Valve Disorders Flashcards
Name the Semi-Lunar Valves.
Aortic
Pulmonary
How many leaflets do the Semi-Lunar Valves have?
3
Name the Atrioventricular Valves.
Mitral
Tricuspid
What acts as the anchor to attach the valves to the heart muscle?
Annulus (Fibrous Ring)
Leaflets on the on the Aortic Valve close edge-to-edge via a fibrous collagen called the what?
Commissures
The walls of the Aorta bulge out slightly behind each leaflet and form what?
Sinus of Valsalva
What is the name of the opening that leads to the Coronary Arteries?
Ostia
(Right + Left)
When do Coronary Arteries fill?
Diastole
In patients with Aortic Stenosis due to a Congenital Bicuspid or Unicuspid valve, when do symptoms usually occur?
Around 50 Years Old
Does Aortic Stenosis that is acquired typically progress to the point where it is obstructive and hemodynamically significant?
No
(Only about 10% of cases)
What accounts for about half of all occurrences of Aortic Stenosis?
BICUSPID VALVES
Type of Aortic Stenosis with a Bicuspid or Unicuspid Valve.
Fibrinous fused commissures.
Symptoms start around the age of 50.
Congenital Aortic Stenosis
Type of Aortic Stenosis with Nodular Calcification.
3 Cusp Valve with no commissural fusion.
Limited Leaflet Movement.
Symptoms begin around the age of 70.
Degenerative Calcific Aortic Stenosis
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.
Rheumatic Aortic Stenosis
In Aortic Stenosis, mild valve thickening or calcification affects normal leaflet motion. As the disease progresses, this causes what?
Thicker Leaflets
Calcium Nodules
New Blood Vessels
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?
Restricted Leaflet Motion
Obstruction of Left Ventricular Outflow
As the left ventricle encounters chronic resistance from the Aortic Stenosis, what happens to the heart?
Left Ventricular Hypertrophy
Left Ventricular Hypertrophy causes an increase in what?
Increased Diastolic Pressure
(Stiffer walls = harder to fill, must overcome that pressure)
Left Ventricular Hypertrophy ultimately results in what?
Reduced LV Systolic Contractility
(EF < 50%)
- Left Ventricle can no longer generate enough pressure to overcome the after load.
What bacteria causes Rheumatic Fever?
Group A Strep.
What valves are typically affected by Rheumatic Fever?
Mitral
Aortic
Chronic inflammation due to Rheumatic Fever may cause what?
Narrowing of the Valves
Systolic Ejection Murmur that peaks in early systole and progressively later as the severity progresses.
Aortic Stenosis
What is the sound pattern of Aortic Stenosis?
Crescendo-Decrescendo
Where is Aortic Stenosis best heard?
Upper Right Sternal Border
- May radiate to Carotids
How do you diagnose Aortic Stenosis?
- EKG
- Chest X-Ray
- Echocardiogram
- Cardiac Catheterization
What is the GOLD STANDARD for diagnosis of Aortic Stenosis?
Transthoracic Echo
(2-dimensional Doppler)
When is Aortic Stenosis considered severe or hemodynamically important?
Jet Velocity > 4.0
Pressure > 40
Valve Area < 1.0
What is the only effective treatment for Symptomatic Severe Aortic Stenosis?
Surgical Repair
(Valve Replacement)
Without surgical intervention, what is average life expectancy of a patient with Severe Aortic Stenosis?
2 - 3 Years
What can you absolutely NOT give to a patient with Aortic Stenosis when treating their hypertension?
Beta Blockers
Repair of the Aortic Valve of a patient less than 60 years old will be done via what?
Mechanical Prosthesis
(Must be on Anticoagulation!)
Repair of the Aortic Valve of a patient older than 60 will be done via what?
Porcine or Bovine Valve
(Does not need anticoagulation)
How long do Porcine or Bovine Valves typically last?
10 - 15 Years
Diastolic leakage of blood from the Aorta into the Left Ventricle.
Aortic Regurgitation
What are two causes of Aortic Regurgitation?
Congenital Bicuspid Aortic Valve
Dilation of Aortic Root
Is Acute or Chronic Aortic Regurgitation a medical emergency?
