Valvular disease- Bricks Flashcards
Aortic stenosis occurs when _
Aortic stenosis occurs when aortic valve leaflets become stiff and are unable to fully open –> makes it difficult for the heart to pump blood to the rest of the body
The 3 cardinal signs of aortic stenosis are:
The 3 cardinal signs of aortic stenosis are:
1. Angina
2. Syncope
3. Dyspnea
What makes aortic stenosis angina unique?
Angina induced by aortic stenosis may present without coronary artery disease
* It is rather caused by a high myocardial oxygen demand since we need to generate really high pressures in the LV to pump blood through the stenotic valve
The three most common causes of aortic stenosis are:
The three most common causes of aortic stenosis are:
1. Degenerative calcifications (aka dystrophic calcification)
2. Congenital bicuspid valve
3. Rheumatic heart disease
Aortic stenosis can lead to _ heart failure
Aortic stenosis can lead to diastolic heart failure
* High LV pressure –> concentric hypertrophy –> Diastolic HF
* Associated with S4 heart sound
Aortic stenosis has _ S2 sounds
Aortic stenosis has single S2 because the aortic valve closure is very delayed
Aortic stenosis is associated with _ murmur best heart over _ region
Aortic stenosis is associated with harsh crescendo-decrescendo systolic ejection murmur best heart over second ICS at the URSB
Aortic stenosis murmur is best heard in the aortic region but will also radiate to the _
Aortic stenosis murmur is best heard in the aortic region but will also radiate to the carotid
Aortic stenosis murmurs will be louder with:
(Increased/Decreased) prelod
(Increased/Decreased) afterload
(Inspiration/Expiration)
Aortic stenosis murmurs will be louder with:
Increased preload
Decreased afterlod
Expiration
Right sided murmurs are louder on (inspiration/expiration)
Right sided murmurs are louder on inspiration
* Because during inspiration we increase venous return to the RA –> increases RV preload –> makes the murmur louder
Left sided murmurs are louder on (inspiration/ expiration)
Left sided murmurs are louder on expiration
Another sign of aortic stenosis is _ , a dulled, delayed carotid pulse; this occurs becuase _
Another sign of aortic stenosis is pulsus parvus et tardus , a dulled, delayed carotid pulse
* This occurs because it takes longer to complete LV contraction and close the aortic valve
* The carotid upstroke is delayed after the S2 heart sound
Draw the expected PV loop in aortic stenosis
Why is volume depletion or vasodilation so dangerous for patients with AS?
Because patients with AS are preload dependent
* Their stenosis already decreases the SV
* Therefore, they are especially preload dependent
Squatting (increases/decreases) preload
Squatting increases preload
* Increases afterload too
Passive leg raise (increases/decreases) preload
Passive leg raise increases preload
Valsalva and standing both _ preload
Valsalva and standing both decrease preload
(Systolic/Diastolic) murmurs are almost always abnormal
Diastolic murmurs are almost always abnormal
Dystrophic calcification is (normal/abnormal) valve + (normal/abnormal) calcium
Dystrophic calcification is abnormal valve + normal calcium
Metastatic calcification is (normal/abnormal) valve + (normal/abnormal) calcium
Metastatic calcification is normal valve + abnormal calcium
Aortic regurgitation is a condition in which _
Aortic regurgitation is a condition in which the heart’s aortic valve does not close tightly and blood travels back from the aorta into the LV
* This occurs during diastole (so both the aortic valve and the mitral valve will be open
Aortic regurgitation may not present with noticeable symptoms (acute cases more likely symptomatic because there is no time for the body to compensate)
Sx (acute aortic regurgitation):
* Exertional dyspnea
* Pulmonary edema
Aortic regurgitation is often caused by _ which can either be secondary to acute conditions like _ or chronic conditions like _
Aortic regurgitation is often caused by aortic dilatation which can either be secondary to
* Acute conditions like dissection, aneurysm or
* Chronic conditions like Ehlers-Danlos, Marfans, syphilis, hypertension
Aside from diseases of the aortic root (dilations), aortic regurg can also be caused by _
Aside from diseases of the aortic root (dilations), aortic regurg can also be caused by diseased aortic leaflets
* Calcified valves from old age
* Bicuspid aortic valve
* Rheumatic fever
LVEDV (increases/decreases) in aortic regurgitation
LVEDV increases in aortic regurgitation
To compensate for the increased LVEDV in aortic regurg, _ occurs
To compensate for the increased LVEDV in aortic regurg, we get eccentric hypertrophy –> Systolic HF –> S3
Increased pulse pressure and “water hammer pulse” describes _
Increased pulse pressure and “water hammer pulse” describes aortic regurgitation
Head bobbing is associated with _
Head bobbing is associated with aortic regurgitation
With aortic regurgitation, we expect to hear a _ murmur
With aortic regurgitation, we expect to hear an early decrescendo diastolic murmur
