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Clin Med - Cardiology > Valvular Disease > Flashcards

Valvular Disease Flashcards

1
Q

What is the definition of regurgitation/insufficiency of a heart valve?

A

leaking (backflow) across a closed valve

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2
Q

What is the definition of stenosis of a heart valve?

A

obstruction of forward flow across and opened valve

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3
Q

What are common etiologies of stenosis of heart valves?

A

rheumatic fever

congenital

degenerative

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4
Q

What are common causes of valvular regurgitation?

A

myocardial dysfunction (MI)

infective endocarditis

rheumatic

congenital

Marfan’s

syphilis

anklyosing spondylitis

trauma

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5
Q

What is the most common cause of aortic stenosis?

A

age-related degenerative changes (calcification)

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6
Q

When you see the presentation of aortic stenosis in someone <65, what is the most common developmental defect?

A

bicuspid aortic valve

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7
Q

What happens to the left ventricle as a result of aortic stenosis?

A

Left ventricular hypertrophy (earlier)

later, dilatation

then, CHF (left heart failure)

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8
Q

What is the survival at 2 years after the onset of symptoms in aortic stenosis?

A

50%

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9
Q

What is the definitve therapy for aortic stenosis?

A

valve replacement?

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10
Q

what are the pros and cons of mechanical heart valves?

A

last longer than bio (20-30 years)

requires chest-opening surgery and need anti-coags

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11
Q

What are the findings on physical exam for aortic stenosis?

A
  • slow, diminished pulses
  • single S2
  • palpable systolic thrill
  • harsh systolic ejection murmur (radiates to neck)
  • forceful PMI
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12
Q

What are the findings on EKG in aortic stenosis?

A

left ventricular hypertrophy

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13
Q

What are the findings on chest x-ray in aortic stenosis?

A

aortic valve calcification

dilated aorta

normal or increased heart size

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14
Q

What is the most common cause of mitral stenosis?

A

rheumatic fever (50% >20 years prior to presentation)

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15
Q

What conditions increase mitral valve flow and pressure?

A
  • hypervolemia
  • hyperthyroidism
  • pregnancy
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16
Q

What are the key symptoms of mitral stenosis?

A
  • fatigue on exertion
  • dyspnea (on exertion at first)
  • venous stasis in LA - strokes and clots forming
  • LA and RV hypertrophy (dilatation late)
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17
Q

What are the signs of mitral stenosis on PE?

A
  • RV lift
  • loud S1 in mild
  • quiet S1 in severe
  • diastolic rumble at apex
  • opening snap
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18
Q

What are the signs of mitral stenosis on ECG?

A
  • normal sinus or a fib
  • right ventricular hypertrophy
  • left atrial enlargement
19
Q

What are the signs of mitral stenosis on CXR and Echo?

A

left atrial enlargement and right ventricular dilatation

calcified mitral valve

20
Q

What is the Rx for mitral stenosis?

A
  • diuretics
  • If in A fib: rate control and anticoagulation
21
Q

What happens to the heart to compensate in mitral regurgitation?

A

LV dilates to increase total stroke volume, compensating for “backward” flow through the incompetent valve.

22
Q

What can cause acute mitral regurgitation?

A
  • reputure of the chordae tendinae due to acute MI or endocarditis
23
Q

What is the end result of mitral regurgitation if untreated?

A

left heart failure (due to dilatation of the LV)

24
Q

What is the Rx for mitral regurgitation

A

diuretics

valve repair/replacement

25
Q

What is a surgical repair of mitral regurgitation called and what does it do?

A

annuloplasty and it shores up edges of leaflet so it closes during systole

26
Q

What are the PE findings with mitral regurgitation?

A

pansystolic murmur and an S3 gallop

27
Q

What are the ECG findings with mitral regurgitation?

A

LVH and LA dilatation

28
Q

What are the findings on CXR and Echo in mitral regurgitation?

A

CXR - cardiomegaly

Echo - dilated LV, LA, MVP, ruptured chord, vegetation, thickening

29
Q

What extra heart sounds do you hear in mitral valve prolapse?

A

midsystolic click and late systolic murmur

30
Q

What happens to the heart as a result of aortic regurgitation?

A

the LV gets volume overloaded and dilates

31
Q

What happens to the entire CV system as a result of aortic regurgitation?

A
  • Peripheral vasodilation to minimize pressure and regurgitation
  • low arterial diastolic pressure
  • increased systolic pressure
  • widened pulse pressure as a result of above
32
Q

What are the signs of aortic regurgitation on PE?

A
  • bounding pulses
  • wide pulse pressure
  • diastolic blowing murmur, diastolic rumble
  • systolic ejection murmur
33
Q

What are the signs of aortic regurgitation on ECG?

A

LVH

34
Q

What are the signs of aortic regurgitation on CXR/Echo?

A

LV dilatation

aortic root dilatation

dilated LV, valve thickening, vegetation, dilated aorta

diastolic fluttering of the MV

35
Q

Why is nitro contraindicated in severe aortic stenosis?

A

Patients with severe aortic stenosis already have a reduced cardiac output and LV strain, from trying to push blood through the narrowed valve to the circulation. Nitro will produce venous dilation, reducing preload and further reducing cardiac output through the narrowed valve. In addition it will reduce coronary artery filling.

Main problems are syncope and angina.

36
Q

What are additional problems, other than aortic stenosis, of a congenital bicuspid valve?

A
  • Bicuspid aortic valves also put patients at increased risk for aortic enlargement and dissection and are associated with coarctation of the aorta.
37
Q

What is the most common cause of tricuspid stenosis?

A

rheumatic heart disease

38
Q

What are the symptoms aortic stenosis?

A
  • angina
  • syncope
  • heart failure

(ordered from least to most severe)

NB: People are typically asymptomatic for a long time

39
Q

What are the two most common causes of acute aortic regurgitation?

A
  • aortic dissection
  • endocarditis
40
Q

what are the symptoms of tricuspid stenosis?

A

usually occurs with mitral valve disorders, so hard to distinguish

edema and ascites with normal RV function

41
Q

What are some of the PE findings with tricuspid stenosis?

A
  • prominent a wave on inspection of jugular venous pulsations.
  • An opening snap may be audible.
  • A soft diastolic-flow rumble may be identified by placing the bell of a stethoscope at the right parasternal border but may be inaudible.
  • The key to distinguishing murmurs of right-sided origin is the respiratory variation in intensity, which augments with inspiration.
42
Q

What is the Rx for tricuspid stenosis?

A

Diuretics, but you get increasing fatigue and dyspnea

43
Q

How common is pulmonary valve stenosis/regurgitation?

A

Rare - usually identified in childhood and results from congenital disorders (Noonan’s Syndrome)

44
Q

What physical exam findings might you see with pulmonary stenosis/regurgitation?

A

RV lift

and a diastolic decrescendo murmur

Clin Med - Cardiology (17 decks)

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