Valve Disease (Newman) Flashcards
2 causes of endocarditis
bugs in blood and diseased valve
What determines the integrity of the valves?
leaflets/cusps
support network
cardiac chambers, great vessels
a narrowing of an orifice, lumen
stenosis
leakage upstream
regurgitation
What the size diff of healthy and stenotic valve?
3 cm vs 0.5 cm
in what valve does regurgication happen most common?
aorta (in diastole)»_space; mitral/left ventricle (in systole)
What is the cardiac adaptation to a stenotic valve?
Does a stenotic valve cause a pressure or volume overload?
inc thickness of wall = concentric hypertrophy
pressure overload due to inc pressure upstream
What is the cardiac adaptation to regurgitation?
Does a regurgitation cause an pressure or volume overload?
eccentric hypertrophy (enlarged chamber inc mass but normal thickness)
= heart dialtes without getting thicker!!
(volume overload bc volume increases upstream)
What is the thickness of the inter-ventricular septum?
1 cm
loud murmur without hypertrophy (eccentric)
acute regurgitation
What causes acute regurg? (3)
ischemia, infection, dissection
heart failure (PND, edema, JVD) chest pain syncope arrhymias ** could be asymptomatic
acute regurgitation
chest pain (angina)
Where on the chest would you hear mitral regurg
right under left nipple
mitral regurg murmur is heard during _____
systolic murmur
lub –fhh–dub
aortic regurg murmur is heard during _____
diastolic murmur
lub-dub-fhh
Where on the chest would you hear aortic regurg?
under right clavicle
aortic stenosis murmur is heard during _____
Systole
lub-ugh-dub (cough sound)
in mitral stenosis the first heart sound is
louder
how must a pt be positioned? WHat part of hand do you use to feel for it?
left lateral dequibitis
interphalngeal joints
Where will PMI be felt with eccentric hypertrophy?
axilla
What should the size of the PMI be normally? pathologic?
size of dime–> quarter
concentric hypertrophy is a risk factor for …
CAD
the gradient
?
left ventricle pressure < aorta
to determine the severity of the stenosis you must know…
gradient
CO (or Q)
inflammation, scarring of leaflets, chordae, and papillary muscles, frequent calcification
mitral stenosis
Clinical pres:
dyspnea, RHF, thrombi
mitral stenosis
HTN: left atrium > pulmonary bed > right heart
mitral stenosis
pulmonary artery catheter measures
left ventricular pressure?
disease affecting:
supporting valve structures
leaflets
dilation of left atria
mitral regurg
loud first heart sound
mitral stenosis
what is the most common cause of mitral regurg?
mitral prolapse
leaflets replaced by myxomatous tissue
mitral valve prolapse –> mitral regurg
eccentric hypertrophy is the result of
Chronic mitral regurg
inc preload with dec afterload
mitral regurg
What are the 2 most common causes of mitral regurg?
infection (endocarditis)
ischemia (MI)
loud murmus, pulmonary edema, without enlarged ventricle or atia
acute mitral regurg
hwo is accute and chronic regurg diff?
lack of hypertrophy = acute
lub- ugh -dub heard under right clavicle
aortic stenosis
tardus
delayed arterial pressure (stays a little longer on your finger)
parvus
weakened arterial pulse
concentric hypertrophy + tardus + parvus
aortic stenosis
angina
syncope
HF
sudden death
arotyic stenossi
lub-dub-shh under right clavicle
aortic regurg
wide pulse pressure
chronic aortic regurg
bacteremia + disease valve (or lesion)
2 requirements for endocaditis
combo of platelets + fibrin + bugs + RBCs and WBCs
vegetation
valve destruction –>
acute regurg
complications of infective endocarditis
valve destruction –> acute regurg
embolization
immunologic phenomena
What are the 3 indications for surgery in IE
- heart failure unresponsive to medical management
- uncontrolled infection
- recurrent major emboli
Turbulent flow is indicative of…
stenosis
Inappropriate timing is indicative of…
regurgitation
Severity of stenosis is determined by:
pressure gradient
CO
In mitral stenosis, the severity is proportional to
HR
SIgns of aortic regurg
widened pulse pressure
head bobbing
Endocarditis requires:
bacteremia
diseased valves
