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CABS2: Cardiology > Valvular Disease > Flashcards

Valvular Disease Flashcards

1
Q

What is eccentric

A

stretching out
dilating

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2
Q

what is concentric

A

getting closer
constricting

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3
Q

During systole what 2 valves are open

A

aortic and pulmonic

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4
Q

during diastole what 2 valves are open

A

tricuspid and mitral

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5
Q

during the start of systole, what valves CLOSE

A

mitral and tricuspid (AV valves)

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6
Q

when systole ends, what valves CLOSE

A

aortic and pulmonic (semilunar valves)

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7
Q

where is Erb’s point

A

third left intercostal space - left sternal border
more for pathology

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8
Q

What is the splitting of S1 indicative of

A

pathologic - asynchronous closure of the mitral and tricuspid valves

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9
Q

what is the splitting of S2 indicative of

A

often heard during inspiration
can be normal or associated with atrial septal defect
aorta closes before the pulmonic with this finding

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10
Q

what is S3 associated with

A

early diastole, ventricular gallop
associated with change in ventricular compliance - dilated cardiomyopathy

Ken-tuc-ky

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11
Q

what is S4 associated with

A

late diastole, atrial gallop
just prior to S1

Ten-nes-see

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12
Q

What happens with stenosis

A

valve is not able to open completely
may be due to fibrosis, sclerosis, calcification - atherosclerosis

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13
Q

What happens with regurgitation

A

valve is not able to shut completely and allows blood to flow retrograde

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14
Q

what is rheumatic heart disease

A

autoimmune response to the initial GAS (group A strep) infection
results in inflammatory response within the CNS, Heart, skin and joints

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15
Q

what is a complication of Group A strep infection

A

Rheumatic fever/rheumatic heart disease

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16
Q

what does rheumatic fever cause within the heart

A

fibrotic valvular changes
-mitral regurgitation
-mitral stenosis
- aortic regurgitation
-aortic stenosis

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17
Q

when does rheumatic fever occur

A

weeks after initial illness (initial complaint will be sore throat - strep)

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18
Q

who is most likely to get rheumatic fever

A

most common in developing countries
- children 5-15
- associated with environmental factors
- to lesser degree, associated with lack of abx

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19
Q

what does chronic rheumatic heart disease lead to

A

valvular diseases

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20
Q

what surrounds the aortic valve

A

annulus that is made up of fibrous ring

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21
Q

what are symptoms of severe aortic stnosis

A

HF
Angina
Syncope

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22
Q

what is the most common initial symptom of aortic stenosis

A

dyspnea

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23
Q

what occurs with jet velocity with aortic stenosis

A

increases from 2m/s to 4m/s

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24
Q

what is aortic stenosis

A

thickening of the aortic valve, with calcification, which leads to increased velocity
decreased opening during systole - causes systolic murmur

25
Q

what are the causes of valvular stenosis

A

congenital causes - bicuspid, unicuspid, fusion of leaflets at birth
calcification of typical tri-leaflet valve
Rheumatic heart disease

26
Q

What is BNP used for

A

Brain naturetic peptide
helps determine if patient has CHF
released from the ventricles during times of excess stretch

27
Q

when does aortic regurgitation occur

A

during diastole, the blood that should be within the aorta or systemic circulation is able to reenter the LV
results in diastolic murmur

28
Q

what causes aortic regurgitation

A

bicuspid valve
rheumatic heart disease
endocarditis
traumatic
post surgical
aortic disease (HTN, aneurysm, dissection, CT d/o)

29
Q

what does aortic root cause

A

adherence to valvular cusps to seperate - aneurysms, dissection

30
Q

what are mitral stenosis

A

fibrotic and/or calcified valve reduces the opening/circumference of the valve
diastolic heart disease
decreased blood flow from the LA to the LV

31
Q

what causes mitral stenosis

A

rheumatic heart disease
older pts
end renal disease
calcification deposits

32
Q

how big is the normal mitral valve opening

A

4-6 cm

33
Q

when does mitral valve stenosis become symptomatic

A

< 2cm opening

34
Q

what is the presentation of mitral stenosis

A

dyspnea
orthopnea
hemoptysis

35
Q

how does mitral stenosis cause hemoptsis

A

leads to BV having increased pressure, vessels can rupture, blood will enter alveoli and fill airways

36
Q

what are the primary mitral regurgitation causes

A

infective endocarditis (s. viridans, bulky vegetation)
rheumatic heart disease
mitral valve prolapse
CT disorder
myocardial infarction (papillary rupture)

37
Q

what are secondary mitral regurgitation causes

A

valve is normal
problem is within the ventricle causing change in the shape of the annulus
hypertrophic obstructive cardiomyopathy

38
Q

what is mitral valve prolapse thought to be associated with

A

autonomic dysfunction and neuroendocrine dysfunction
increased catecholamine levels

39
Q

Where is the moderator band located

A

sits near the papillary muscle and carries a large amount of the RBB to the myocardium of the RV and tricuspid valve

40
Q

what is tricuspid stenosis

A

rare- typically associated with disease that affect the other valves as well
valve becomes non-complaint, difficult to open

41
Q

what does a dilated right atrium increase the risk for

A

arrhythmia

42
Q

what are the causes of tricuspid stenosis

A

rheumatic heart disease
carcinoid syndrome
tumors

43
Q

when are the symptoms of tricuspid regurgitation worse

A

with increased preload
like when doing squats or inspiration

44
Q

what can tricuspid regurgitation cause

A

pulmonary HTN
endocarditis (IVDU, S. aureus)
papillary muscle rupture (acute infarction)

45
Q

what occurs with pulmonic stenosis

A

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

46
Q

What causes pulmonary stenosis

A

congenital
Acquired: carcinoid heart disease due to carcinoid tumors, plaque deposits

47
Q

What occurs with pulmonary regurgitation

A

valves unable to close properly
during diastole, blood is able to flow back from pulmonary circulation into the RV - diastolic heart murmur
RV dilation

48
Q

What can cause pulmonary regurgitation

A

endocarditis
Carcinoid syndrome
post-surgical changes after balloon dilation for TOF

49
Q

What is vegetation

A

size of the thrombus/bacteria will enlarge

50
Q

what happens to the valves with endocarditis

A

valvular destruction due to the body fighting the bacteria and the bacteria releasing proteases

51
Q

What is FROM JANE

A

signs of bacterial endocarditis
Fever
Roth spots
Osler nodes
Murmur

Janeway lesions
Anemia
Nail-bed hemorrhages
Emboli

52
Q

What is the Duke Criteria

A

is how you can diagnose endocarditis
need 2 major or 1 Major and 2 minor positives or 5 minors

53
Q

What is a septic emboli

A

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

54
Q

What are the causes of endocarditis

A

IVDU
structural heart disease
prosthetic valve
poor dental hygiene
HIV
Hemodialysis
in kids: associated with congenital valvular disease, nosocomila infection, rheumatic heart disease

55
Q

What are the acute pathogen causes of endocarditis

A

S.aureus
B-hemolytic strep
Aerobic gram-negative bacilli

56
Q

what are the subacute pathogen causes of endocarditis

A

S. viridans
S. aureus
enterococci
Coagulase-negative strep or staph

57
Q

what is the presentation of endocarditis

A

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

58
Q

How is endocarditis diagnosed

A

blood cultures
echocardiography
clinical findings

CABS2: Cardiology (11 decks)

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