Valvular disease-Lecture Flashcards
Which ausculation area is at the mid-clavicular line?
Mitral
The most common cause of aortic stenosis in adults is _
The most common cause of aortic stenosis in adults is age-related calcification
* Followed by rheumatic fever, congenital abnormality
Initially, the heart will compensate for aortic stenosis with _ ;
Next we can see _ occur as the result of elevated diastolic ventricular pressure
Initially, the heart will compensate for aortic stenosis with left ventricular concentric hypertrophy ;
Next we can see left atrial hypertrophy occur as the result of elevated diastolic ventricular pressure
Left ventricular hypertrophy
If you see a patient in 60s-70s with age-related valvular disease it is probably _
If you see a patient in 60s-70s with age-related valvular disease it is probably aortic stenosis
* It is the most common cause of acquired valvular disease in the developed world
Calcific aortic stenosis is thought to develop from wear and tear on the left side of the heart –> inflammation –> active calcification by _
Calcific aortic stenosis is thought to develop from wear and tear on the left side of the heart –> inflammation –> active calcification by osteoblast-like cell
Aortic stenosis
* Has thickened, rigid, calcified cusps
Three clinical manifestations of aortic stenosis:
Three clinical manifestations of aortic stenosis: makes people SAD
* Syncope exercise vasodilates –> drops SV
* Angina imbalance between oxygen supply and demand
* Dyspnea due to heart failure
What causes exertional syncope in patients with aortic stenosis?
- Inability to augment cardiac output (due to fixed stenotic orfice)
- Exercise causes vasodilation of the peripheral muscle beds
- These two things cause decreased cerebral perfusion pressure
Explain the pathogenesis of dyspnea in aortic stenosis
Progressive aortic stenosis –> LV develops contractile dysfunction over time (bc of high afterload) –> increased left ventricular diastolic volume and pressure –> elevated LA and pulmonary venous pressures –> pulmonary alveolar congestion
The average survival of a patient with aortic stenosis from the onset of angina is _ years
The average survival of a patient with aortic stenosis from the onset of angina is 5 years
The average survival of a patient with aortic stenosis from the onset of syncope is _ years
The average survival of a patient with aortic stenosis from the onset of syncope is 3 years
The average survival of a patient with aortic stenosis from the onset of dyspnea (heart failure) is _ years
The average survival of a patient with aortic stenosis from the onset of dyspnea (heart failure) is 2 years
The 5-3-2 survival predication is for patients with _
The 5-3-2 survival predication is for patients with aortic stenosis
Features of aortic stenosis murmur
Aortic stenosis:
* Crescendo decrescendo systolic murmur
* The worse the AS, the later the peak of the murmur
* Loudest at the base of the heart (aortic area)
* Carotid pulse is weak
* Parvus et tardus
The mitral valve has _ leaflets and _ papillary muscles
The mitral valve has two leaflets and two papillary muscles (mitral = bicuspid)
* We have an anterior and posterior commissure at the point where the leaflets join
* The coronary sinus and circumflex artery wrap around the mitral valve
Acute rheumatic fever is a condition that develops 2-3 weeks after infection with _
Acute rheumatic fever is a condition that develops 2-3 weeks after infection with group A strep (strep pharyngitis)
* Leads to a pancarditis (pericarditis, myocarditis, endocarditis)
* The valve problems do not resolve –> chronic rheumatic heart disease
After 10-30 years, chronic rheumatic heart disease can lead to valves that are _
After 10-30 years, chronic rheumatic heart disease can lead to valves that are thickened, fibrotic, stenotic, with leaflet fusion
The most common long term consequence of chronic rheumatic fever is _
The most common long term consequence of chronic rheumatic fever is mitral stenosis
* Mitral > aortic > others
* Recall that RF likes the high volume valves
Mitral stenosis causes CO to decrease due to _
Mitral stenosis causes CO to decrease due to reduced LVEDV –> reduced preload –> reduces stroke volume
Mitral stenosis may lead to (right/ left) heart failure
Mitral stenosis may lead to right heart failure
* The problem is that blood accumulates in the left atrium –> backs up into the pulmonary circulation –> this provides extra resistance to the right side of the heart –> RV hypertrophy –> Right heart failure –> JVP, hepatomegaly, ascites, peripheral edema
Another consequence of mitral stenosis is the development of _ (arrythmia)
Another consequence of mitral stenosis is the development of atrial fibrillation
* Back up of blood in LA –> dilation –> stretches atrial conduction fibers –> atrial fibrillation
Right ventricular hypertrophy can be identified on ECG by a large R wave in lead _
Right ventricular hypertrophy can be identified on ECG by a large R wave in lead V1
* Recall that a normal ECG shows more negative deflection in V1 meaning R wave is small and S wave is big
In individuals with mitral stenosis, whom we worry are at risk of a.fib/ stroke, we will give _ medication
In individuals with mitral stenosis, whom we worry are at risk of a.fib/ stroke, we will give warfarin
* Clinical studies show it is the best method of anticoagulation for these patients
What does the mitral stenosis murmur sound like?
Opening snap followed by a mid-diastolic rumbling
Name some causes of mitral regurgitation
Mitral regurgitation:
* Annular calcification
* LV cavity dilation
* Myxomatous degeneration (MVP)
* Rheumatic disease
* Endocarditis
* SAM
* Chordae tendineae rupture
* Papillary muscle rupture
Acute mitral regurgitation causes
Acute causes:
* Trauma
* Endocarditis
* MI (papillary rupture)
Chronic mitral regurgitation causes
Chronic causes:
* Valve degeneration
* Infective endocarditis
* Rheumatic heart disease
* Congenital heart disease
* Ventricular disease (cardiomyopathy)
What does mitral regurgitation look like on the PV loop?
Inferior, posterior STEMI
Myxomatous degeneration on histology looks like _
Myxomatous degeneration on histology looks like valve collagen and elastic fibers fragment –> remodeling –> makes the leaflets stretch and prolapse
What does mitral valve prolapse sound like?
Late crescendo murmur with midsystolic click
Causes of aortic regurgitation:
Aortic regurgitation:
