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Cardiology: Exam > Valve Disorders > Flashcards

Valve Disorders Flashcards

1
Q

Name the Semi-Lunar Valves.

A

Aortic
Pulmonary

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2
Q

How many leaflets do the Semi-Lunar Valves have?

A

3

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3
Q

Name the Atrioventricular Valves.

A

Mitral
Tricuspid

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4
Q

What acts as the anchor to attach the valves to the heart muscle?

A

Annulus (Fibrous Ring)

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5
Q

Leaflets on the on the Aortic Valve close edge-to-edge via a fibrous collagen called the what?

A

Commissures

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6
Q

The walls of the Aorta bulge out slightly behind each leaflet and form what?

A

Sinus of Valsalva

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7
Q

What is the name of the opening that leads to the Coronary Arteries?

A

Ostia
(Right + Left)

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8
Q

When do Coronary Arteries fill?

A

Diastole

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9
Q

In patients with Aortic Stenosis due to a Congenital Bicuspid or Unicuspid valve, when do symptoms usually occur?

A

Around 50 Years Old

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10
Q

Does Aortic Stenosis that is acquired typically progress to the point where it is obstructive and hemodynamically significant?

A

No
(Only about 10% of cases)

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11
Q

What accounts for about half of all occurrences of Aortic Stenosis?

A

BICUSPID VALVES

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12
Q

Type of Aortic Stenosis with a Bicuspid or Unicuspid Valve.
Fibrinous fused commissures.
Symptoms start around the age of 50.

A

Congenital Aortic Stenosis

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13
Q

Type of Aortic Stenosis with Nodular Calcification.
3 Cusp Valve with no commissural fusion.
Limited Leaflet Movement.
Symptoms begin around the age of 70.

A

Degenerative Calcific Aortic Stenosis

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14
Q

Type of Aortic Stenosis with Fibrous Thickening.
3 Cusp Valve with mild calcification. About half of the patients have a history of Rheumatic Fever.
Commissures are fused.

A

Rheumatic Aortic Stenosis

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15
Q

In Aortic Stenosis, mild valve thickening or calcification affects normal leaflet motion. As the disease progresses, this causes what?

A

Thicker Leaflets
Calcium Nodules
New Blood Vessels

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16
Q

In Aortic Stenosis, calcium nodules located within the layers of the leaflet bulge outward toward the aorta and extend to the sinuses of Valsalva causing what?

A

Restricted Leaflet Motion
Obstruction of Left Ventricular Outflow

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17
Q

As the left ventricle encounters chronic resistance from the Aortic Stenosis, what happens to the heart?

A

Left Ventricular Hypertrophy

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18
Q

Left Ventricular Hypertrophy causes an increase in what?

A

Increased Diastolic Pressure
(Stiffer walls = harder to fill, must overcome that pressure)

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19
Q

Left Ventricular Hypertrophy ultimately results in what?

A

Reduced LV Systolic Contractility
(EF < 50%)
- Left Ventricle can no longer generate enough pressure to overcome the after load.

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20
Q

What bacteria causes Rheumatic Fever?

A

Group A Strep.

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21
Q

What valves are typically affected by Rheumatic Fever?

A

Mitral
Aortic

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22
Q

Chronic inflammation due to Rheumatic Fever may cause what?

A

Narrowing of the Valves

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23
Q

Systolic Ejection Murmur that peaks in early systole and progressively later as the severity progresses.

A

Aortic Stenosis

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24
Q

What is the sound pattern of Aortic Stenosis?

A

Crescendo-Decrescendo

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25
Q

Where is Aortic Stenosis best heard?

A

Upper Right Sternal Border
- May radiate to Carotids

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26
Q

How do you diagnose Aortic Stenosis?

A
  1. EKG
  2. Chest X-Ray
  3. Echocardiogram
  4. Cardiac Catheterization
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27
Q

What is the GOLD STANDARD for diagnosis of Aortic Stenosis?

A

Transthoracic Echo
(2-dimensional Doppler)

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28
Q

When is Aortic Stenosis considered severe or hemodynamically important?

A

Jet Velocity > 4.0
Pressure > 40
Valve Area < 1.0

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29
Q

What is the only effective treatment for Symptomatic Severe Aortic Stenosis?

A

Surgical Repair
(Valve Replacement)

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30
Q

Without surgical intervention, what is average life expectancy of a patient with Severe Aortic Stenosis?

A

2 - 3 Years

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31
Q

What can you absolutely NOT give to a patient with Aortic Stenosis when treating their hypertension?

A

Beta Blockers

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32
Q

Repair of the Aortic Valve of a patient less than 60 years old will be done via what?

A

Mechanical Prosthesis
(Must be on Anticoagulation!)

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33
Q

Repair of the Aortic Valve of a patient older than 60 will be done via what?

A

Porcine or Bovine Valve
(Does not need anticoagulation)

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34
Q

How long do Porcine or Bovine Valves typically last?

A

10 - 15 Years

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35
Q

Diastolic leakage of blood from the Aorta into the Left Ventricle.

