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Clinical Medicine - Cardiology > Valve Disease - Part 1 > Flashcards

Valve Disease - Part 1 Flashcards

1
Q

Which valves have 3 leaflets?

Which valves have 2 leaflets?

A

3: tricuspid, pulmonic, aortic
2: mitral

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2
Q

What are the basic types of pathologic mechanisms seen with valve disease?

A

Stenosis
Regurgitation
Prolapse

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3
Q

Right Sided Heart Failure - what physical changes do we see with this?

A 
Increased RV pressure
Increased RA pressure
Increased CVP
Increased JVD
Hepatomegaly
Ascites
Edema
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4
Q

Left Sided Heart Failure - what physical changes do we see with this?

A 
Increased LV pressure
Increased LA pressure
Increased PA pressure
Shortness of breath
CHF
Decreased EF
Decreases systemic perfusion
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5
Q

What tests can help you diagnose valve disease?

A 
History and physical
EKG
CXR
Echo - TTE, TEE, 3D
Cardiac cath
Swan ganz cath
CT scan/Gated MRA
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6
Q

What are the basic options for tx of valve disease?

A 
Observation
Medical
Percutaneous
--balloon valvulopasty
--TAVR (Transcatheter aortic valve replacement)
Surgery
--repair
--replacement
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7
Q

What are the causes of tricuspid stensosis?

A

Rheumatic
Carcinoid
Congenital

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8
Q

Tricuspid Stenosis - Rheumatic cause

  • Seen in combo with …
  • Usually what type of disease
  • Hallmark is …
  • What changes are seen?
  • Calcification?
A
  • Seen in combo with mitral rheumatic disease
  • Usually regurg with variable stenosis
    • -rare causes may be pure stenosis
  • Hallmark is commissural fusion
  • Chordal thickening and mild fusion
  • Calcification absent
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9
Q

Tricuspid Stenosis - Carcinoid cause

  • Secondary to …
  • Deformity?
  • Leaflets?
  • What changes are seen?
A
  • Seen secondary to serotonin production
  • Seen with carcinoid syndrome
  • Cicatricial deformity in TV and PV
  • Fibrous plaques form on leaflets
  • Commissure fusion, leaflets thicken and shorten, chordae become thick and fused
  • Combined stenosis and regurg
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10
Q

Symptoms of tricuspid stenosis

A

Excessive fatigue

Dyspnea (can be from associated left sided lesions)

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11
Q

What kind of failures are seen with tricuspid stenosis?

A

Both forward and backwards failure

Forwards

  • decreased LV preload
  • decreased SV
  • salt and water retention via RAA system

Backwards
-hepatic congestion and peripheral edema

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12
Q

What kind of murmur is heard with tricuspid stenosis?

A

Mid-diastolic murmur over left lower sternal border

Murmur increases on inspiration

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13
Q

What findings does a CXR show with tricuspid stenosis?

EKG?
Echo?

A

CXR!!!! Pathognomonic

  • increased RA
  • lack of pulmonary artery enlargement
  • clear lung fields

EKG - prominent P waves (unless a fib)

Echo

  • RA enlargement
  • leaflet thickening
  • measure gradient
  • look for associated lesions
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14
Q

What are the causes of tricuspid regurgitation?

A
  • Rheumatic
  • Endocarditis
  • Trauma
  • Carcinoid
  • Myxoma
  • Diffuse collagen disorders
  • Fibroelastosis
  • Functional (majority due to MV disease mainly)
  • Congenital: Ebstein’s Anomaly
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15
Q

What is ebstein’s anomaly?

A

Ventricularization of tricuspid valve

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16
Q

What findings might you see with tricuspid regurgitation?

A
  • PANSYSTOLIC murmur maximal over lower sternal border
  • murmur increases with inspiration
  • enlarged liver - systolic pulsitations, tender
  • JVD
  • Hepatojugular reflex present
  • Edema
  • Ascites
  • Anasarca
17
Q

What other finding will you see in a majority of patients that have tricuspid regurgitation?

A

Atrial fib

18
Q

What are the tx options for tricuspid valve disease?

A

Observation
–a majority of lesions fall into this category

Medical

  • -tx left sided valve lesions for function disease
  • -diuretics for possible after load reduction

Tricuspid valve ring valvuloplasty/repair

Commissurotomy
–mostly for congenital disease

Tricuspid valve replacement

19
Q

Pulmonary valve lesion are mainly …

A

congenital lesions

e.g. tetralogy of fallout, pulmonary atresia

20
Q

What is a Ross procedure?

A

Remove pulmonary valve to use as an autograph to replace Aortic valve

  • –valve can grow with child as child grows
  • –can be done in adults occassionally
21
Q

What are the important anatomical components of the mitral valve?

A
  1. Leaflets - two - anterior and posterior
  2. Annulus - hinge on which leaflets are attached
  3. Chordae tendineae - from papillary mm to actual leaflet
  4. Papillary mm
22
Q

Mitral Stenosis

  • flow
  • CO
  • Size
  • Consequences
A
  • Decreased flow to LV
  • Decreased CO (b/c dec SV) - fatigue, mm wasting, weakness
  • LA hypertrophy (LV normal or small)
  • Pulmonary HTN
  • Increased pulmonary vascular resistance
  • pulmonary edema (if mean LA pressure exceeds oncotic pressure of plasma)
23
Q

Mitral stenosis symptoms

A 
Pulmonary congestions
Cough
Hemoptysis
Orthopnea
PND (paroxysmal nocturnal dyspnea)
Pulmonary edema
Dyspnea on exertion
Cardiac cachexia
24
Q

What auscultory triad is seen with mitral stenosis?

A

Apical diastolic rumble
Increased 1st heart sound
Opening snap

25
Q

What findings are seen on CXR with mitral stenosis?

A

Increased LA
Normal cardiac size
Straight left heart border

Often MV is calcified - this can be seen on CXR, echo, cath

26
Q

What are Kerley’s Lines?

A

Seen with severe mitral stenosis

Engorged pulmonary lymphatics

27
Q

What is nearly the exclusive cause of mitral stenosis?

A

Rheumatic disease

except for rare congenital lesions, extra-valvular causes like myxoma, and severe senile calcific disease

28
Q

Progress mitral stenosis eventually results in …

A

fibrosis of leaflets, commissures, subvalvular apparatus, and calcifies

29
Q

What are the findings on ECHO with mitral stenosis?

A 
LA enlargement
Leaflet thickness
Vegetations
Changes in valve area and EF
Associated lesions
Thrombus
Calcification

Leaflet “doming” secondary to restrictive opening of the stenotic valve

30
Q

Mitral Stenosis Tx

A

Observation/medical

  • centered on following echo exams on asymptomatic patients
  • medical tx of a fib and HR control

Percutaneous balloon commissurotomy

  • in symptomatic patients with MVA less than/equal to 1.5
  • in pts with minimal calcium and favorable anatomy in the absence of LA thrombus and mod-severe MR

Commissurotomy or replacement

Repair for rheumatic disease

Clinical Medicine - Cardiology (11 decks)

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