Acute Aortic Regurg
What are the most common causes of Acute Aortic Regurgitation?
Aortic Dissection
Endocarditis (IV Drug Use)
What is the most common cause of Chronic Aortic Regurgitation?
Bicuspid Aortic Valve
How long do most patients with Chronic Aortic Regurgitation remain asymptomatic for?
Decades
What does Aortic Regurgitation ultimately result in?
Congestive Heart Failure
What is the sound pattern of Aortic Regurgitation?
Decrescendo with Blowing
(High Pitched)
Where is Aortic Regurgitation best heard?
Left Sternal Border
Exhalation
What is seen with the blood pressure in Aortic Regurgitation?
Wide Pulse Pressure
What happens to diastolic pressure in Aortic Regurgitation?
Drops Rapidly
(Blood is spilling back into the LV)
What are some symptoms seen in patients with Aortic Regurgitation?
Exertional Dyspnea + Fatigue
Paroxysmal Nocturnal Dyspnea
Pulmonary Edema
Murmur that is caused by the regurgitant flow causing vibration of the mitral apparatus, is lower pitched and short in duration.
Austin-Flint Murmur
Manifestations of severe chronic Aortic Regurgitation are often due to what?
Widened Pulse Pressure
What are two specific named signs of Aortic Regurgitation?
Corrigan Pulse
- Abrupt distention and quick collapse on palpation of the peripheral arterial pulse
Quincke Sign
- Visible pulsations of the fingernail bed
What is the Gold Standard diagnosis for Aortic Regurgitation?
Transthoracic Echocardiography
What is the most common cause of Mitral Stenosis?
Rheumatic Fever
(can present 20 - 40 years later)
Is Rheumatic Mitral Stenosis more common in males or females?
Females
When does the onset Mitral Stenosis typically occur?
3ʳᵈ or 4ᵗʰ Decade of Life
How large is the normal Mitral Valve Orifice?
4 - 6 sq. cm
Mitral Valves with an area of less than 1 sq. cm cause what?
Pulmonary Hypertension
In severe Mitral Stenosis, left Ventricular filling is depending on what?
Atrial Kick
Loss of the Left Atrial Kick with Mitral Stenosis results in what?
Sudden Congestive Heart Failure
What are the most common signs and symptoms of Mitral Stenosis?
Chest Pain
Pulmonary Hypertension
Hemoptysis
A-Fib
Right Sided Heart Failure
What is the sound pattern of Mitral Stenosis?
Low Pitched
Mid-Diastolic Rumble
OPENING SNAP
(OS = MS)
Where is Mitral Stenosis best heard?
Apex
(Via Bell)
How can you better hear Mitral Stenosis?
Left Lateral Decubitus
Isometric Exercise
What can be seen on a Chest X-Ray of a patient with Mitral Stenosis?
Kerly B Lines
What is the GOLD STANDARD of diagnosis for Mitral Stenosis?
Transthoracic Echo
When is Mitral Stenosis considered Severe?
Valve Area < 1 sq. cm
Pulmonary Artery Pressure > 50
Mean Gradient < 10 mmHg
What is the primary prevention treatment of Mitral Stenosis in patients with Strep. Throat
Rheumatic Fever Prophylaxis
Benzathine Penicillin
What medication should be considered n patients with Mitral Stenosis?
Warfarin
What is the target INR of patient with Mitral Stenosis?
2.0 - 3.0
Development or presence of what is the indication for intervention with Mitral Stenosis?
Pulmonary Hypertension
How do you treat Mitral Stenosis
Percutaneous Mitral Balloon Valvuloplasty
- or -
Valve Replacement
When is Mitral Valve Replacement indicated over Percutaneous Mitral Balloon Valvuloplasty?
Symptomatic Patients:
- NYHA Class II - IV
- MV Area < 1.5
Asymptomatic Patients
- PA Pressure > 60 at Rest
What are the most common causes of Mitral Regurgitation?
Degenerative with Mitral Valve Prolapse
(Primary)
Coronary Heart Disease
(Secondary)
Connective tissue disorder characterized by thickening and elongation of the mitral leaflets and chordae and by dilatation of the mitral annulus
(Long Chordae)
Myxomatous Degeneration
(common cause for operation)
Cause of Mitral Regurgitation that results in leaflet vegetations and destruction.May result in rupture and massive Mitral Regurgitation.
