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Foundations II (Cholley) > Valvular disease > Flashcards

Valvular disease Flashcards

1
Q

Closure of mitral valve

A

S1

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2
Q

Closure of aortic valve

A

S2

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3
Q

Ventricular gallop

A

S3

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4
Q

What is S3 most commonly associated w/?

A

Left ventricular failure/overload

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5
Q

Atrial gallop

A

S4

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6
Q

What is S4 most commonly associated w/?

A

Left ventricular hypertrophy

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7
Q

Right sided murmurs increase w/ what?

A

Inspiration

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8
Q

Ventricular Septal Defect (VSD)

A
  • Harsh
  • Systolic
  • Best at LSB but heard throughout precordium
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9
Q

Why do you feel pulse while you listen to murmurs?

A

Helps identify:

  • Systolic vs diastolic
  • S1 vs S2
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10
Q

Signs & sx of left HF

A
  • Dyspnea (exertional, postural, nocturnal paroxysmal)
  • Rales/crackles
  • Pleural effusion (diminished breath sounds)
  • Pallor or cyanosis
  • Fatigue
  • Tachycardia
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11
Q

When is an echo indicated?

A
  • systolic murmur > II

- diastolic murmur (any grade)

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12
Q

What does an echo do?

A
  • Assess chamber size/fxn & other valve disease
  • Identifies culprit lesion(s)
  • Severity, pressure gradients, magnitude of regurgitant flow
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13
Q

Cardiac cath (right & left)

A

Direct measurement of pressure gradients if valves are stenotic

  • intrachamber pressures
  • identifies concomitant CAD
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14
Q

What is the most common cause of aortic stenosis?

A

A calcified valve

- Also due to congenital bicuspid AOV, rheumatic fever,

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15
Q

What is the initial response of aortic stenosis?

A

Compensatory LVH

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16
Q

Sx of AS

A
  • Long asymptomatic period
  • Classic triad*:
    ˚ Angina
    ˚ Syncope
    ˚ HF
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17
Q

In aortic stenosis, what do you see on PE?

A
  • Delayed carotid upstroke
  • Sustained apical impulse (non-displaced, diffuse)
  • Split S2, S3 if HF, & S4 due to stiff LV
  • Systolic ejection crescendo-decrescendo murmur @ RUSB radiating to neck
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18
Q

Surgical intervention for AS

A

Replacement = #1 choice

- w/ mechanical or tissue valve

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19
Q

What indicates that someone should undergo surgery for AS?

A
  • Severe w/ sx
  • LV dysfunction
  • Moderate when the patient needs CABG
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20
Q

What options are available for those not candidates for surgery?

A
  • TAVR

- Balloon valvuloplasty

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21
Q

Features of a bioprosthetic valve

A
  • 10-15 yr lifespan

- Usually used in elderly

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22
Q

Features of a mechanical valve

A
  • lasts longterm
  • Usually used in younger population
  • Requires anticoagulation w/ warfarin
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23
Q

What are the biggest complications w/ TAVR?

A
  • CVA
  • Complete heart block
  • Paravalvular leak
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24
Q

What are causes of aortic regurgitation?