A

Aortic Regurgitation

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36
Q

What are two causes of Aortic Regurgitation?

A

Congenital Bicuspid Aortic Valve
Dilation of Aortic Root

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37
Q

Is Acute or Chronic Aortic Regurgitation a medical emergency?

A

Acute Aortic Regurg

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38
Q

What are the most common causes of Acute Aortic Regurgitation?

A

Aortic Dissection
Endocarditis (IV Drug Use)

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39
Q

What is the most common cause of Chronic Aortic Regurgitation?

A

Bicuspid Aortic Valve

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40
Q

How long do most patients with Chronic Aortic Regurgitation remain asymptomatic for?

A

Decades

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41
Q

What does Aortic Regurgitation ultimately result in?

A

Congestive Heart Failure

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42
Q

What is the sound pattern of Aortic Regurgitation?

A

Decrescendo with Blowing
(High Pitched)

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43
Q

Where is Aortic Regurgitation best heard?

A

Left Sternal Border
Exhalation

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44
Q

What is seen with the blood pressure in Aortic Regurgitation?

A

Wide Pulse Pressure

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45
Q

What happens to diastolic pressure in Aortic Regurgitation?

A

Drops Rapidly
(Blood is spilling back into the LV)

46
Q

What are some symptoms seen in patients with Aortic Regurgitation?

A

Exertional Dyspnea + Fatigue
Paroxysmal Nocturnal Dyspnea
Pulmonary Edema

47
Q

Murmur that is caused by the regurgitant flow causing vibration of the mitral apparatus, is lower pitched and short in duration.

A

Austin-Flint Murmur

48
Q

Manifestations of severe chronic Aortic Regurgitation are often due to what?

A

Widened Pulse Pressure

49
Q

What are two specific named signs of Aortic Regurgitation?

A

Corrigan Pulse
- Abrupt distention and quick collapse on palpation of the peripheral arterial pulse

Quincke Sign
- Visible pulsations of the fingernail bed

50
Q

What is the Gold Standard diagnosis for Aortic Regurgitation?

A

Transthoracic Echocardiography

51
Q

What is the most common cause of Mitral Stenosis?

A

Rheumatic Fever
(can present 20 - 40 years later)

52
Q

Is Rheumatic Mitral Stenosis more common in males or females?

A

Females

53
Q

When does the onset Mitral Stenosis typically occur?

A

3ʳᵈ or 4ᵗʰ Decade of Life

54
Q

How large is the normal Mitral Valve Orifice?

A

4 - 6 sq. cm

55
Q

Mitral Valves with an area of less than 1 sq. cm cause what?

A

Pulmonary Hypertension

56
Q

In severe Mitral Stenosis, left Ventricular filling is depending on what?

A

Atrial Kick

57
Q

Loss of the Left Atrial Kick with Mitral Stenosis results in what?

A

Sudden Congestive Heart Failure

58
Q

What are the most common signs and symptoms of Mitral Stenosis?

A

Chest Pain
Pulmonary Hypertension
Hemoptysis
A-Fib
Right Sided Heart Failure

59
Q

What is the sound pattern of Mitral Stenosis?

A

Low Pitched
Mid-Diastolic Rumble
OPENING SNAP
(OS = MS)

60
Q

Where is Mitral Stenosis best heard?

A

Apex
(Via Bell)

61
Q

How can you better hear Mitral Stenosis?

A

Left Lateral Decubitus
Isometric Exercise

62
Q

What can be seen on a Chest X-Ray of a patient with Mitral Stenosis?

A

Kerly B Lines

63
Q

What is the GOLD STANDARD of diagnosis for Mitral Stenosis?

A

Transthoracic Echo

64
Q

When is Mitral Stenosis considered Severe?

A

Valve Area < 1 sq. cm
Pulmonary Artery Pressure > 50
Mean Gradient < 10 mmHg

65
Q

What is the primary prevention treatment of Mitral Stenosis in patients with Strep. Throat

A

Rheumatic Fever Prophylaxis
Benzathine Penicillin

66
Q

What medication should be considered n patients with Mitral Stenosis?

A

Warfarin

67
Q

What is the target INR of patient with Mitral Stenosis?

A

2.0 - 3.0

68
Q

Development or presence of what is the indication for intervention with Mitral Stenosis?

A

Pulmonary Hypertension

69
Q

How do you treat Mitral Stenosis

A

Percutaneous Mitral Balloon Valvuloplasty
- or -
Valve Replacement

70
Q

When is Mitral Valve Replacement indicated over Percutaneous Mitral Balloon Valvuloplasty?

A

Symptomatic Patients:
- NYHA Class II - IV
- MV Area < 1.5

Asymptomatic Patients
- PA Pressure > 60 at Rest

71
Q

What are the most common causes of Mitral Regurgitation?

