg murmur
    • If dec ventricle vol … hear click and murmur earlier
    • If inc ventricle vol… hear click and murmur later

*Chordae tendinae can rupture —> immediate heart failure

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10
Q

Mitral Valve Prolapse (cause and complications)

A
  • Myxomatous degeneration of mitral valve w/ redundant leaflets (too long for diameter of L ventricle)
  • Means fibrous valve replaced w/ gel-like, unstructured substance; THICK and parachute like
  • Mid to late systolic click (when leaflets reach elastic limits in atrium); Can be followed by late systolic mitral regurg murmur
    • If dec ventricle vol … hear click and murmur earlier
    • If inc ventricle vol… hear click and murmur later

*Chordae tendinae can rupture —> immediate heart failure

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11
Q

4 Physical Exam Signs of Aortic Stenosis

A
  • Hypertrophy —> PMI becomes more inferolateral and pre-systolics have (can feel when atria contracts to push blood into STIFF ventricle)
  • Smaller and delayed carotid pulse (pulses parvus et tardus)
  • EKG - left axis deviation, L atrium or L ventricle enlargement
  • Also see cardiomegaly on chest X-ray
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12
Q

3 Cardinal Symptoms of Aortic Stenosis

A
  • Usually long latent period then downhill once these develop…

1-Angina (inc wall stress inc oxygen demand while dec CO and thus coronary flow)

2-Syncope (dec CO)

3-Dyspnea/CHF (inc in L ventricle EDP backs up whole heart)

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13
Q

4 Causes of Aortic Stenosis

A
  • Congenital - bicuspid valve (present in 30s-50s)
  • Rheumatic (problem starts at tip of valve)
  • Degenerative calcification (present in 70s-80s - problem starts at base)
  • Systemic inflammatory diseases - rheumatoid arthritis, ankylosing spondylitis
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14
Q

5 Causes of Aortic Regurgitation

A
  • Rheumatic valve disease
  • Endocarditis (vegetations)
  • Aortic root disease - aortic aneurysm or dissection
  • Systemic diseases - lupus, rheumatoid arthritis, ankylosing spondylitis, etc
  • Congenital - bicuspid aortic valve, subaortic membranes, ventricular septal defects
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15
Q

5 Physical Exam Signs of Aortic Regurgitation

A
  • Lateral PMI b/c cardiomegaly
  • Quincke’s sign - prominent pulsations in cap beds of fingernails (compress fingernail)
  • Corrigan’s/Water hammer pulse - exaggerated peripheral pulse
  • Deroziez’s sign - systolic femoral murmur if compress proximal femoral artery; diastolic murmur if compress distal vessel
  • Hill’s sign - >60 mmHg diff in brachial v popliteal systolic pressures
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16
Q

Why does aortic regurgitation lead to inc in pulse pressure?

A

High systolic - large EDV ejected into aorta

Low diastolic -then back flow of blood from aorta —> L ventricle means low diastolic pressure in aorta

17
Q

Rheumatic Valve Disease Criteria

A

need 2 major or 1 major and 2 minor

  • Major
    * Carditis (myocarditis, pericarditis or valvulitis)
    * Polyarthritis (asymmetrical, migratory and larger joints like knee, shoulder, elbow)
    * Chorea (if basal ganglia affected - rapid jerky movements “St Vitus’ Dance”)
    * Subcutaneous nodules (painless, moveable, on elbows and knees)
    * Erythema marginatum
  • Minor
    * Arthralgia (diffuse joint pain)
    * Fever
    * High ESR or cRP
    * Inc PR interval on EKG
18
Q

Carcinoid Heart Disease

A
  • Carcinoid tumor (somewhere else in body -GI) secretes hormones/vasoactive compounds that damage RIGHT side of heart
  • Serotonin, histamine, bradykinin, prostaglandins
  • Results in thick plaques on RIGHT sided valves
19
Q

4 Types of Endocarditis (distinguishing features)

A

1- Rheumatic (first inflammation then scars later in life)

2- Infectious

3- Non-bacterial Thrombotic Endocarditis (NBTE) (“Marantic Endocarditis”)

    * Usually in cancer patients 
    * Thrombus on valve w/o bacteria or inflammation/ BLANK/clear on histo slides
    * Can flick off valve and travel (stroke if on L valves) 
        * “Pt with cancer that later has stroke”

4- Libman-Sacks Endocarditis

    * SLE or other autoimune diseases 
    * Thrombi on both OUTSIDE and INSIDE of valve surface 
    * Fibrin/debris
20
Q

When does eccentric hypertrophy take place? When does concentric hypertrophy take place?

A

Eccentric - elongated (so large radius but thin); dilated
-In mitral regurgitation and aortic regurgitation (in both instances this is chronic compensation for volume overload; inc compliance; EDPVR shifts right and down)

Concentric - thick walls
-In aortic stenosis (dec in compliance so ventricle is very stiff and EDPVR shifts up and left)

Cardiology Exam 2 (13 decks)

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