Valvular Disease Flashcards
What is eccentric
stretching out
dilating
what is concentric
getting closer
constricting
During systole what 2 valves are open
aortic and pulmonic
during diastole what 2 valves are open
tricuspid and mitral
during the start of systole, what valves CLOSE
mitral and tricuspid (AV valves)
when systole ends, what valves CLOSE
aortic and pulmonic (semilunar valves)
where is Erb’s point
third left intercostal space - left sternal border
more for pathology
What is the splitting of S1 indicative of
pathologic - asynchronous closure of the mitral and tricuspid valves
what is the splitting of S2 indicative of
often heard during inspiration
can be normal or associated with atrial septal defect
aorta closes before the pulmonic with this finding
what is S3 associated with
early diastole, ventricular gallop
associated with change in ventricular compliance - dilated cardiomyopathy
Ken-tuc-ky
what is S4 associated with
late diastole, atrial gallop
just prior to S1
Ten-nes-see
What happens with stenosis
valve is not able to open completely
may be due to fibrosis, sclerosis, calcification - atherosclerosis
What happens with regurgitation
valve is not able to shut completely and allows blood to flow retrograde
what is rheumatic heart disease
autoimmune response to the initial GAS (group A strep) infection
results in inflammatory response within the CNS, Heart, skin and joints
what is a complication of Group A strep infection
Rheumatic fever/rheumatic heart disease
what does rheumatic fever cause within the heart
fibrotic valvular changes
-mitral regurgitation
-mitral stenosis
- aortic regurgitation
-aortic stenosis
when does rheumatic fever occur
weeks after initial illness (initial complaint will be sore throat - strep)
who is most likely to get rheumatic fever
most common in developing countries
- children 5-15
- associated with environmental factors
- to lesser degree, associated with lack of abx
what does chronic rheumatic heart disease lead to
valvular diseases
what surrounds the aortic valve
annulus that is made up of fibrous ring
what are symptoms of severe aortic stnosis
HF
Angina
Syncope
what is the most common initial symptom of aortic stenosis
dyspnea
what occurs with jet velocity with aortic stenosis
increases from 2m/s to 4m/s
what is aortic stenosis
thickening of the aortic valve, with calcification, which leads to increased velocity
decreased opening during systole - causes systolic murmur
what are the causes of valvular stenosis
congenital causes - bicuspid, unicuspid, fusion of leaflets at birth
calcification of typical tri-leaflet valve
Rheumatic heart disease
What is BNP used for
Brain naturetic peptide
helps determine if patient has CHF
released from the ventricles during times of excess stretch
when does aortic regurgitation occur
during diastole, the blood that should be within the aorta or systemic circulation is able to reenter the LV
results in diastolic murmur
what causes aortic regurgitation
bicuspid valve
rheumatic heart disease
endocarditis
traumatic
post surgical
aortic disease (HTN, aneurysm, dissection, CT d/o)
what does aortic root cause
adherence to valvular cusps to seperate - aneurysms, dissection
what are mitral stenosis
fibrotic and/or calcified valve reduces the opening/circumference of the valve
diastolic heart disease
decreased blood flow from the LA to the LV
what causes mitral stenosis
rheumatic heart disease
older pts
end renal disease
calcification deposits
how big is the normal mitral valve opening
4-6 cm
when does mitral valve stenosis become symptomatic
< 2cm opening
what is the presentation of mitral stenosis
dyspnea
orthopnea
hemoptysis
how does mitral stenosis cause hemoptsis
leads to BV having increased pressure, vessels can rupture, blood will enter alveoli and fill airways
what are the primary mitral regurgitation causes
infective endocarditis (s. viridans, bulky vegetation)
rheumatic heart disease
mitral valve prolapse
CT disorder
myocardial infarction (papillary rupture)
what are secondary mitral regurgitation causes
valve is normal
problem is within the ventricle causing change in the shape of the annulus
hypertrophic obstructive cardiomyopathy
what is mitral valve prolapse thought to be associated with
autonomic dysfunction and neuroendocrine dysfunction
increased catecholamine levels
Where is the moderator band located
sits near the papillary muscle and carries a large amount of the RBB to the myocardium of the RV and tricuspid valve
what is tricuspid stenosis
rare- typically associated with disease that affect the other valves as well
valve becomes non-complaint, difficult to open
what does a dilated right atrium increase the risk for
arrhythmia
what are the causes of tricuspid stenosis
rheumatic heart disease
carcinoid syndrome
tumors
when are the symptoms of tricuspid regurgitation worse
with increased preload
like when doing squats or inspiration
what can tricuspid regurgitation cause
pulmonary HTN
endocarditis (IVDU, S. aureus)
papillary muscle rupture (acute infarction)
what occurs with pulmonic stenosis
there is a thickening of the pulmonic valve which leads to increased velocity
decreased opening during systole and causes systolic murmur
can cause RV hypertrophy
What causes pulmonary stenosis
congenital
Acquired: carcinoid heart disease due to carcinoid tumors, plaque deposits
What occurs with pulmonary regurgitation
valves unable to close properly
during diastole, blood is able to flow back from pulmonary circulation into the RV - diastolic heart murmur
RV dilation
What can cause pulmonary regurgitation
endocarditis
Carcinoid syndrome
post-surgical changes after balloon dilation for TOF
What is vegetation
size of the thrombus/bacteria will enlarge
what happens to the valves with endocarditis
valvular destruction due to the body fighting the bacteria and the bacteria releasing proteases
What is FROM JANE
signs of bacterial endocarditis
Fever
Roth spots
Osler nodes
Murmur
Janeway lesions
Anemia
Nail-bed hemorrhages
Emboli
What is the Duke Criteria
is how you can diagnose endocarditis
need 2 major or 1 Major and 2 minor positives or 5 minors
What is a septic emboli
vegetations on the right side will shed into the pulmonary circulation
vegetation on the left side will shed into the systemic circulation
can have Osler nodes and Roth sports associated with immune response
What are the causes of endocarditis
IVDU
structural heart disease
prosthetic valve
poor dental hygiene
HIV
Hemodialysis
in kids: associated with congenital valvular disease, nosocomila infection, rheumatic heart disease
What are the acute pathogen causes of endocarditis
S.aureus
B-hemolytic strep
Aerobic gram-negative bacilli
what are the subacute pathogen causes of endocarditis
S. viridans
S. aureus
enterococci
Coagulase-negative strep or staph
what is the presentation of endocarditis
patients prevent with the illness but also with the valvulopathy and septic emboli
Acute: sick (fever, HF, septic emboli, hypotension)
Subacute: More non-specific, lesser degree of the above
How is endocarditis diagnosed
blood cultures
echocardiography
clinical findings
