Valvular Disease Flashcards
Gradient (what it is and equation)
Pressure difference formed from obstructed valve, = 4 x velocity^2
4 Systolic Murmurs
Aortic stenosis
Mitral insufficiency
Mitral valve prolapse
Tricuspid insufficiency
2 Diastolic Murmurs
Aortic insufficiency
Mitral stenosis
General Management of Valve Disease
Most are chronic/progress slowly and have very serious surgeries, so wait and follow for awhile to see if it worsens. If surgery considered, it can be helpful as long as done before vents are seriously damaged
Aortic Stenosis Development
Calcifications from artherosclerotic process (LDL deposits and mac consumption) buildup on valve, more common w/ bicuspid (and earlier)
Aortic Stenosis Auscultory Sounds (Mild, Moderate, Severe, and 1 other)
Slow rising carotid pulse
Mild - EJ right after S1, systolic murmur
Moderate - lose EJ, late peak in murmur, smaller A2
Severe - lose A2
Classification of Treatment Determination
I - Should be performed/administered
IIa - It is reasonable
IIb - may be considered
III - shouldn’t be done
2 AS Non-surgical Treatments
Maybe statins
TAVI: Trans-Catheter Aortic Valve Implant
2 Aortic Regurg Etiologies
Abnormal valve leaflets
Dilated aortic root (like from Marfan’s)
AR Pressure Effect
Very wide pulse pressure (high systolic and low diastolic), so lots of pulsing/rhythmic signs like Quincke’s sign (capillary pulsation at nail beds)
Austin-Flint Murmur
Mid-diastolic AR jet directed at anterior mitral leaflet in severe AR
AR Angina
More nocturnal than exertional, bc decreased diastolic aortic pressure and increased LVEDP decrease coronary a. diastolic flow
AR Medical Therapy
Anti-HTN and vasodilators like nifedipine or ACE inhibitors or something
Chronic vs. Acute AR (BP, murmur, ECG, mitral closure)
Highsystolic/wide pulse vs. low
Long blowing diastolic vs. short diastolic
LVH vs. ST T abnormality
Normal mitral closure vs. Mitral preclosure before systole
Mitral Stenosis Ascultation
S1 accentuated and snapping, opening sound (OS) after aortic valve closure (S2), and diastolic rumble
Mitral Stenosis Complications
Can get pulmonary edema/heart failure w/ exercise, pregnancy, or Afib (which is commonly developed) as blood backs up in LA
4 Treatments for MS
Treat arrhythmia/anti-coag for Afib Rheumatic Fever Prophylaxis If serious: Valvuloplasty w/ percutaneous balloon Valve replacement if valvuloplasty not possible
4 Causes of Mitral Regurg
I - Normal leaflet motion: dilated annuls (dilated LA maybe?) or perforation
II - Increased leaflet motion - mitral prolapse, papillary or chordae fuck-ups
IIIa - Restricted opening and closure - fibrosis/calcified leaflets or chordae thickening
IIIb - Restricted closure - Leaflet tehtering
Chronic MR Palpation/Auscultation
Holoysystolic murmur loudest at apex, w/ laterall displaced PMI and S3 gallop
MR Intervention
Mitral valve clip
Mitral Valve Prolapse
Flails into LA in systole, either from myxomatous degeneration of leaflets and chordae or maybe some fibroelastic deficiency
MVP Auscultation
Midsystolic click w/ late systolic murmur (earlier and louder w/ small LV)
Most Common Outcome of MVP
Benign course
Biovalves
Less durable, but don’t require anticoagulants so might want for shitty patients you know won’t take their meds or young women who want babies later
