Valvular Disease

Question 1

acute rheumatic fever (ARF)

Answer 1

an inflammatory disease that is a complication of upper respiratory tract infections caused by streptococci

Question 2

What is the consequence of ARF?

Answer 2

it affects all 3 layers of the heart but the worst is involved in valvular endocardium

Question 3

T/F: the deformity & impairment of cardiac valves due to ARF take only few months to fully develop

Answer 3

False

10-30 years

Question 4

stenosis

regurgitation

Answer 4

cardiac valves doesn’t open fully

cardiac valves doesn’t close fully

Question 5

concentric hypertrophy

what is the result of concentric hypertrophy?

Answer 5

thickening of ventricular wall due to hypertension

decrease wall stress -> decrease oxygen demand

Question 6

What is the downside of concentric hypertrophy?

Answer 6

thickening ventricle will become stiffer -> no compliance -> require more pressure to increase EDV

Question 7

mitral stenosis

Answer 7

the mitral valves doesn’t fully open

Question 8

What are the causes of mitral stenosis?

Answer 8

fibrous thickening & calcification of valve leaflets

fusion of commissures (the border where leaflets meet)
thickening & shortening of chordae tendinae

Question 9

what are the consequences of mitral stenosis?

Answer 9

obstructing blood flow from LA -> LV

Question 10

What are the results of obstructing blood flow from LA -> LV?

Answer 10

high pressure in left atrium -> high pressure in pulmonary veins -> pulmonary edema, dypsnea hemostyosis, enlarged liver

reduce SV & CO in LV

Question 11

what are the consequences of chronic increase in LA?

Answer 11

atrial enlargement -> stretching conducting fibers in atrium -> atrial fibrilation : increase HR & decrease the time of filling left ventricle

formation of intra atrial thrombi which can swell to become emboli

Question 12

pulmonary hypertension

what is the downside & benefit of pulmonary hypertension?

Answer 12

the “reactive” hypertension in which pulmonary arterioles undergo smooth muscles hypertrophy

beneficial in reduce blood flow to engorged pulmonary vessels

downside: increase the blood flow in ventricle leading to right heart failure -> jugular vein distention

Question 13

what are the treatment for mitral stenosis?

Answer 13

beta-blocker drugs -> decrease HR & allow time for filling the left LV

replace the new valves

percutaneous balloon mitral valvuloplasty - to break apart the commissural adhesion

Question 14

what are the cause of mitral regurgitation?

Answer 14

mitral annulus calcification

rupture & endocarditis of chordae tendineae

dysfunction & rupture of papillary muscles

left ventricle dilation

valve leaflet disease: endocarditis. rheumatic, hypertrophic cardiomyopathy

Question 15

What is the consequence of mitral regurgitation?

Answer 15

small amount of SV goes back to left atria -> LA dilation -> LA pressure increase

decrease CO & BP

increase wall stress in LV because regurgitated volume returns to left ventricle + normal pulmonary veins return -> LV volume overload -> increase SV -> eccentric hypertrophy

Question 16

What is the downside of mitral regurgitation?

Answer 16

stretching myocardium out -> no synchronous action potentials -> HR increases & deterioration of systolic function

Question 17

What will happen to the left atrium for chronic regurgitation?

Answer 17

LA become more compliant -> LA pressure is less during systole

Question 18

regurgitation fraction

small regurgitation fraction meaning?

Answer 18

the volume of mitral regurgitation return to left atrium/ total LV stroke volume

the less severe of mitral regurgitation

Question 19

In acute mitral regurgitation, what will happen to LA?

Answer 19

LA will exhibits higher pressure but no dilation -> pulmonary edema can occur

Question 20

what are the treatment of