A

Degenerative with Mitral Valve Prolapse
(Primary)

Coronary Heart Disease
(Secondary)

72
Q

Connective tissue disorder characterized by thickening and elongation of the mitral leaflets and chordae and by dilatation of the mitral annulus
(Long Chordae)

A

Myxomatous Degeneration
(common cause for operation)

73
Q

Cause of Mitral Regurgitation that results in leaflet vegetations and destruction.May result in rupture and massive Mitral Regurgitation.

A

Endocarditis
(IV Drug Users)

74
Q

The Anterior Papillary muscle of the Mitral Valve is supplied by what artery?

A

LAD

75
Q

The Posterior Papillary muscle of the Mitral Valve is supplied by what artery?

A

RCA
- or -
Distal LCX

76
Q

What is the most common form of Valvular Heart Disease?

A

Mitral Valve Prolapse

77
Q

What is the most common cause of Mitral Regurgitation in North America

A

Mitral Valve Prolapse

78
Q

What patient population is Mitral Valve Prolapse most common in?

A

Women
15 - 30 Years Old

79
Q

What is the sound pattern of Mitral Valve Prolapse

A

Mid or Late Systolic Click
High Pitched
Crescendo-Decrescendo
Whooping or Honking at Apex

80
Q

What is the sound pattern of Mitral Regurgitation?

A

High Pitched
Holosystolic

81
Q

Where is Mitral Regurgitation best heard?

A

Apex
(Radiates to Axilla)

82
Q

What is the Gold Standard for Mitral Regurgitation diagnosis?

A

Transthoracic Echo

83
Q

What is the goal INR when there is a Mechanical Valve?

A

2.5 - 3.0

84
Q

Who is Tricuspid Stenosis more common in?

A

Women

85
Q

What is unique about Tricuspid Stenosis?

A

Does NOT occur Alone
(Usually with Mitral Stenosis)

86
Q

What is the sound pattern of Tricuspid Stenosis?

A

Mid-Diastolic Rumble
(Worse on Inspiration)

87
Q

Where is Tricuspid Stenosis best heard?

A

Left Sternal Border
Above Xiphoid Process

88
Q

What physical exam findings would you see on a patient with Tricuspid Stenosis?

A

JVD + Giant A-Wave

89
Q

What is the Gold Standard Diagnosis for Tricuspid Stenosis?

A

Transthoracic Echo

90
Q

What would you seen on a Transthoracic Echo in a patient with Tricuspid Stenosis?

A

Enlarged R. Atrium and IVC.
Thick Valve + Doming in Diastole
Valve Area < 1.0 cm²

91
Q

How do you treat Tricuspid Stenosis?

A

Diuretics

92
Q

A non-primary valve disease that occurs secondary to dilation of the annulus from Right Ventricle enlargement due to Pulmonary Artery Hypertension.

A

Tricuspid Regurgitation

93
Q

What is the sound pattern of Tricuspid Regurgitation?

A

Blowing Holosystolic Murmur
Intense = Inspiration
Reduced = Expiration or Valsalva

94
Q

Where is Tricuspid Regurgitation heard best?

A

Left or Right Sternal Border

95
Q

What are some physical exam findings seen in a patient with Tricuspid Regurgitation?

A

Distended Neck Veins
Hepatomegaly
Ascites
Pleural Effusions
Edema

96
Q

What is the Gold Standard for Tricuspid Regurgitation diagnosis?

A

Transthoracic Echo

97
Q

What would you see on a Transthoracic Echo of a patient with Tricuspid Regurgitation?

A

R. Atrium Dilation
R. Ventricle volume overload
Abnormal Interventricular Wall Movement
Prolapsed Leaflet

98
Q

What is the most common cause of Pulmonary Valve Disease?

A

Congenital Etiologies

99
Q

Who is Pulmonary Stenosis most common in?

A

Pediatric Females

100
Q

Isolated Pulmonary Stenosis accounts for what percent of all congenital heart diseases?

A

10%

101
Q

What is the most common symptom of Pulmonary Stenosis?

A

Dyspnea on Exertion

102
Q

What is the sound pattern of Pulmonary Stenosis?

A

Loud + Harsh Systolic Murmur
Ejection Click

103
Q

What can decrease the sound of Pulmonary Stenosis?

A

Inspiration

104
Q

Where can you feel lifts and thrills with Pulmonary Stenosis?

A

Thrill = 2ⁿᵈ or 3ʳᵈ Left Intercostal
Lift = Right Ventricle (due to RVH)

105
Q

What is treatment for Pulmonic Stenosis?

A

Percutaneous Balloon Valvuloplasty + Diuretics

106
Q

What type of Pulmonic Regurgitation is most common?

A

High Pressure
- Secondary to Pulmonary Hypertension

107
Q

How do most patients with Pulmonic Regurgitation typically present?

A

Asymptomatically

108
Q

What typically dominates the picture of Pulmonic Regurgitation?

A

Pulmonary Hypertension

109
Q

What is the sound pattern of Pulmonic Regurgitation?

A

High Pitched
Decrescendo
Louder with Inspiration

110
Q

Where is Pulmonic Regurgitation heard?

A

Left Sternal Border

Cardiology: Exam (5 decks)

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