Endocarditis
(IV Drug Users)
The Anterior Papillary muscle of the Mitral Valve is supplied by what artery?
LAD
The Posterior Papillary muscle of the Mitral Valve is supplied by what artery?
RCA
- or -
Distal LCX
What is the most common form of Valvular Heart Disease?
Mitral Valve Prolapse
What is the most common cause of Mitral Regurgitation in North America
Mitral Valve Prolapse
What patient population is Mitral Valve Prolapse most common in?
Women
15 - 30 Years Old
What is the sound pattern of Mitral Valve Prolapse
Mid or Late Systolic Click
High Pitched
Crescendo-Decrescendo
Whooping or Honking at Apex
What is the sound pattern of Mitral Regurgitation?
High Pitched
Holosystolic
Where is Mitral Regurgitation best heard?
Apex
(Radiates to Axilla)
What is the Gold Standard for Mitral Regurgitation diagnosis?
Transthoracic Echo
What is the goal INR when there is a Mechanical Valve?
2.5 - 3.0
Who is Tricuspid Stenosis more common in?
Women
What is unique about Tricuspid Stenosis?
Does NOT occur Alone
(Usually with Mitral Stenosis)
What is the sound pattern of Tricuspid Stenosis?
Mid-Diastolic Rumble
(Worse on Inspiration)
Where is Tricuspid Stenosis best heard?
Left Sternal Border
Above Xiphoid Process
What physical exam findings would you see on a patient with Tricuspid Stenosis?
JVD + Giant A-Wave
What is the Gold Standard Diagnosis for Tricuspid Stenosis?
Transthoracic Echo
What would you seen on a Transthoracic Echo in a patient with Tricuspid Stenosis?
Enlarged R. Atrium and IVC.
Thick Valve + Doming in Diastole
Valve Area < 1.0 cm²
How do you treat Tricuspid Stenosis?
Diuretics
A non-primary valve disease that occurs secondary to dilation of the annulus from Right Ventricle enlargement due to Pulmonary Artery Hypertension.
Tricuspid Regurgitation
What is the sound pattern of Tricuspid Regurgitation?
Blowing Holosystolic Murmur
Intense = Inspiration
Reduced = Expiration or Valsalva
Where is Tricuspid Regurgitation heard best?
Left or Right Sternal Border
What are some physical exam findings seen in a patient with Tricuspid Regurgitation?
Distended Neck Veins
Hepatomegaly
Ascites
Pleural Effusions
Edema
What is the Gold Standard for Tricuspid Regurgitation diagnosis?
Transthoracic Echo
What would you see on a Transthoracic Echo of a patient with Tricuspid Regurgitation?
R. Atrium Dilation
R. Ventricle volume overload
Abnormal Interventricular Wall Movement
Prolapsed Leaflet
What is the most common cause of Pulmonary Valve Disease?
Congenital Etiologies
Who is Pulmonary Stenosis most common in?
Pediatric Females
Isolated Pulmonary Stenosis accounts for what percent of all congenital heart diseases?
10%
What is the most common symptom of Pulmonary Stenosis?
Dyspnea on Exertion
What is the sound pattern of Pulmonary Stenosis?
Loud + Harsh Systolic Murmur
Ejection Click
What can decrease the sound of Pulmonary Stenosis?
Inspiration
Where can you feel lifts and thrills with Pulmonary Stenosis?
Thrill = 2ⁿᵈ or 3ʳᵈ Left Intercostal
Lift = Right Ventricle (due to RVH)
What is treatment for Pulmonic Stenosis?
Percutaneous Balloon Valvuloplasty + Diuretics
What type of Pulmonic Regurgitation is most common?
High Pressure
- Secondary to Pulmonary Hypertension
How do most patients with Pulmonic Regurgitation typically present?
Asymptomatically
What typically dominates the picture of Pulmonic Regurgitation?
Pulmonary Hypertension
What is the sound pattern of Pulmonic Regurgitation?
High Pitched
Decrescendo
Louder with Inspiration
Where is Pulmonic Regurgitation heard?
Left Sternal Border
