Valve Dysfunction

Question 1

what are some causes of valve dysfunction?

Answer 1

infections (including tooth plaque), congenital deformity (2 leaflets instead of 3, can’t fully close), disease (rheumatic fever)

Question 2

what are the two classifications of valve dysfunction?

Answer 2

functional (stenosis, insufficient) or anatomical deformity (prolapse, congenital)

Question 3

why is valve dysfunction a problem?

Answer 3

heart works harder, eventually will hypertrophy leading to decreased ventricle space, walls get thicker, decreased CO

Question 4

what is stenosis in valve dysfunction?

Answer 4

impedence of forward flow due to incomplete or narrowed opening of valves

Question 5

what is insufficiency in valve dysfunction?

Answer 5

incomplete closing of valve leading to regurgitation/back flow of blood

Question 6

what are murmers in valve dysfunction

Answer 6

turbulence of flow heard during auscultations cause by stenosis or regurgitation

Question 7

how is the severity of valve dysfunction scored?

Answer 7

mild, moderate, severe, or critical based on valve diameter, degree of regurgitation, and calculation of blood flow across valve

Question 8

what aortic valve area is mild?

Answer 8

> 1.5 cm2

Question 9

what aortic valve area is moderate?

Answer 9

1.0 - 1.5

Question 10

what aortic valve area is severe?

Answer 10

< 1.0

Question 11

what aortic valve area is critical?

Answer 11

< 0.6

Question 12

what is the pathophysiology of aortic stenosis?

Answer 12

narrowing of valve –> increased afterload –> increased LV systolic pressure and LV volume overload –> LV hypertrophy –> decreased stroke volume and decreased compliance –> systolic function maintained for a while especially @ rest –> eventual systolic and diastolic dysfunction

Question 13

what causes mitral regurgitation?

Answer 13

damage to papillary muscles from MI, heart gailure, congenital, endocarditis, rheumatic fever(most common cause of mitral regurgitation due to untreated strep)

Question 14

what is the pathophysiology of chronic mitral regurgitation?

Answer 14

incompetent valve –> increased blood volume in left atrium –> blood can backflow through pulm. veins –> left atrium dilates over time –> reduced atrial pressure –> reduced atrial kick –> reduced LV EDV –> reduced cardiac output

Question 15

what causes mitral stenosis?

Answer 15

progressive calcium deposits, congenital, rheumatic fever

Question 16

what is the pathophysiology of mitral stenosis?

Answer 16

narrowed valve –> increased pressure gradient across valve –> reduced ventricular filling w/ increased dependence on atrial kick –> increased LA pressure and pulm. pressures –> LA dilation over time –> reduced LV EDV and cardiac output

Question 17

what is aortic insufficiency caused by?

Answer 17

weakened valve closure, stiffened leaflets

Question 18

what is the pathophysiology of aortic regurgitation?

Answer 18

incomplete closure of valve –> backflow of blood from aorta during diastole –> increased LV EDV –> increased preload, larger stroke volume, increased afterload –> LV dilation and hypertrophy –> decreased systolic function and ejection fraction

Question 19

what are the clinical manifestations of valve dysfunction?

Answer 19

easy fatigue, SOB, dyspnea w/ exertion, exhaustion, sx of HF (dyspnea, fluid back up, edema)

Question 20

how do you diagnose a valve dysfunction?

Answer 20

auscultation, symptoms, confirmed w/ echocardiography

Question 21

what are the two main types of echos?

Answer 21

transthoracic (TTE) and transesophageal (TEE)

Question 22

what does an echocardiography assess?

Answer 22

size of ventricular cavity, functioning of valves, performance of left ventricle, estimates SV and EF

Question 23

what is a transesophageal echocardiography?

Answer 23

view of heart and mediastinum, camera thru esophagus

Question 24

what is the first sound (“lub”) in normal heart sounds of the lub dub?

Answer 24

S1 - closure of mitral/tricuspid valves onset of ventricular systole

Question 25

what is the second sound (“dub”) in normal heart sounds of the lub dub?

Answer 25

S2 - closure of aortic and pulmonary valves at start of ventricular diastole

Question 26

what are murmurs and the types of murmurs?

Answer 26

abnormal heart sounds

Question 27

what are the three categories of a murmur?

Answer 27

high rates of flow through normal or abnormal valves, forward flow thru constricted or deformed valve or into dilated vessel/chamber, backward flow thru valve

Question 28

what are the types of systolic murmurs?

Answer 28

aortic stenosis, pulmonic stenosis, mitral regurgitation, tricuspid regurgitation

Question 29

what are the types of diastolic murmurs?

Answer 29

aortic/pulmonic regurgitation, mitral/tricuspid stenosis

Question 30

how do you manage valve dysfunction

Answer 30

control HR, manage HTN, manage fluid volume

Question 31

how would you surgically manage valve dysfunctions?

Answer 31

percutaneous or surgical – valvuloplasty or valvulotomy for aortic/mitral vlaves. can do valve replacement or repair

Question 32

what are the types of valves in a valve replacement surgery?

Answer 32

mechanical or tissue

Question 33

what is a mechanical valve replacement?

Answer 33

metallic or synthetic material, more durable and can last length of patient’s life, requires lifelong anticoagulation, recommended for younger patients

Question 34

what is a bioprosthetic (tissue) valve replacement?

Answer 34

made from human or animal tissue, lifespan 10-20 years, no lifelong anticoagulation needed, recommended for older patients