Valve Disease II Flashcards
Causes of Mitral Regurgitation?
Rheumatic Dystrophic/Degenerative Ischemic/MI Infective Endocarditis Connective Tissue Diseases Prolapse Myxomatous/Barlows Disease Trauma
Auscultory findings in mitral regurgitation
Loud pansystolic murmur transmitted to axilla
Effects of Mitral Regurg on the body
Increase LA, Pulmonary vein pressure
Fatigue, Dyspnea, Decreased exercise tolerance, Palpitations
Respiratory Symptom associated with acute MR
Flash edema from increase in the pressure without time to accomodate it
Mitral regurgitation CXR findings?
Enlarged LA and eventually LV
Various degrees of pulmonary congestion
Mitral regurgitation treatment?
Observe in mild cases, watch for thrombus
Medical treatment – diuresis, rhythm control/anticoag
Surgical - MV repair, replacement is you have to
Drug mentioned to help control heart rhythm?
Amnioderone
What heart structures are preserved in MV replacement?
Posterior leaflet chords (to preserve LV geometry and function)
Causes of aortic stenosis
Degenerative/Calcific (Most common)
Congenital (Bicuspid most common, earlier age)
Rheumatic
Concern with calcific aortic stenosis?
May affect the conduction system if Ca extends to the conduction system
Pathology of Aortic Stenosis
Increased afterload with impaired LV emptying in systole
Concentric LV hypertrophy, diminishing compliance
Atrial systole becomes more and more important
LV hypertrophy can eventually cause LV failure
Hypertrophy increases blood requirements for ventricle
Classic symptoms of aortic stenosis
Angina, Syncope, CHF
Most common fatal valve lesion
AS
Most untreated AS patients will die of…
CHF
Physical findings of aortic stenosis?
Systolic ejection murmur in the 2nd ICS
Radiated to the carotids
EKG findings with aortic stenosis
LVH
May have IVC delays like R and L BBB, AV nodal block, atrial fib
CXR findings with aortic stenosis?
Calcification of the aortic valve/aorta
LVH
Post stenotic aorta enlargement
Echo measurement done in aortia stenosis
measure AVA (0.8 or less is severe)
Medical therapy for aortic stenosis?
Control hypertension (be careful with diuretics) Control arrythmias
What to do for a high risk patient who needs replacement but is too high risk
Transcatheter Aortic Valve Replacement
Causes of aortic regurgitation?
Calcific AV disease, Congenital, Rheumatic
Endocarditis, aortic dissection,
Annuloaortic ectasia, RA, VSD, Myxoma
What is annuloaortic ectasia?
abnormal dilation of the annulous and aortic root
Associated with Marfans
Changes of the heart in aortic regurgitation?
Eccentric hypertrophy of the LV
(Increased chamber size AND increased wall thickness)
Can cause massive dilation of LV - Cor Bovinum
Symptoms associated with aortic regurgitation?
Dyspnea, Orthopnea, PND, Angina
Rarely – Syncope
