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Cardio Path > Valve Disorders > Flashcards

Valve Disorders Flashcards

0
Q

Explain pathophysiology of mitral valve stenosis

A

Mitral valve stenosis = FIBROSIS + CALCIFIED – >

⬆️LA work in order to fill LV @ diastole –>

LA dilated + hypertrophied + stretched
= compress oesophagus = dysphagia –>
ConS Fib + Con Rahim

Pulmonary CCCONgestion = oedema + haemorrhage
–> Crackle hemoptysis Dyspnoea

Blood which should have passively emptied into LV gushes due to stenosis + ⬆️ contraction –>
Opening SSSSnap after S2

Atrial FIB –> stasis – > mural thrombosis

Pulmonary HTN - CONcentric RVH

Early mid diastolic rumble

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1
Q

What causes mitral valve stenosis

A

Chronic rheumatic fever

Women >man

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2
Q

Risk factors for mitral valve regurgitation

A

MRS IO SAMLIND

Mitral valve prolapse
Rupture posteromedial popular in muscle
Stretched mitral valve ring – functional regurg

Infective endocarditis
Other:

SLE, Acute RF, Myocarditis,
Libman sack, IHD, Nonbact thrombotic endocarditis, Dilated cardiomyopathy

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3
Q

What murmur you get in mitral valve regurg?
Radiate where?
What enhances the murmur?

A

Pansystolic regurgitant ‘blowing’ murmur
Radiate to axilla

Enhanced by manoeuvres that increase TPR eg squat/handgrip/expiration:

Because less blood will go through aorta and more through mitral valve

Expiration ⬆️blood entering LA –>
⬆️️BF out of aorta + ⬆️BF retrograde into LA

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4
Q

Explain pathphys of mitral regurgitation

A

MV regurg – >retrograde blood flow into LA – >

LA dilate = eccentric hypertrophy – >

More blood into LV = eccentric LVH

Not enough blood go forward due to regurg = LHF

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5
Q

What do you see clinically in mitral regurg

A

Dyspnoea, inspiratory crackles, hemoptysis

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6
Q

Risk factors for mitral valve prolapse

A

MR Chordae

  1. Marfans, Ehlors Danlos, Kleinfelter –>
    myxoid degeneration =
    Ground substance accumulation +
    XS dermatan sulphate @ MV leaflet
  2. Remitted fever
  3. Chordae rupture
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7
Q

Explain pathophysiology of mitral valve prolapse

A

@Systole –> chordae tenses = parachute open –>

Valve parachutes open =
REGURGITANT late systolic crescendo murmur
+
MID SYStolic CLICK

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8
Q

What is the effect of decreasing and increasing the preload?

A

⬇️preload –> ⬇systole LLLLLLENGTH –>

click + murmur move closer to S1

VICE VERSA FOR ⬆️preload

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9
Q

What factors decreased preload

What factors increased preload

A

Decrease preload:
- Standing – > ⬇️ VR –> ⬇️preload

  • Anxiety – > ⬆️HR –> ⬇️filling time-> ⬇️️preload
  • Valsalva manoeuvre (hold breath close epiglottis) -> ⬆️ Intrathoracic pressure –> ⬇️VR –> ⬇️preload

Increased preload:

  • SSSupine/Recline – > ⬆️VR –>
  • ⬆️️vol @ RH, lung, LH –> ⬆️preload
  • SSSquat/handgrip–> ⬆️TPR –> ⬇️LV empty
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10
Q

What is the most common valve lesion in adults?

A

aortic stenosis < 1 cm^2

Normal = 4 cm^2

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11
Q

How does aortic stenosis occur?

If you have a bicuspid aortic valve what problem is there?

