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Cardiopulmonary > Valvular Disease > Flashcards

Valvular Disease Flashcards

1
Q

Which valves are open during diastole?

A

mitral and triscuspid valves

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2
Q

Which valves are open during systole?

A

Pulmonary and Aortic valves

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3
Q

What happens when pressure in a heart chamber decreases below the downstream pressure?

A

The corresponding heart valve will close

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4
Q

Which valves have chordae tendinae and papillary muscles?

What can happen if these structures are damaged from an MI?

A

Atrio-ventricular valves (Bicuspid/mitral valve on left side and tricuspid on right side)

back flow can happen (regurgitation)

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5
Q

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

A

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

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6
Q

What are the general symptoms for cardiac valvular disease?

A
  • easily fatigued
  • dyspnea
  • palpitations
  • murmurs
  • chest pain
  • pitting edema
  • orthopnea
  • dizziness
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7
Q

What is the result of increased LV mass with normal relative wall thickness?

A

Eccentric hypertrophy

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8
Q

What is the result of normal LV mass with increased relative wall thickness?

A

Concentric remodeling

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9
Q

What is the result of an increase in both LV mass and relative wall thickness?

A

Concentric hypertrophy

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10
Q

What are the two main types of pathophysiology for valvular disease and what are examples of each?

A

Congenital (genetic and maternal exposure)

Acquired (rheumatic fever, endocarditis, gradual fibrosis)

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11
Q

What is mitral stenosis?

What population does it primarily occur in?

What is the main cause of mitral stenosis?

A

Narrowing of the mitral valve which increases resistance to blood flow between A-V

Women (66%)

Rheumatic heart disease

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12
Q

Where would you expect to see hypertrophy in a patient’s heart that has mitral stenosis?

A

Left Atrium (upstream from stenosis)

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13
Q

What ausculatory sounds would be common for mitral stenosis?

A

an opening snap with diastolic rumble

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14
Q

What is mitral regurgitation/incompetence?

A

When mitral valve does not close completely during systole (incompetence) which creates backflow (regurgitation)

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15
Q

True or False: roughly 20% of people over the age of 55 have some degree of mitral regurgitation.

A

True

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16
Q

What are the implications of mitral regurgitation to the structure of the heart?

A

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

17
Q

What medication is indicated if a patient with mitral regurgitation has symptoms w/ exercise?

A

Beta blockers

18
Q

What is a mitral valve prolapse?

How common is it?

A

when the valve snaps open during systole

2-6% of the population has some degree of mitral prolapse

19
Q

What accounts for the majority of aortic stenosis cases?

How common is aortic stenosis?

A

calcific aortic stenosis and congenital bicuspid aortic valve stenosis

~25% of the population older than 65 have some degree of aortic stenosis

20
Q

What ausculatory sounds would you expect in the left ventricle of a patient with aortic stenosis?

A

Diastolic murmur “blowing”

21
Q

What are some common causes of aortic regurgitation/incompetence?

What are some more rare conditions that can cause aortic regurgitation?

A

congenital, rheumatic, endocarditis, deterioration with age as well as long standing HTN

Marfan syndrome, ankylosing spondylitis and certain STDs

22
Q

True or False: If a patient has aortic regurgitation/incompetence you will see pulmonary symptoms almost immediately.

A

False, there will be no pulmonary symptoms until very advanced stages

23
Q

What exercise considerations should be made for patients with valvular stenosis?

A
  • 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
24
Q

True or False: Mechanical replacement valves usually last a lifetime but require anticoagulant medication

A

True

25
Q

True or False: Older patients are typically better candidates for mechanical valve replacements due to the decreased risk of infection

A

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

26
Q

What tissue layer covers the heart directly?

A

Epicardium

27
Q

What are the three layers of the pericardium?

A

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

28
Q

What is pericarditis?

What are common causes?

A

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

29
Q

What are signs and symptoms of pericarditis?

A
  • 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
30
Q

What is pericardial effusion?

What are common causes?

What can it progress into?

A

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

31
Q

What are signs and symptoms of pericardial effusion?

A

Symptoms: pressure pain in chest, dysphagia, dyspnea

Signs: muffled heart sounds, possibly JVD

32
Q

What are the four primary auscultation areas? Where is each located?

A

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

33
Q

What are the two main normal heart sounds and what does each represent?

A

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

34
Q

True or False: The S2 heart sound is shorter in duration and lower in frequency that S1

A

False, while S2 is shorter it is a higher frequency

35
Q

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

A

True

36
Q

What are the two extra heart sounds?

A

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

37
Q

What 5 ways do we asses murmurs?

A

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

38
Q

What is the 6 point scale in which murmurs are classified based on intensity?

Which level are thrills associated with murmurs?

A 
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

Cardiopulmonary (12 decks)

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