Valvular Disease: Atrioventricular Valves Flashcards
is the mitral valve bi or tri cuspid
bicuspid. anteiror and posteiror leaflets
Obstruction to left ventricular filling caused
by narrowing of the mitral valve orifice
(opening)
mitral stenosis
1 cause of mitral stenosis
- rheumatic heart disease
- degenerative changes
- SLE/RA
what happens to the LA- LVpressure greadient in MS
there is a significatn gradient between La and LV. degree of pressure gradient correlates to the severity of MS
how can mitral stenosis lead to pulmonary vascular disease
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.
symptoms of mitral stenosis
**PND indicates high left sided pressures
what sounds would you hear in a person with MS
- 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
complications of mitral stenosis
congestive heart failure
atrial fibrillation because atrium is dilated and under high pressure
systemic embolization
bacterial endocarditis
medical therapy for MS
- 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)
mechanical therapy for MS
valvuloplasty or mitral valve replacement
key MS feature that it causes
pulmonary hypertension
made worse by increased HR
MR is Regurgitation (leaking) of blood into the
left atrium from the left ventricle during
___
during SYSTOLE
Causes of MR
usually valvular abnormality
-
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.
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.
how does compensated vs decompensated mR change EF?
compensated= normal EF or increased
decompensaated = reduced EF
in MR, LA pressure is ___ at the end of systole
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
Symptoms of MR
In COMPENSATED MR:
- Normal volume pulse
- Dilated ___
- __ heart sound
• Pansystolic murmur at ___
radiating to ___
• May have diastolic rumble apex
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
medical and surgical therapy for mR
90% of tricuspid stenosis cases are caused by ___ ____
rheumatic fever/rheumatic heart disease
-the others are caused by congenital tricuspid stenosis or carcinoid heart disease
what side of the heart does tricuspid stenosis affect/
right side of the heart. RA pressure increases and then dilates and then increases the pressure in the SVC and IVC and causes backflow.
symptoms of tricuspid stenosis
- typical fatigue and dyspnea and palpitations but also peripheral edema, ascites, and hepatic congestion because of the right heart failure and backflow.
causes of tricuspid regurgitation
Acquired Valvular • Endocarditis • Pacer lead • Trauma • Rheumatic Functional • RV dilation • Pulmonary hypertension
- can be congential, but acquired more liekly.
symptoms of tricuspid regurgitation
Symptoms • Fatigue • Dyspnea • Palpitations • Peripheral edema • Hepatic congestion • Ascites
what happens to the JVP in tricuspid regurgitation
elevated JVP with V wave dominance.
what happens to apex in TR
normal. apex dilation/incresae in size is more left sided.
where would you hear the pancystolic murmur in TR?
LLSB and increases in inspiration
treatment of TR
