Valve Disease Flashcards
What causes S1?
Closure of AV valves
What causes S2?
Closure of SL valves
In relation to S1 and S2 when does systole occur?
Between S1 and S2
In relation to S1 and S2 when does diastole occur?
Between S2 and S1
What is S3?
Vibration of ventricular wall as filling slows
When does S3 occur?
Middle third of diastole
When is S3 normal?
Children
Young adults
Pregnancy
If pathological, what is S3 called?
Ventricular gallop
If pathological what is S3 associated with?
CHF
Where would you see S3 on a phonocardiogram?
Closer to and after S2
When does S4 occur?
After atrial contraction
In who can S4 be normal?
Elderly
If pathological S4 is called?
Atrial gallop
In what rhythm is S4 impossible, and why?
A fib, because atria arn’t contracting
If pathological S4 can be seen with what conditions?
HTN
Atrial stenosis
Angina
MI
Where would you see S4 on a phonocardiogram?
After S2 but closer to S1
Where is auscultation of aortic valve?
Right sternal border
2nd intercostal space
Where is auscultation of pulmonic valve?
Left sternal border
2nd intercostal space
Where is auscultation of tricuspid valve?
Left sternal border
5th intercostal space
Where is auscultation of mitral valve?
Mid-clavicular line
5th intercostal space
What is valve stenosis?
Valve leaflets adhere and are difficult to open
What is valve regurgitation/insufficiency?
Leaflets don’t seal and are difficult to close
What causes the sound of a heart murmur?
Valve lesions cause turbulent flow which is heard as a murmur
What valve diseases cause a systolic murmur?
Aortic stenosis
Mitral insufficiency
What valve disease cause a diastolic murmur?
Aortic insufficiency
Mitral stenosis
What murmur is the loudest of all the murmurs?
Aortic stenosis
How does the normal valve function?
Responds to pressure gradients
Opens easily
Leaflet edges seal completely
Describe a stenotic valve, it’s opening, and what kind of pressure is required
Stiff and calcified
Difficult to open
Requires greater pressure
Describe the leaflets of a regurgent valve, and it’s seal
Leaflet edges are uneven
Fails to seal so it leaks
Difficult to close
Which valves are the atrioventricular valves?
Right: tricuspid
Left: mitral
Which valves are the semilunar valves?
Right: pulmonic
Left: aortic
Systolic murmur would be heard when (in relation to S1 and S2)?
Between S1 and S2
Diastolic murmurs would be heard when (in relation to S1 and S2)?
Between S2 and S1
-think “luv dub whoosh”
What is the primary hemodynamic effect of valve disease?
Decreased forward flow
What are the secondary hemodynamic effects of valve disease?
Compensation maintains forward flow, but eventually decompensation occurs
Some congenital syndromes involve what other valves?
Tricuspid or pulmonic
In general adults get valve disease because of?
Congenital anomaly
What other way does valve disease occur?
It’s acquired
What causes chronic acquired valve disease?
Congenital anatomical anomaly
Aging
Associated disease: Marfan’s, lupus, cardiomyopathy, etc
History of Rheumatic fever
What causes acute acquired valve disease?
Acute events:
Ischemia
Endocarditis
Trauma
What is the problem with aortic valve disease?
Decreased forward SV
What compensatory mechanisms occur with aortic valve disease?
LV hypertrophy
Increased blood volume
Why does blood volume increase as a compensatory mechanism of aortic valve disease?
Decreased forward flows causes renal retention of fluid
RBCs increase in response to tissue hypoxia
How does increased blood volume help compensate with aortic valve disease?
Helps maintain venous return
Increases LVEDP and LVEDV
How does LV hypertrophy help with compensation of AV valve disease?
Hypertrophied muscle increases force of contraction
How/why does AV valve disease lead to ischemia without CAD? (4)
Increased ventricular SBP inhibits coronary flow
Increased muscle mass means increased O2 need
Increased LVEDP means decreased CPP
DBP is decreased in aortic regurgitation
Anything that increases LVEDP decreases ______?
CPP
CPP =
DBP-LVEDP
What is the overall problem with mitral valve disease?
Decreased forward SV
What are the compensatory mechanisms with MV disease?
Increased blood volume
How does increased blood volume help compensate for MV disease?
Decreased forward SV causes renal retention which helps maintain venous return
What are the consequences of MV disease? (4)
Enlarged LA
Pulmonary edema
Atrial dysrhythmia
Loss of atrial kick
What is the overall goal of valve disease?
Promote forward flow
Stenotic valve diseases are described by?
Pressure gradient across the valve
