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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
Q

Sx of AR

A

Usually asymptomatic for a long time

  • Dyspnea
  • Sx of left HF
26
Q

What is the workup for AR?

A
  • EKG: LVH, LAD, left atrial abnormalities
  • CXR: cardiomegaly, dilated aortic knob, pulmonary edema
  • Echo: overall severity, root size, LV size/fxn
27
Q

When is surgery indicated for AR?

A
  • Symptomatic regardless of LVEF
  • If Asx, but undergoing other heart surgery
  • AVR & LV dysfunction or LV dilation
  • Aortic root dilation over 5cm
28
Q

What is the most common cause of MR?

A

Mitral valve prolapse

29
Q

What causes mitral valve prolapse?

A

Myxomatous degeneration of mitral valve

30
Q

What are the primary causes of chronic mitral regurgitation

A
  • Mitral valve prolapse
  • Myxomatous degeneration
  • Rheumatic (leaflet fibrosis)
31
Q

What are the secondary causes of chronic mitral regurgitation?

A
  • Ischemic
  • Endocarditis
  • Annular dilation/ dilated cardiomyopathy
32
Q

Sx of mitral regurgitation

A

Usually Asx for yrs

  • Dyspnea
  • Exercise intolerance
  • Fatigue
  • Sx of left HF
  • AF
33
Q

Medical tx of MR

A
  • Vasodilators, diuretics, warfarin (if AF)

However, will not prevent progression

34
Q

Surgical indications of MR

A
  • Based on severity, sx, cardiomyopathy

- Repair is always favored over replacement

35
Q

Acute mitral regurgitation patho

A
  • Papillary muscle infarct

- Chordae tendinae rupture (related to myxomatous degeneration)

36
Q

What are causes of mitral valve stenosis?

A
  • Rheumatic fever
  • Congenital (rare)
  • Systemic diseases (rare)
37
Q

What is the recommended therapy for mitral stenosis according to severity? (Mild vs mild w/ sx vs AF)

A
  • Mild (MVA > 1.5): No tx
  • Mild sx of dyspnea: Diuretics & salt restriction, beta blockers
  • AF: Anticoagulant w/ Warfarin ONLY
38
Q

What are surgical options for mitral stenosis?

A
  • Percutaneous balloon valvuloplasty

- Full replacement (if open repair required)

39
Q

Fxn of cardiac valves

A
  • Prevent back flow

- Ensure blood moves in 1 direction

40
Q

What 2 valves are considered the “AV Valves”? How many cusps do they each have?

A
  • Mitral: has smaller posterior cusp & larger anterior cusp
  • Tricuspid: has anterior & posterior cusps, along w/ a septal cusp
41
Q

What 2 valves are considered the semilunar valves? Where are they located?

A
  • Aortic: btwn left ventricle & aorta

- Pulmonary: btwn right ventricle & pulmonary artery

42
Q

Anatomy of mitral & tricuspid valves

A
  • Made up of fibrous ring & leaflets/cusps

- Attached to chordae tendinae

43
Q

What can stenotic lesions lead to?

A

Pressure overload

44
Q

What do regurgitant lesions lead to?

A

Volume overload & dilation of chambers

45
Q

Define: Preload (What can cause it to increase?)

A

Amt of blood in ventricle at the end of diastole

- Increases w/ exercise, sympathetic tone, & blood volume

46
Q

What has a direct relationship w/ CO?

A

Preload

47
Q

Preload is determined by what 2 factors?

A
  • Amt of venous return

- Blood left after systole

48
Q

Afterload

A

Resistance or impedance to ejection of blood from LV

- Load the muscle must move after it starts to contract

49
Q

What has an inverse relationship to CO?

A

Afterload

- Ex. Low aortic pressure/decreased afterload = quicker contraction (& vice versa!)

50
Q

Diastolic dysfunction

A
  • 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
Q

Causes of LV diastolic dysfunction

A
  • HTN
  • Ventricular hypertrophy
  • Fibrosis
  • Infiltrative cardiomyopathy
  • Pericardial constriction
52
Q

Causes of RV diastolic dysfunction (rare)

A
  • Constrictive pericarditis

- Restrictive cardiomyopathy

53
Q

Sx of valvular heart disease

A
  • SOB (constant or w/ exertion)
  • Chest pain
  • Palpitations
  • Syncope
  • Edema
  • Weakness
  • Fatigue
54
Q

Sx of right HF

A
  • Fatigue
  • Tachy
  • Weight gain
  • Ascites, peripheral edema
  • Hepatojugular reflex
  • Jugular venous distension
55
Q

Murmur grades/intensity

A
  • 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
Q

What does AR look like on PE?

A
  • 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
Q

Acute aortic regurgitation (what dx should you not miss?)

A
  • Aortic dissection
  • Do-not-miss dx
  • Endocarditis
58
Q

What does acute AR cause?

A

Hemodynamic emergency bc LV has no time to develop compensatory mechanisms
- Results in cardiovascular decompensation

59
Q

Sx of acute AR

A
  • Sudden hemodynamic deterioration (weakness, change in mental status, dyspnea, syncope) –> collapse
  • *Chest pain - aortic dissection
60
Q

What does acute AR look like on PE?

A
  • Signs of hemodynamic compromise
  • Soft diastolic murmur
  • Pulse is weak, thready, & rapid
  • Soft or absent S1
61
Q

What is the workup for acute AR?

A
  • EKG: ST/T changes, sinus tach
  • CXR: widened mediastinum
  • TEE & blood cultures (if endocarditis suspected)
  • Echo
62
Q

Tx for acute AR?

A
  • Surgical emergency
  • hemodynamic stabilization (vasodilators, IV inotrops)
  • Beta blockers (if acute aortic dissection)

Foundations II (Cholley) (25 decks)

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