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FA CARDIO 3 > Valve Dz 2 > Flashcards

Valve Dz 2 Flashcards

1
Q

mc cause of mitral stenosis

A

rheumatic fever

followed by denegeration of valve apparatus

2/3 of people are female

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2
Q

pathophys of mitral stenosis (6)

A
  1. decreased emptying of LA causes increased LA pressure
  2. LA pressure causes pulmonary venous congestion
  3. vasoconstriction and hypertrophy of pulmonary arteries
  4. remodeling and pulmonary HTN
  5. increased RV pressure leads to RV hypertrophy
  6. RV failure

** LV remains preserved until MS becomes so severe diastolic filling declines

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3
Q

symptoms of MS

A

YOUNG (30-40)

  1. dyspnea/orthopnea
  2. AFib and other dysrhythmia, atrial thombus/emboli
  3. chest pain, palpitations, fatigue, weakness and peripheral edema, blood tinged sputum (pulmonary edema)
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4
Q

signs of mitral stenosis (murmur)

A

Opening snap

low, rumbling diastolic murmur @ LV apex (5-6th ICS)

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5
Q

evaluation of MS

A

echo (okay for right side, might find it)

cardiac (L heart cath, femoral artery and thru LV to LA)

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6
Q

elements of MS treatment (6)

A
  1. diuretics
  2. dietary sodium reduction and nitrates
  3. rate control (esp. in AF w/CCB or BB)
  4. consider anticoagulation
  5. Statins (anti inflammatory, slows progression)
  6. avoid after load reduction
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7
Q

surgical MS treatment (3)

A

given to patients with severe symptoms and moderate to severe stenosis

percutaneous valvuloplasty

open mitral valve commissurotomy

open mitral valve replacement

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8
Q

critical MS value

A

< 1.5

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9
Q

percutaneous balloon valuloplasty

A

abrupt inflation of balloon across mitral valve

results in separation of fused cusps

PREFERRED if test is available

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10
Q

open mitral valve comissurotomy or replacement

A

2 dif surgeries
commissurotomy - debridement and separation of fused cusps

replacement - mechanical or tissue valve entirely replaced

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11
Q

blood ejects into aorta as well as left atrium during systole

A

mitral regurgitation

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12
Q

functional etiologies of mitral regurg

A

valve apparatus degeneration or deformation

i.e. CAD, dilated CM, papillary muscle dysfunction

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13
Q

organic etiologies of mitral regurge (3)

A
  1. myxedematous degeneration of mitral valve, associated with MVP
  2. Infectious endocarditis valve leaflet/chordae destruction
  3. Rheumatic disease
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14
Q

pathophysiology of MR (6)

A
  1. Atria dilate
  2. LV dilation – pre load + regurgitated volume (some hypertrophy)
  3. Pulmonary congestion
  4. Pulmonary HTN (due to vasoconstriction and hypertrophy of pulmonary arteries)Pulmonary veins engorged
  5. RV hypertrophy
  6. RV fails—losing systolic function, can’t squeeze
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15
Q

symptoms of MR

A

Asymptomatic gradually develop increasing pulmonary HTN

symptoms start at exercise

HF secondary to reduced CO and pulmonary congestion (DOE, fatigue, AF)

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16
Q

MR signs

A

holosystolic murmur (high pitched, blowing)

could be: wide split, S3, hyper dynamic LV, brisk upstroke

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17
Q

MR diagnostics

A

ECHO

can do cardiac cath

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18
Q

MR monitoring

A

followed annually

surgery done before LV remodeling can occur

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19
Q

pharm tx of MR

A

decreased after load (equalized pressure b/t systemic and LA)

via ACEI, nitrates, anti-HTN and diuretics

20
Q

surgical MR tx

A

pulmonary HTN and AF indicated earlier surgery

procedure of choice is REPAIR rather than replacement

true replacement indicated if valve is too damaged, papillary muscle dysfunction, or IE

21
Q

why do we repair instead of replace valve in MR

A
  1. less need for IE prophylaxis
  2. permanent fix
  3. decreased need for anti-coagulation
22
Q

Acute MR due to

A

ischemia or infarction of chordae, papillary muscles, or IE

acutely ill due to less time to compensate and make hemodynamic changes(RV) and decreased preload (LV)

23
Q

Symptoms of acute AR

A

Acute LV Failure

Acute RV Failure

Rapid pulmonary congestion/Pulmonary edema

HoTN/shock

24
Q

acute AR tx

A

after load reduction

nitroprusside and urgent valve replacement

25
Q

MVP etiologies

A

pevelance greater in women

  1. genetic (marfan’s, connective tissue dz)
  2. myxedematous deteriorated leaflets = large floppy leaflet
26
Q

symptoms of MVP

A

asymptomatic

minor amounts have palpitations, anxiety, dizziness, CP

may be associated with MR but not always

27
Q

murmur MVP

A

mid systolic click

late systolic murmur

28
Q

diagnostics of MVP

A

2D echo (determines if there, and if MR as well)

serial echo 1-2 yrs to document lack of progression

29
Q

MVP treatment

A

stimulant avoidance (cocaine, caffeine, tobacco, chocolate)

propranolol if palpitations

30
Q

tricuspid stenosis etiologies

A

rheumatic heart disease

typically concomitant mitral or aortic valve disease

female predominance

31
Q

Tricuspide stenosis symptoms

A

signs of RV failure

peripheral edema
ascites
hepatic congestion (pain in RUQ)

32
Q

tricuspid stenosis signs

A

opening snap at LSB

palpable pre-systolic pulsation over liver

33
Q

tricuspid stenosis treatment

A

medical and surgical treatment to treat other valvular disease

may do a valve replacement

34
Q

pathophys Tricuspid regurge

A

RV dilation secondary to pulmonary HTN and RV failure

caused by: COPD, Pulmonary emboli, HF

35
Q

symptoms of TR

A

initially tolerated

pulmonary HTN –> symptomatic

systemic back up = peripheral edema, hepatic congestion

36
Q

TR signs

A

pan systolic, high pitched murmur

best heart at sternal border, augmented by increased venous return

37
Q

TR treatment

A

treating underlying cause of pulmonary HTN or RV failure

may need valve replacement

38
Q

pulmonic stenosis

A

congenital

doesn’t req. tx until adulthood

can treat with balloon valvuloplasty

39
Q

pulmonic regurgitation

A

occurs when valve annals dilates secondary to pulmonary HTN

tx directed at cause of pulmonary HTN or RV failure

40
Q

bioprosthetic valves pros and cons

A

only need anticoagulation for a few months BUT degeneration sooner (10 yrs)

41
Q

mechanical valves pros and cons

A

req. anticoagulation for life

lasts longer than bioprosthetic (20yrs)

42
Q

when is greatest risk of clot following valve replacement?

A

first three months

ONLY give warfarin

43
Q

aortic valve mechanical replacement no risk factors

A

anticoagulation with VKA (warfarin) to INR 2.5 + ASA

44
Q

aortic mechanical valve replacement and risk factors

A

VKA(warfarin) to INR 3 + ASA

AF, prior thrombus, LV dysfunction, hyper coagulable conditions

45
Q

mitral valve replacement

A

VKA (warfarin) target INR of 3 + ASA

46
Q

bioprosthetic valve replacement guidelines

A

3-6 months, 2.5 INR + ASA

47
Q

TAVR anticoagulation

A

low bleeding risk = anticoagulate 3+ months for INR 2.5 + ASA

MAYBE clopidogril for 6 mo.

FA CARDIO 3 (5 decks)

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