Valvular Disease Flashcards
Which valves are open during diastole?
mitral and triscuspid valves
Which valves are open during systole?
Pulmonary and Aortic valves
What happens when pressure in a heart chamber decreases below the downstream pressure?
The corresponding heart valve will close
Which valves have chordae tendinae and papillary muscles?
What can happen if these structures are damaged from an MI?
Atrio-ventricular valves (Bicuspid/mitral valve on left side and tricuspid on right side)
back flow can happen (regurgitation)
True or False: The aortic and pulmonic semi-lunar valves do not have papillary muscles or chordae tendinae and lie back against the walls of the aorta and pulmonary artery
False, while they do not have either papillary muscles or chordae tendinae the valves do not rest against the walls of the aorta or pulmonary artery
What are the general symptoms for cardiac valvular disease?
- easily fatigued
- dyspnea
- palpitations
- murmurs
- chest pain
- pitting edema
- orthopnea
- dizziness
What is the result of increased LV mass with normal relative wall thickness?
Eccentric hypertrophy
What is the result of normal LV mass with increased relative wall thickness?
Concentric remodeling
What is the result of an increase in both LV mass and relative wall thickness?
Concentric hypertrophy
What are the two main types of pathophysiology for valvular disease and what are examples of each?
Congenital (genetic and maternal exposure)
Acquired (rheumatic fever, endocarditis, gradual fibrosis)
What is mitral stenosis?
What population does it primarily occur in?
What is the main cause of mitral stenosis?
Narrowing of the mitral valve which increases resistance to blood flow between A-V
Women (66%)
Rheumatic heart disease
Where would you expect to see hypertrophy in a patient’s heart that has mitral stenosis?
Left Atrium (upstream from stenosis)
What ausculatory sounds would be common for mitral stenosis?
an opening snap with diastolic rumble
What is mitral regurgitation/incompetence?
When mitral valve does not close completely during systole (incompetence) which creates backflow (regurgitation)
True or False: roughly 20% of people over the age of 55 have some degree of mitral regurgitation.
True
What are the implications of mitral regurgitation to the structure of the heart?
An increased Stroke Volume is needed to compensate for back flow which causes the L atrium to dilate out and eccentric hypertrophy to accommodate for increased volume
What medication is indicated if a patient with mitral regurgitation has symptoms w/ exercise?
Beta blockers
What is a mitral valve prolapse?
How common is it?
when the valve snaps open during systole
2-6% of the population has some degree of mitral prolapse
What accounts for the majority of aortic stenosis cases?
How common is aortic stenosis?
calcific aortic stenosis and congenital bicuspid aortic valve stenosis
~25% of the population older than 65 have some degree of aortic stenosis
What ausculatory sounds would you expect in the left ventricle of a patient with aortic stenosis?
Diastolic murmur “blowing”
What are some common causes of aortic regurgitation/incompetence?
What are some more rare conditions that can cause aortic regurgitation?
congenital, rheumatic, endocarditis, deterioration with age as well as long standing HTN
Marfan syndrome, ankylosing spondylitis and certain STDs
True or False: If a patient has aortic regurgitation/incompetence you will see pulmonary symptoms almost immediately.
False, there will be no pulmonary symptoms until very advanced stages
What exercise considerations should be made for patients with valvular stenosis?
- closely monitor with RPE
- low muscle perfusion may limit exercise
- supressed BP response to exercise, possibly exaggerated HR
- low cardiac output
- pts w/ symptomatic aortic stenosis are typically not candidates for exercise programs
- instensity should be low and progressed gradually for asymptomatic pts
- angina may be a symptom
True or False: Mechanical replacement valves usually last a lifetime but require anticoagulant medication
True
True or False: Older patients are typically better candidates for mechanical valve replacements due to the decreased risk of infection
False, mechanical replacements have a higher risk for infection, thrombus, and emboli but they last a lifetime which is why younger patients are typically better candidates since biological may fail overtime
What tissue layer covers the heart directly?
Epicardium
What are the three layers of the pericardium?
Fibrous layer: outermost
Serous layer” innermost
Pericardial space” potential space between the two layers which is filled with fluid to lubricate the heart and reduce friction
What is pericarditis?
What are common causes?
swelling and irritation of the pericardium
viral infections, bacterial infections (less common), fungal infections (rare), or may occur due to a heart attack, radiation therapy, and post open heart surgery
What are signs and symptoms of pericarditis?
- sharp retrosternal pain w/ radiation to the back (which lasts hours)
- fever
- pain worsens with deep breathing or coughing
- pain is improved while sitting up and leaning forward
- friction rub on auscultation
What is pericardial effusion?
What are common causes?
What can it progress into?
Accumulation of fluid in the pericardial sac
viral infections, bacterial infections (less common), fungal infections (rare), or may occur due to a heart attack, radiation therapy, and post open heart surgery
Cardiac Tamponade
What are signs and symptoms of pericardial effusion?
Symptoms: pressure pain in chest, dysphagia, dyspnea
Signs: muffled heart sounds, possibly JVD
What are the four primary auscultation areas? Where is each located?
Aortic region: right 2nd intercostal space, parasternal
Pulmonic Region: Left 2nd intercostal space, parasternal
Tricuspid Region: Left 4th intercostal space, parasternal
Mitral Region: Left 5th intercostal space, midclavicular
What are the two main normal heart sounds and what does each represent?
S1 (“Lub”)-closure of the AV valves and marks the approximate beginning of systole
S2 (“Dub”)- closure of the semilunar valves (aortic and pulmonic) marks the end of systole
True or False: The S2 heart sound is shorter in duration and lower in frequency that S1
False, while S2 is shorter it is a higher frequency
True or False: The S1 heart sound can sometimes be split into two different sound marking the asynchronous closing of the mitral and tricuspid valves
True
What are the two extra heart sounds?
S3- occurs at beginning of diastole and is lower in pitch than S1 or S2 because it is not of valvular origin
S4- occurs prior to S1, produced by the sound of blood being forced into a stiff or hypertrophic ventricle
What 5 ways do we asses murmurs?
Shape-crescendo (grows louder), decrescendo, crescendo-decrescendo, plateau
Location-Determined by the site where the murmur originates (A, P, T, M listening areas)
Timing-murmurs are longer than heart sounds or which phase the murmurs are found (systole, diastole, continuous)
Intensity-graded on a 6 point scale
Pitch-high, medium, low
What is the 6 point scale in which murmurs are classified based on intensity?
Which level are thrills associated with murmurs?
1-very faint 2-quiet but heard immediately 3-moderately loud 4-loud 5-heard with stethoscope partly off chest 6- no stethoscope needed
thrills are assoc, w/ murmurs of grades 4-6