A
  • Disease of leaflets or abnormalities of aortic root or ascending aorta
  • Chronic (over 10 yrs for LV dysfunction to develop): Bicuspid AOV, valve disease, root dilation, rheumatic fever, endocarditis, collagen vascular diseases
  • Acute: Aortic dissection*, endocarditis, post valve replacement or valvoplasty
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25
Sx of AR
Usually asymptomatic for a long time - Dyspnea - Sx of left HF
26
What is the workup for AR?
- EKG: LVH, LAD, left atrial abnormalities - CXR: cardiomegaly, dilated aortic knob, pulmonary edema - Echo: overall severity, root size, LV size/fxn
27
When is surgery indicated for AR?
- Symptomatic regardless of LVEF - If Asx, but undergoing other heart surgery - AVR & LV dysfunction or LV dilation - Aortic root dilation over 5cm
28
What is the most common cause of MR?
Mitral valve prolapse
29
What causes mitral valve prolapse?
Myxomatous degeneration of mitral valve
30
What are the primary causes of chronic mitral regurgitation
- Mitral valve prolapse - Myxomatous degeneration - Rheumatic (leaflet fibrosis)
31
What are the secondary causes of chronic mitral regurgitation?
- Ischemic - Endocarditis - Annular dilation/ dilated cardiomyopathy
32
Sx of mitral regurgitation
Usually Asx for yrs - Dyspnea - Exercise intolerance - Fatigue - Sx of left HF - AF
33
Medical tx of MR
- Vasodilators, diuretics, warfarin (if AF) However, will not prevent progression
34
Surgical indications of MR
- Based on severity, sx, cardiomyopathy | - Repair is always favored over replacement
35
Acute mitral regurgitation patho
- Papillary muscle infarct | - Chordae tendinae rupture (related to myxomatous degeneration)
36
What are causes of mitral valve stenosis?
- Rheumatic fever - Congenital (rare) - Systemic diseases (rare)
37
What is the recommended therapy for mitral stenosis according to severity? (Mild vs mild w/ sx vs AF)
- Mild (MVA > 1.5): No tx - Mild sx of dyspnea: Diuretics & salt restriction, beta blockers - AF: Anticoagulant w/ Warfarin ONLY
38
What are surgical options for mitral stenosis?
- Percutaneous balloon valvuloplasty | - Full replacement (if open repair required)
39
Fxn of cardiac valves
- Prevent back flow | - Ensure blood moves in 1 direction
40
What 2 valves are considered the "AV Valves"? How many cusps do they each have?
- Mitral: has smaller posterior cusp & larger anterior cusp - Tricuspid: has anterior & posterior cusps, along w/ a septal cusp
41
What 2 valves are considered the semilunar valves? Where are they located?
- Aortic: btwn left ventricle & aorta | - Pulmonary: btwn right ventricle & pulmonary artery
42
Anatomy of mitral & tricuspid valves
- Made up of fibrous ring & leaflets/cusps | - Attached to chordae tendinae
43
What can stenotic lesions lead to?
Pressure overload
44
What do regurgitant lesions lead to?
Volume overload & dilation of chambers
45
Define: Preload (What can cause it to increase?)
Amt of blood in ventricle at the end of diastole | - Increases w/ exercise, sympathetic tone, & blood volume
46
What has a direct relationship w/ CO?
Preload
47
Preload is determined by what 2 factors?
- Amt of venous return | - Blood left after systole
48
Afterload
Resistance or impedance to ejection of blood from LV | - Load the muscle must move after it starts to contract
49
What has an inverse relationship to CO?
Afterload | - Ex. Low aortic pressure/decreased afterload = quicker contraction (& vice versa!)
50
Diastolic dysfunction
- LV inability to relax - Decreased LV wall compliance - Limits filling of ventricle --> reliance of LA - Pressure rises in LA --> pulmonary edema, enlargement of atria (predisposing to atrial arrhythmias)
51
Causes of LV diastolic dysfunction
- HTN - Ventricular hypertrophy - Fibrosis - Infiltrative cardiomyopathy - Pericardial constriction
52
Causes of RV diastolic dysfunction (rare)
- Constrictive pericarditis | - Restrictive cardiomyopathy
53
Sx of valvular heart disease
- SOB (constant or w/ exertion) - Chest pain - Palpitations - Syncope - Edema - Weakness - Fatigue
54
Sx of right HF
- Fatigue - Tachy - Weight gain - Ascites, peripheral edema - Hepatojugular reflex - Jugular venous distension
55
Murmur grades/intensity
- I: heard in quiet room - II: heard by most - III: loud w/out thrill - IV: loud w/ thrill - V: very loud thrill, audible w/ stethoscope pressed to chest - VI: very loud thrill, audible w/ stethoscope away from chest
56
What does AR look like on PE?
- Widened pulse pressure - Water Hammer pulse (rapid upstroke, quick collapse) - Blowing diastole decrescendo murmur @ LUSB - Austin Flint murmur (mid-late diastolic rumble heard at apex) - Signs of left HF
57
Acute aortic regurgitation (what dx should you not miss?)
* Aortic dissection - Do-not-miss dx - Endocarditis
58
What does acute AR cause?
Hemodynamic emergency bc LV has no time to develop compensatory mechanisms - Results in cardiovascular decompensation
59
Sx of acute AR
- Sudden hemodynamic deterioration (weakness, change in mental status, dyspnea, syncope) --> collapse - *Chest pain - aortic dissection
60
What does acute AR look like on PE?
- Signs of hemodynamic compromise - Soft diastolic murmur - Pulse is weak, thready, & rapid - Soft or absent S1
61
What is the workup for acute AR?
- EKG: ST/T changes, sinus tach - CXR: widened mediastinum - TEE & blood cultures (if endocarditis suspected) - Echo
62
Tx for acute AR?
- Surgical emergency - hemodynamic stabilization (vasodilators, IV inotrops) - Beta blockers (if acute aortic dissection)

Foundations II (Cholley) (25 decks)

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