Valve Disorders Flashcards
Explain pathophysiology of mitral valve stenosis
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
What causes mitral valve stenosis
Chronic rheumatic fever
Women >man
Risk factors for mitral valve regurgitation
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
What murmur you get in mitral valve regurg?
Radiate where?
What enhances the murmur?
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
Explain pathphys of mitral regurgitation
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
What do you see clinically in mitral regurg
Dyspnoea, inspiratory crackles, hemoptysis
Risk factors for mitral valve prolapse
MR Chordae
- Marfans, Ehlors Danlos, Kleinfelter –>
myxoid degeneration =
Ground substance accumulation +
XS dermatan sulphate @ MV leaflet - Remitted fever
- Chordae rupture
Explain pathophysiology of mitral valve prolapse
@Systole –> chordae tenses = parachute open –>
Valve parachutes open =
REGURGITANT late systolic crescendo murmur
+
MID SYStolic CLICK
What is the effect of decreasing and increasing the preload?
⬇️preload –> ⬇systole LLLLLLENGTH –>
click + murmur move closer to S1
VICE VERSA FOR ⬆️preload
What factors decreased preload
What factors increased preload
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
What is the most common valve lesion in adults?
aortic stenosis < 1 cm^2
Normal = 4 cm^2
How does aortic stenosis occur?
If you have a bicuspid aortic valve what problem is there?
Increased trauma to aortic valve – >
⬆️Fibrosis + calcification –>
dystrophic calcification stenosis
2 Bicuspid valves = doing job of 3
What’s the difference between stenosis from
chronic rheumatic fever + stenosis from wear&tear
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
Explain pathophysiology of aortic stenosis
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
Explain the murmur you hear at aortic stenosis
Radiate where?
What is pulsus parvus et tardus
Splitting??
PanSystolic crescendo decrescendo ejection murmur
Radiate to carotid
Pulses = weak + delayed peak
Paradoxical splitting
Explain the effect of exercise in aortic stenosis?
Explain what happens haematologically?
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
Causes of aortic regurgitation
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
Explain the effect of acute aortic regurgitation on SV, ️CO, pulse pressure
Retrograde blood flow into LV @diastole =
eccentric LV hypertrophy –>
️Vol =same BUT ⬆️EDP @ LV –>
⬇️SV + ⬇️CO + ⬇️PP
Explain the effects of chronic aortic regurgitation on LV, SV, CO, PP
LV EDP return to normal as LV eccentrically hypertrophies – >
SV ⬆️ – > systolic pressure ⬆️
Regurg-blood drip back to LV ->diastolic pressure⬇️
–> ⬇️PP
Explain the murmur you get with aortic regurgitation
Diastolic DEcrescendo blowing murmur
The regurgitant stream hits the anterior mitral valve leaflet = Austin Flint diastolic murmur
Explain what happens as a result of increased pulse pressure
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)
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.
@ 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
What murmur you get in tricuspid valve regurg?
Radiate where?
What enhances the murmur?
Pansystolic high-pitched blowing murmur
Radiates to right sternal border
Enhanced by manoeuvers that ⬆️VR eg.
Inspiration, supine
What happens as a result of retrograde back flow of blood into the right atrium @systole
Right Atrium dilate percent hypertrophy
Blood back up into venous system
Symptoms = D(giant c wave) AT shop
Explain features of pulmonary valve stenosis
Splitting?
Congenital heart defect / carcinoid heart disease ->
Concentric are a VH
Systolic crescendoed decrescendo murmur
WIDE SPLITTING!!!!
What causes PV regurg?
Murmur?
Pul HTN -> stretch PV ring – >
Diastolic decrescendo Graham Steel murmur ->
Right ventricle eccentric hypertrophy
What valve does SLE effect?
Libman sack endocarditis sterile vegetation + MV
