Valve Disorders - Part 2 - Exam 1 Flashcards
_____ is when the valve doesn’t open properly. _____ is when the valve doesn’t close properly.
stenosis= doesn’t open
regurgitation= doesn’t close
ejection click think ______
midsystolic click think ______
ejection= aorta
midsystolic = mitral valve prolapse
marfarn, trisomy think ____ because the valves are stretching
regurgitation
not enough leaflet think ______
what side of the stethoscope do you use to listen to mitral?
not enough leaflets think stenosis
mitral= use bell
palpable P2 at the upper left sternal border think _____
mitral stenosis
tricuspid stenosis is MC in _______
What is the MC cause in the US?
women
MCC in US: Carcinoid syndrome, prosthetic valve degeneration
What is the MC cause of tricuspid stenosis worldwide?
rheumatic heart disease
What are the s/s of right sided heart failure? left sided?
right: s/s are peripheral edema and then SOB. floods feet up
left: SOB, angina and then peripheral edema. floods lungs down
What are some additional s/s of right sided heart symptoms? What wave will be elevated in JVP?
hepatomegaly, ascites, peripheral edema, fatigue, palpable pre systolic liver pulsation may be appreciated
elevated A wave
What will tricupsid stenosis murmur sound like?
Soft, high-pitched, diastolic rumbling murmur along lower left sternal border Mimics mitral stenosis, except for INCREASED sound with inspiration - increased return with inspiration
opening snap may be heard
What is a possible EKG finding for tricuspid stenosis? CXR? Why?
right atrial enlargement because the right atrium is pumping much harder
CXR: cardiomegaly
cardiomegaly is closely associated with what valve disorder?
tricuspid stenosis
What is the tx for tricupsid stenosis? When would you add on an aldosterone antagonist?
loop diuretics (torsemide or bumetanide)
liver congestion or ascites present
OR
triscupid valve replacement if the pt is symptomatic
What is the tricuspid valve shaped like? What happens to the shape when regurgitation is present?
TV annulus is saddle shaped, so as the valve collapses and becomes elliptical with RV failure/dilation, regurgitation worsens
What is the major cause of tricuspid regurgitation? What are some additional causes?
right ventricle dilation due to PULMONARY HTN
Endocarditis, carcinoid syndrome, congenital abnormality, chest wall trauma
tricuspid regurgitation causes ______ and tricuspid stenosis causes _____-
regurg= increased RA pressure
stenosis= reduced right atria emptying into right ventricle
When you have tricuspid regurgitation without pulm HTN, what happens?
present with symptoms of RV failure
Fatigue, ascites, and peripheral edema
What does a tricuspid regurgitation sound like? Where is it best heard? What makes it worse?
Murmur is high-pitched and pansystolic, best heard at left sternal border
Accentuated with inspiration/leg-raising/squatting by increasing venous return
on echo, RV systolic pressure _____ highly suspicious for TV regurg. What will EKG show?
<40 mmHg
afib/flutter possible
When is a tricupsid regurgitation repair indicated? replacement? When is anticoagulation needed?
Repair is typically considered (annuloplasty) to restore TV function for patients with persistent symptoms
replacement: must be considered for underlying primary leaflet pathology
anticoag is only needed if Afib is present
What is the underlying cause of pulmonic stenosis?
**CONGENITAL and usually isolated
genetic syndromes such as Noonan and Trisomy 13
What is the MC acquired cause of pulmonic stenosis? What is the stenosis a result from?
carcinoid syndrome
pulmonic stenosis is usually the result of fused pulmonary leaflets due to pressure overloaded state that results in right ventricle hypertrophy
How will critical pulmonary stenosis present? How will moderate/severe pulmonary stenosis present?
neonates with central cyanosis at birth
teenager who is participating in sports for the first time who is SOB. progressive fatigue and dyspnea on exertion
**What will a pulmonic stenosis murmur present like? Where is it best heard? Where will it radiate?
Systolic ejection murmur best heard at left upper sternal border, increases with inspiration
radiate to left shoulder