Aortic regurgitation is best heard at the _
Aortic regurgitation murmur is best heard at the left 3rd intercostal space (Erb’s point)
Like other regurgitation murmurs, aortic regurgitation will be louder with
_ preload
_ afterload
Like other regurgitation murmurs, aortic regurgitation will be louder with
Increased preload
Increased afterload
(also louder on expiration)
Mitral stenosis is _
Mitral stenosis is narrowing of the mitral valve, restricting blood flow from LA –> LV
The most common symptoms of mitral stenosis are _ and _
The most common symptoms of mitral stenosis are exertional dyspnea and pulmonary edema due to pulmonary hypertension and decreased cardiac ouput
* Can also present with hoarseness, dysphagia
* Loud S1
Causes of mitral stenosis:
Causes of mitral stenosis:
* Rheumatic heart disease
* Congenital mitral stenosis
* Mitral annular calcification
* Radiation
As a result of mitral stenosis _ will dilate and _ pressure will increase
As a result of mitral stenosis left atrium dilates and PCWP increases
A serious complication that occurs from the left atrial dilation seen in mitral stenosis is _
A serious complication that occurs from the left atrial dilation seen in mitral stenosis is atrial fibrillation, thrombus, stroke
Mitral stenosis presents with _ murmur
Mitral stenosis presents with diastolic murmur with an opening snap and low-pitched rumble
The mitral stenosis murmur is best heard at _ location
The mitral stenosis murmur is best heard at apex (left 5th ICS midclavicular line)
* It radiates to the axilla
What is the most common cause of mitral stenosis?
The most common cause of mitral stenosis is rheumatic fever
* The mitral valve is the most common valve affected by RF
Rheumatic fever is an inflammatory condition that can develop after inadequate treatment of _
Rheumatic fever is an inflammatory condition that can develop after inadequate treatment of streptococcal pharyngitis or scarlet fever caused by GAS
In severe mitral stenosis, the stenotic valve will obstruct blood flow into the LV and _ preload, SV and CO
In severe mitral stenosis, the stenotic valve will obstruct blood flow into the LV and decrease preload, SV and CO
Patients with mitral stenosis will be put on _ to control heart rate and if they have atrial fibrillation they will be put on _
Patients with mitral stenosis will be put on beta blockers to control heart rate and if they have atrial fibrillation they will be put on warfarin
Mitral valve prolapse occurs when _
Mitral valve prolapse occurs when mitral leaflets balloon into the left atrium during systole
Mitral valve prolapse is usually caused by _
Mitral valve prolapse is usually caused by myxomatous degeneration, an excess of disorganized connective tissue in the valve leaflets –> degeneration
* Puts increased tension on chordae and papillary muscles
The main sign associated with mitral valve prolapse is _
The main sign associated with mitral valve prolapse is mid-systolic click with late systolic crescendo
* The mid-systolic click comes from the tensing of the chordae
The mid-systolic click in mitral prolapse is best heard over the _
The mid-systolic click in mitral prolapse is best heard over the apex
Mitral prolapse is unique in that the murmur is louder with _
Mitral prolapse is unique in that the murmur is louder with decreased preload
* Think HOCM
Four associations with mitral valve prolapse
Mitral valve prolapse is associated with:
1. Marfans
2. Papillary muscle rupture
3. Infective endocarditis
4. Rheumatic heart disease
The most common right heart valve abnormality is _
The most common right heart valve abnormality is tricuspid regurgitation
Tricuspid regurgitation is commonly associated with _
Tricuspid regurgitation is commonly associated with infective endocarditis from IV drug use
* Note that infective endocarditis most commonly affects the mitral valve but in endocarditis caused by IV drug use it affects tricuspid valve more commonly
The most common pathogen associated with infective endocarditis from IV drug use is _
The most common pathogen associated with infective endocarditis from IV drug use is s. aureus
Tricuspid regurgitation causes volume overload of the right heart which results in the eventual _
Tricuspid regurgitation causes volume overload of the right heart which results in the eventual dilation of right ventricle –> right heart failure
* Sx: hepatomegaly, ascites, peripheral edema
Tricuspid regurgitation presents with a _ murmur
Tricuspid regurgitation presents with a holosystolic murmur at left 4th ICS
Another association with tricuspid regurgitation is _ , a high level of serotonin that induces fibrous tissue deposits in the heart valves
Another association with tricuspid regurgitation is carcinoid syndrome , a high level of serotonin that induces fibrous tissue deposits in the heart valves
* The lung inactivates the vasoactive substances before they can cause left heart damage
What changes do we see in the jugular venous waveform in tricuspid regurgitation?
Disappearance of the x descent with giant c-v wave fusion
