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Clinical Medicine - Cardiology > Valve Disease - Part 2 > Flashcards

Valve Disease - Part 2 Flashcards

1
Q

Mitral Regurgitation Causes

A
  • Rheumatic
  • Dystrophic/Degnerative
  • Ischemia - secondary to coronary disease
  • Infective endocarditis - bacterial/fungal
  • Cardiomyopathies
  • CT disease - Marfans, etc
  • Prolapse
  • Myxomatous/Barlows disease
  • Trauma
  • Papillary mm rupture, dysfxn, displacement
  • LV aneurysm
  • Atrial myxoma
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2
Q

What is heart on heart exam of a patient with mitral regurgitation?

A

Loud pansystolic murmur transmitted to axilla

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3
Q

Mitral regurgitation

  • pressures
  • symptoms
  • heart changes
A

Inc LA pressure/PCWP/Pulmonary vein pressure

Fatigue, dyspnea, dec exercise tolerance, palpitations/a fib

Increased LA size

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4
Q

What is the difference between gradual and acute mitral regurgitation onset in terms of functioning?

A

With gradual changes, can accommodate extra load w/o pressure rise till late and then will become symptomatic

With acute MR, normal or small LA cannot accommodate with resultant acute pulmonary edema and possible in extremis status

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5
Q

With MR, which way does the mitral annulus dilate?

A

Posteriorly

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6
Q

LV functioning in mitral regurg

A

LV fxn (in chronic forms of MR) usually remained adequate for a long period of time

But eventually decompensated with LV dilation and decreased EF

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7
Q

What changes with been seen on CXR with mitral regurg?

A

Enlarged LA
Eventually LV dilation

Various degrees of pulmonary congestion
–depending on where you are on spectrum of disease

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8
Q

MItral regurg tx

A

Observation
-follow with serial echo exams

Medical

  • diuresis
  • afterload reduction
  • rhythm control
  • beta blockers

Surgery - repair if at all possible

  • MR repair
  • MR annuloplasty
  • MR replacement
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9
Q

If you have to do mitral valve replacement, what is an important step to take in the surgery?

A

Keep the posterior leaflet chords in tact to preserve LV geometry and function

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10
Q

Aortic stenosis causes

A
  • degenerative/calcific disease aka senile calcific
    • -most common
    • -may affect conduction system
  • congenital
  • rheumatic
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11
Q

Aortic stenosis pathology

A
  • increased after load with secondary impaired LV emptying in systole
  • concentric LV hypertrophy
  • LV less compliant
  • LVH can lead to LV failure
  • LV hypertrophy (inc mm mass, inc O2 demand)
  • Microinfarcts
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12
Q

With decreasing LV complicance, how does the functioning of the heart change?

A

Have to rely on LA from maintaining LV filling and CO

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13
Q

Classic symptoms of aortic stenosis

A

Angina
Syncope
CHF (manifested as exertional dyspnea)

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14
Q

Aortic stenosis and sudden death

A

AS can result in sudden death - 20%

AS is the most common “fatal” valve lesion

Most pts die of CHF

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15
Q

Aortic stenosis - clinical course in terms of symptomatic apperance

A

Asymptomatic for years

Symptomatic can be a malignant diagnosis w/o treatment

Average survival post onset of:

  • CHF – 2 years
  • syncope – 3 years
  • angina – 5 years
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16
Q

What findings are seen on exam of someone with aortic stenosis?
CXR?
EKG?

A

Exam - systolic ejection murmur in R 2nd ICS; diminished upstroke of carotid pulse

CXR - calcification of aortic valve/aorta, LVH, post-stenotic aorta enlargement

EKG - various changes can be seen, such as:

  • -BBB
  • -AV nodal block
  • -a fib
17
Q

Aortic stenosis treatment

A

Observation

Medical therapy

  • control HTN (careful in end stage disease)
  • control arrhythmias
  • cautious use of diuretics (don’t want to lower preload)

Surgery (its rare to repair valve)

  • aortic valve replacement
  • TAVR (transcath aortic valve replacment)
18
Q

Aortic regurgitation causes

A
  • Usually mixed AS/AR
  • Degenerative calcific AV disease
  • rheumatic
  • congenital
  • annuloaortic ectasia
  • marfans
  • myxoid degeneration aortic leaflets
  • aortic dissection
19
Q

What is annuloaortic ectasia

A

Abnormal dilatation of annulus and aortic root

Pulls leaflets of aortic valve apart to the point where they can’t touch each other

20
Q

Aortic regurgitation can be seen in association with

A
  • bacterial endocarditis
  • RA
  • ankylosing spondylitis
  • blunt/penetrating trauma
  • VSD
  • atrial myxomas
21
Q

What functional changes are seen with aortic regurgitation?

A
  • volume overload of LV
  • increased LVEDP/LV diastolic volume/wall stress
  • LV dilation and eventual failure
  • eccentric hypertrophy of LV
    • -inc chamber size and wall thickness
22
Q

What is the difference between eccentric hypertrophy and concentric hypertrophy?

A

Eccentric

  • with AR
  • increased chamber size and wall thickness

Concentric

  • with AS
  • increased wall thickness
  • no change in chamber size (until failure)
23
Q

Symptoms of Aortic Regurgitation

A
  • Angina (subendocardial ischemia)
  • Dyspnea
  • Orthopnea
  • PND
  • Syncope
24
Q

With aortic regurg, what change in pulse pressure is seen?

A

Widened pulse pressure

-can’t hold diastolic pressure because blood is rushing back

25
Q

What specially named symptoms, etc are seen with aortic regurg?

A
  • Austin flint murmur
  • Water hammer pulse
    • -Corrigan’s
    • -Watson’s
  • De Musset’s sign
  • Quincke’s pulse
  • Duroziez’s sign
  • Traube’s sign
26
Q

Austin flint murmur

A

when regurgitant jet hits anterior leaflet of mitral valve it tends to close it causes murmur at apex

27
Q

Water hammer pulse

A

Bounding and forceful peripheral pulse

  • -corrigan’s - when in carotid
  • -watson’s - when in limb
28
Q

De musset’s sign

A

Bobbing of head with cardiac cycle

29
Q

Quincke’s pulse

A

pulsating nail beds

30
Q

Duroziez’s sign

A

systolic/diastolic murmur over femoral arteries

31
Q

Traube’s sign

A

pistol shot sounds over large arteries

32
Q

What is seen on a CXR of aortic regurg?

A

LV enlargement
Enlarged ascending aorta
Pulmonary edema
Inc LA

33
Q

Treatment of aortic regurg

A

Observation

Medical

  • afterload reduction
  • diureticds
  • tx HTN

Surgery
- usually repair

34
Q

How long will various valve replacements last?

A

bioprosthetic valves

    • 10-20 years
    • no anti coagulation required

Mechanical vale

    • lifetime
    • but have to be anti coagulated

Clinical Medicine - Cardiology (11 decks)

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