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Cardio > Valvular Disease II- MS, MR, AS, AR > Flashcards

Valvular Disease II- MS, MR, AS, AR Flashcards

1
Q

AS causes in adults

A

congenital abnormalities, rheumatic fever, age-related calcific AS

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2
Q

pathophys of AS

A

impeded systolic flow through AV, compensations w/ LV concentric hypertrophy, reduced LV compliance, elevated diastolic LV pressure causes LA hypertrophy, eventual rise in pressures in LA and pulmonary circuit cause edema/HF Sx

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3
Q

3 main manifestations of AS

A

angina, exertional syncope, eventual dyspnea/ HF

these are in order of worsening prognosis

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4
Q

angina in AS

A

increased demand from hypertrophied LV and increased wall stress due to high systolic pressures

less supply because high LV diastolic pressure (less volume was ejected) reduces coronary perfusion

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5
Q

exertional syncope in AS

A

fixed, stenotic valve prevents augmentation of CO, combined w/ vasodilation of peripheral muscles from exercise causes decreased cerebral perfusion

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6
Q

dyspnea/HF and AS

A

progressive AS causes LV contractile dysfn, increased LV diastolic volume and pressure, increased LA and pulmonary pressure, pulmonary congestion/HF Sx

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7
Q

AS murmur

A

crescendo-decrescedo systolic, loudest at base, harsh and high pitched,

more severe AS= later peak of the murmur

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8
Q

when to Tx AS and hw

A

Tx w/ aortic valve replacement after development of Sx an evidence of LV dysfn (low EF or signs of dilation)

percutaneous balloon valvuloplasty not as effective, second line Tx

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9
Q

two subtypes of AR causes

A

valve leaflet abnormalities (bicuspid valve, endocarditis, rheumatic)

aortic root abnormalities (aneurysm, dissection, ectasia, syphilis)

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10
Q

3 factors influencing AR severity

A

size of regurg orifice, pressure gradient during diastole, duration of diastole

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11
Q

pathophys of AR

A

LV has volume and pressure overload, eccentric hypertrophy (dilation) compensation, increased compliance of LV

decreased aortic diastolic pressure and higher systolic pressure (more volume into aorta) causes widened pulse pressure

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12
Q

physical exam in AR

A

signs of widened pulse pressure, eg corrigan pulse: water hammer pulse in carotids

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13
Q

AR murmur

A

decrescendo diastolic murmur, increases w/ hand grip (higher SVR), heard best at 4th left intercostal space

can be systolic murmur from high systolic flow and second diastolic murmur (austin flint murmur) from vibration of leaflets and chrodae

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14
Q

angina and AR

A

decreased aortic diastolic pressure decreases coronary perfusion, reduced oxygen supply

increased LV size (eccentric hypertrophy) increases demand

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15
Q

chronic AR and HF

A

progressive remodeling of LV leads to systolic dysfn, then increased LA and pulmonary vascular pressure,then HF

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16
Q

chest xray of AR

A

cardiomegaly, esp LV and LA

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17
Q

Tx of chronic AR

A

depends on LV:
w/ normal fn and symptomatic- vasodilators (CCB, ACEi)

symptomatic or severe AR/ impaired EF- valve replacement

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18
Q

when to replace valve in AR

A

50/50 rule: EF is under 50% or LV end systolic dimension is over 50 mm

even w/o Sx!

19
Q

etiology of MS

A

rheumatic fever, congential, calcific, endocarditis, tumors

20
Q

major Sx of MS

A

dyspnea/HF, hemoptysis, A fib, stroke

21
Q

MS causing dyspnea

A

high LA pressure leads to high pulm pressure, high pulm venous/capillary pressure= transudation of plasma into interstium and SOB

22
Q

pathophys of MS

A

impaired filling of LV causes increased LA volume and pressure (eventually hypertrophy), reduced SV and CO from reduced preload

23
Q

MS and hemoptysis

A

elevated pulm venous pressure causes opening of collateral channels b/w pulmonary and bronchial veins (to alleviate pressure), rupture of bronchial vein can cause blood to be coughed up

24
Q

differentiate 2 forms of pulm HTN in MS

A

passive: LA pressure transferred to pulm system, pulm arteries facing higher resistance
active: medial hypertrophy and intimal fibrosis of pulm arterioles trying to reduce flow to the already backed up pulm system

25
Q

right HF and MS

A

pulm HTN causes higher right heart pressures, RV hypertrophy and dilatation leads to right heart failure and the accompanying manifestations- JVP, hepatomegaly, peripheral edema, etc

26
Q

A fib and MS

A

chronic pressure overload in LA causes LA enlargement, stretched conduction fibers more susceptible to reentry and A fib

27
Q

stroke and MS

A

stagnant blood in large LA (esp w/ A fib) allows for thrombus formation and emboli to peripheral organs like the brain

28
Q

palpation and auscultation of MS

A

RV tap palpable, from high RV pressure

can hear loud S1 w/ early MS, soft S1 later, Opening snap (shorter time b/w S2 and OS= more severe)

diastolic rumble- low frequency decrescendo murmur, accentuated before systole from LA contraction

29
Q

describe the abnormal hemodynamics of MS

A

LA pressure normally equalizes to LV during diastole, in MS it remains elevated

30
Q

Tx for MS

A

medical: diuretics for vascular congestion and betablockers/ anti coag for afib (beta blockers also increase diastole, allow for more foward flow across MV)

percutaneous balloon mitral valvuloplasty very effective w/ rheumatic MS, surgical valve replacement also works

31
Q

causes of MR, 2 categories

A

primary: degenerative disorder of the valve, Tx is surgical correction
secondary: or functional MR, from underlying myocardial problem, Tx directed at cause

32
Q

3 consequences of MR

A

elevated LA volume and pressure, reduction of CO, volume stress on LV

33
Q

compensation for MR

A

increase in SV w/ frank starling

34
Q

some factors that determine severity of MR

A

size of mitral orifice, systolic pressure gradient, SVR, LA compliance, duration of regurg

35
Q

MR murmur

A

high pitched holosystolic, increases w/ hand grip, best heard at apex

can also hear S3

36
Q

hemodynamics of MR

A

lots of extra volume in LA during systole

37
Q

clinical pres in acute vs chronic MR

A

acute: pulmonary edema and high LA pressure
chronic: low CO (fatigue/weakness), LV dysfn (dyspnea, etc), right heart failure Sx (ascities, peripheral edema)

38
Q

Tx for acute MR

A

IV diuretics for edema, vasodilators to augment forward CO, intra-aortic balloon pump

valve repair or replacement

39
Q

Tx for chronic MR

A

vasodilators less useful, Tx the HTN or systolic dysfn

repair or replace valve

40
Q

tricuspid stenosis

A

usually due to rheumatic fever, right heart failure w/ large a wave in JVP (high atrial pressure)

41
Q

tricuspid regurg

A

usually functional following RV enlargement, Tx underlying cause or surgery

42
Q

pulmonic stenosis

A

almost always congenital, only Sx when sever, balloon valvuloplasty for Tx

43
Q

pulmonic regurg

A

lots of causes like severe pulm HTN or dilation of PA, IE, tet of fallot, trauma, rheumatic heart disease

Tx is surgical

Cardio (34 decks)

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