A

Increased trauma to aortic valve – >
⬆️Fibrosis + calcification –>
dystrophic calcification stenosis

2 Bicuspid valves = doing job of 3

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12
Q

What’s the difference between stenosis from

chronic rheumatic fever + stenosis from wear&tear

A

Chronic rheumatic fever
Always have
MITRAL stenosis +
AORTIC Stenosis with fusion of commissures

Stenosis from wearing tear only have aortic stenosis without fusion of the commissioners

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13
Q

Explain pathophysiology of aortic stenosis

A

Av sten ->
Cardiac compensation LV = push harder = concentric LVH ->

jet stream poststenotic dilation of aorta ->

Prolonged asymptomatic stage – maintenance and eventually blow open valve – >

Crescendo decrescendo Systolic ejection murmur = Blood rush through valve RADIATES to carotid

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14
Q

Explain the murmur you hear at aortic stenosis
Radiate where?
What is pulsus parvus et tardus
Splitting??

A

PanSystolic crescendo decrescendo ejection murmur

Radiate to carotid

Pulses = weak + delayed peak

Paradoxical splitting

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15
Q

Explain the effect of exercise in aortic stenosis?

Explain what happens haematologically?

A 
Aortic stenosis --> 
Shit ability to ⬆️️blood flow across valve -->
exercise --> 
Hard to get extra O2 to 
brain --> syncope 
\+ 
heart --> angina

Blood flow across degenerated calcified valve – >
RBC Roger – >microangiopathic haemolytic anaemia

16
Q

Causes of aortic regurgitation

A

Core Trainee DR ASAD

Coarctation aorta
Takayasu Arteritis

Dilation aortic root
Rheumatic fever - mitral regurg > aortic regurg

Ankylosing spondylitis
Syphilitic aneurysm
Aortic dissection
Damage valve @ infectious endocarditis

17
Q

Explain the effect of acute aortic regurgitation on SV, ️CO, pulse pressure

A

Retrograde blood flow into LV @diastole =
eccentric LV hypertrophy –>

️Vol =same BUT ⬆️EDP @ LV –>
⬇️SV + ⬇️CO + ⬇️PP

18
Q

Explain the effects of chronic aortic regurgitation on LV, SV, CO, PP

A

LV EDP return to normal as LV eccentrically hypertrophies – >

SV ⬆️ – > systolic pressure ⬆️
Regurg-blood drip back to LV ->diastolic pressure⬇️

–> ⬇️PP

19
Q

Explain the murmur you get with aortic regurgitation

A

Diastolic DEcrescendo blowing murmur

The regurgitant stream hits the anterior mitral valve leaflet = Austin Flint diastolic murmur

20
Q

Explain what happens as a result of increased pulse pressure

A

Hyperdynamic circulation – >

PP widens – >
BO NA NO
C. Q. M.

BOunding pulses - (Corrigan water-hammer pulse)
NAil bed pulsating (Quincke pulse)
NOdding head - (de Musset Sign)

21
Q

Why does the tricuspid valve regurgitate in adults?
Why does the tricuspid valve regurgitate in kids?
Explain all the reasons for tricuspid valve is regurg.

A

@ Adults – RHF – > stretch tricuspid valve ring

@ Kids - congenital heart defect is

Other reasons = DRIP
– Dilative cardiomyopathy
– RH infarction
– IIIIV drug use – >IIIIIInfective endocarditis
– Pulmonary HTN
22
Q

What murmur you get in tricuspid valve regurg?
Radiate where?
What enhances the murmur?

A

Pansystolic high-pitched blowing murmur

Radiates to right sternal border

Enhanced by manoeuvers that ⬆️VR eg.
Inspiration, supine

23
Q

What happens as a result of retrograde back flow of blood into the right atrium @systole

A

Right Atrium dilate percent hypertrophy
Blood back up into venous system

Symptoms = D(giant c wave) AT shop

24
Q

Explain features of pulmonary valve stenosis

Splitting?

A

Congenital heart defect / carcinoid heart disease ->

Concentric are a VH
Systolic crescendoed decrescendo murmur

WIDE SPLITTING!!!!

25
Q

What causes PV regurg?

Murmur?

A

Pul HTN -> stretch PV ring – >

Diastolic decrescendo Graham Steel murmur ->

Right ventricle eccentric hypertrophy

26
Q

What valve does SLE effect?

A

Libman sack endocarditis sterile vegetation + MV

Cardio Path (18 decks)

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