Valvular Disease: Atrioventricular Valves

Question 1

is the mitral valve bi or tri cuspid

Answer 1

bicuspid. anteiror and posteiror leaflets

Question 2

Obstruction to left ventricular filling caused
by narrowing of the mitral valve orifice
(opening)

Answer 2

mitral stenosis

Question 3

1 cause of mitral stenosis

Answer 3

1. rheumatic heart disease
2. degenerative changes
3. SLE/RA

Question 4

what happens to the LA- LVpressure greadient in MS

Answer 4

there is a significatn gradient between La and LV. degree of pressure gradient correlates to the severity of MS

Question 5

how can mitral stenosis lead to pulmonary vascular disease

Answer 5

recall; the biggest cause of right sided heart failure is left sided heart failure.

• the pressure on the left side gets higher, the perfusion worsens because LV doesn’t receive as much blood at a time because the mitral valve is narrowed. Pressure then increases on the right side and can cause pulmonary vascular disase.

Question 6

symptoms of mitral stenosis

Answer 6

**PND indicates high left sided pressures

Question 7

what sounds would you hear in a person with MS

Answer 7

• palpable/increased intensity S1 (different than aortic stenosis where it decreases S1 intensity)

The first heart sound (S1) is typically loud due to the rapidity with which RV pressure rises (dP/dt) at the time of mitral valve closure (because of high pressure in the left atrium, the left ventricle [LV] needs to reach a higher pressure before it can close the mitral valve and hence LV pressure has more time to accelerate) [5] and the wide closing excursion of the leaflets.

• opening snap
• diastolic rumble

Question 8

complications of mitral stenosis

Answer 8

congestive heart failure

atrial fibrillation because atrium is dilated and under high pressure

systemic embolization

bacterial endocarditis

Question 10

medical therapy for MS

Answer 10

• diuretics
• maintenance of sinus rhythm
• heart rate lowering medications (more time for blood to flow from LA to LV through stenosed valve)
• coumadin (prevent clots from forming in LA)

Question 11

mechanical therapy for MS

Answer 11

valvuloplasty or mitral valve replacement

Question 12

Question 13

key MS feature that it causes

Answer 13

pulmonary hypertension

made worse by increased HR

Question 14

MR is Regurgitation (leaking) of blood into the
left atrium from the left ventricle during
___

Answer 14

during SYSTOLE

Question 15

Causes of MR

Answer 15

usually valvular abnormality

-

Question 16

Hemodynamics of MR:

increased LV ___ –> ____ LV afterload because blood doesn’t need to go into high pressure aora– it has a back door escape –> ___ LV volume —> ___- total stroke volume but ___ forward stroke volume.

Answer 16

increased LV preload –> decreased LV afterload because blood doesn’t need to go into high pressure aora– it has a back door escape –> increased LV volume —> increased total stroke volume but reduced forward stroke volume.

Question 17

how does compensated vs decompensated mR change EF?

Answer 17

compensated= normal EF or increased

decompensaated = reduced EF

Question 18

Question 19

in MR, LA pressure is ___ at the end of systole

Answer 19

high at the end of systole. it should be lower but in this case, blood moves back from ventricle to atria so volume increases and thus pressure increases

Question 20

Symptoms of MR

Answer 20

Question 21

In COMPENSATED MR:

• Normal volume pulse
• Dilated ___
• __ heart sound

• Pansystolic murmur at ___
radiating to ___

• May have diastolic rumble apex

Answer 21

In COMPENSATED MR:

• Normal volume pulse
• Dilated APEX because LV is dilated
• S3 heart sound because of rapid overfilling of ventricle– could indicate heart failure and thus increased preload or more volume going into the ventricle per cycle because not all of it was pushed forward previously.

• Pansystolic murmur at APEX
radiating to AXILLA

• May have diastolic rumble apex

Question 22

medical and surgical therapy for mR

Answer 22

Question 23

90% of tricuspid stenosis cases are caused by ___ ____

Answer 23

rheumatic fever/rheumatic heart disease

-the others are caused by congenital tricuspid stenosis or carcinoid heart disease

Question 24

what side of the heart does tricuspid stenosis affect/

Answer 24

right side of the heart. RA pressure increases and then dilates and then increases the pressure in the SVC and IVC and causes backflow.

Question 25

symptoms of tricuspid stenosis

Answer 25

• typical fatigue and dyspnea and palpitations but also peripheral edema, ascites, and hepatic congestion because of the right heart failure and backflow.

Question 26

causes of tricuspid regurgitation

Answer 26

Acquired Valvular • Endocarditis • Pacer lead • Trauma • Rheumatic Functional • RV dilation • Pulmonary hypertension

• can be congential, but acquired more liekly.

Question 27

symptoms of tricuspid regurgitation

Answer 27

Symptoms • Fatigue • Dyspnea • Palpitations • Peripheral edema • Hepatic congestion • Ascites

Question 28

what happens to the JVP in tricuspid regurgitation

Answer 28

elevated JVP with V wave dominance.

Question 29

what happens to apex in TR

Answer 29

normal. apex dilation/incresae in size is more left sided.

Question 30

where would you hear the pancystolic murmur in TR?

Answer 30

LLSB and increases in inspiration

Question 31

Question 32

treatment of TR

Answer 32