Valve Disease I Flashcards
Three pathological mechanisms in valve disease?
Stenosis
Regurgitation
Prolapse
Pathological mechanisms associated with Right Sided Heart failure?
Increased RV/RA/Central Venous pressure Increased JVD Hepatomegaly Ascites Edema
Pathological Mechanisms associated with L sided heart failure?
Increase LA/LV/Peripheral Arterial Pressure SOB CHF/Pulmonary Edema Decreased Ejection Fraction Decreased Systemic Perfusion
Important things to look for in EKGs?
A Fib, Atrial Enlargement, LVH
Important things to look for in CXR?
Chamber Size, Aortic Dilation, Pulm. Edema
Purpose of cardiac cath in valvular disease treament?
Pre-operative coronary artery evaluation
What might you be looking for in a CT scan or gated MRA?
Myxoma/Aorta size evaluation
Three types of valve replacement
Bioprosthetic
Mechanical
Autograft/Homograft
Three main causes of tricuspid stenosis?
Rheumatic
Carcinoid
Congenital
Rheumatic feveralmost always hits which valve?
Mitral
Tricuspid stenosis from Rheumatic fever usually does what to the valve
Regurgitation with variable stenosis
Rarely Pure Stenosis
Is there calfication in Tricuspid stenosis from Rheumatic fever?
Nope
The hallmark finding of Tricuspid stenosis from Rheumatic fever?
Commissural fusion of the valves
Carcinoid Tricuspid Stenosis is caused by…
Its secondary to serotonin production from liver mets
Carcinoid Syndrome characteristic symptoms
Flushing, Diarrhea, Palpitations
How does Carcinoid disease alter the heart?
Fibrous plaques on leaflets
Commissure fusion, thickened/shortened leaflets and chordae
Causes combined stenosis and regurg
Symptoms commonly seen in a tricuspid stenosis patient?
Excessive fatigue, Dyspnea Forward Failure (low preload, low SV, salt/water retention) Backward Failure (Hepatic congestion/peripheral edema)
What is seen in the physical exam of tricuspid stenosis?
Mid diastolic murmur over left lower sternal border
Increase with Inspiration
Enlarged, non-pulsatile liver
Peripheral edema
CXR findings in a tricuspid stenosis patient?
Increased RA, lack of PA enlargement, and clear lung fields
Pathognomonic
EKG findings in a tricuspid stenosis patient?
Prominent P waves unless A fib present
Echo findings in a tricuspid stenosis patient?
RA enlargement, leaflet thickening, measure gradient, look for associated lesions
Causes of tricuspid regurgitation?
Rheumatic Endocarditis Trauma Carcinoid Myxoma Diffuse Collagen disorders Fibroelastosis Congenital
Infective and Non-infective causes of endocarditis
Infective – IV drug abused fucking up their heart
Non – LSE
Physical findings in a tricuspid regurgitation patient?
Pansystolic murmur – max over lower sternal border
Increases with inspiration
Enlarged liver WITH PULSATIONS, Hepato-jugular reflex
JVD
Edema, Ascites, Anasarca
Common EKG finding in Tricuspid Regurg patients?
A Fib
How to treat a tricuspid valve regurg
Observe if mild.
Medical – treat functional disease, diuretics to drop afterload.
Surgical – Tricuspid valve ring valvuloplasty/repair, Commissurotomy, Replacement
Why use a C ring…
to avoid the conduction system
Common causes of tricuspid valve replacement?
Infective endocarditis
Carcinoid
Tricuspid Stenosis
Most common cause of pulmonary valve lesions?
Tetralogy of Fallot, Pulmonary Atresia
Four components of tetralogy of fallot
Pulmonary Stenosis, Overriding Aorta, VSD, Right Hypertrophy
What is a Ross Procedure?
Remove pulmonary valve to use as an autograft to replace Aortic valve
Why do mitral valve annuli expand?
Dilated with the LV
Describe the leaflets of the mitral valve?
Posterior 2/3 (typically do repairs here)
Anterior 1/3 fixed between, attached to skeleton
Consequences of Mitral stenosis?
Less LV blood flow, Lower CO
LA hypertrophy (A fib, mural thrombi, systemic embolism)
Pulmonary Hypertension/Vascular Resistance
Pulmonary edema if the pressure bumps up too much
Symptoms seen in a mitral stenosis patient
Cough/Congestion/Pulm. Edema Hemoptysis Orthopnea PND Cardiac Cahexia
What is cardia cachexia?
unintentional severe weight loss caused by heart failure
Ausculatory findings with Mitral stenosis?
apical diastolic rumble, Increased 1st heart sound, opening snap
Xray findings with Mitral stenosis?
Increased LA
Straigh L Heart Border
MV often calcified
Kerley’s Lines
How do people get mitral stenosis?
Rheumatic Disease
rarely, congenital lesions, myxoma, or senile calcific disease
Mitral stenosis – probably male or female?
Female in 2/3 cases
Echo findings in Mitral Stenosis?
LA enlagement, leaflet thickness, vegitiations, valve area, EF, associated lesions, thrombus, calcification, leaflet doming
Medical interventions for Mitral stenosis?
Follow echos, look for LA thrombus, MVA, valve gradient, PA pressures, etc.
Percutaneous Balloon commissurotomy
Who can go through Percutaneous Balloon commissurotomy?
MVA under 1.5, Minimal Ca, Favorable anatomy. NO LA thrombus Moderate/Severe MR
Will Pulmonary HTN improve after mitral stenosis treatment?
Usually
