Valvular Disease: Semilunar Valves Flashcards
2 components of S1
M1 and T1
mitral valve closing
tricuspid valve closing.
usually simultaneous but can separate on inspiation in young patients
2 components of S2
A2 and P2
A2= aortic valve closure
P2= pulmonary valve closure
normal= single sound. May split on inspiration because the closure of the pulmonic valve becomes delay as the lungs dill up with air
two semilunar valves
aortic and pulmonary valves.
how many flaps does the aortic valve have
3 it’s tricupd.
Fixed obstruction to left ventricular outflow
at the level of the aortic valve
aortic stenosis
3 common causes of aortic stenosis
- calcific or degenerative changes
- born with bicuspid valve vs normal tricuspid valve.
- rheumatic fever heart disease.
why does AS cause hypertrophy of LV?
if you have a sticky or narrowed valve, the LV has to contract exttra hard to get the same amount of blodo throguht he AV to the aorta
- lV gets thicker
- concentric hypertrophy
- LV increases in size, but not the entire heart
what sounds are caused by AS
- pulsus parvus and tardus
- sustained apex
- SOFT A2 because the aortic valve doesn’t flap down as hard
- S4 due to hypertrophy/stiffer ventrical.
- this can cause congestive heart failure
treatment of AS
- bioprostehtic vs mechanical valve.
- bioprosthetic valve doesn’t need warfarin
- mechanical valve requires warfarin but lasts longer
what happens if AS not fixed?
outline the flow chart of aortic regurgitation
congential heart defect that can cause aortic regurgitation
a bicuspid aortic valve. normallt it is tricuspid.
how does pulse pressure between the aorta and ventrical change in AR
there is a wider pulse pressure. decreased aortic pressure in AR because less blood dlows in.
What happens to the stroke volume and end diastolic volume in AR?
the end diastolic volume first increases becuase more blood is being left in the LV. then, there is eccentric hypertrophy and addition of new sarcomeres. there is then an increased total stroke volume and it gets normalized
classic symptoms of AR
physical exam AR:
Dynamic Circulation
- ___ pulse pressure (160/50)
- Diffuse (big) / dynamic ___- WHY?
- Bounding __ impulse
- “Water-hammer” (___) pulse
- DuMusset sign (head bobbing)
• Duroziez sign (systolic + diastolic femoral
arterial __)
Dynamic Circulation
- WIDENED pulse pressure (160/50)
- Diffuse (big) / dynamic APEX– apex is where the ventricle is. the ventricle is increasing in size beacuse the blood is staying in there rather than going throguh the aorta.• Bounding __ impulse
- “Water-hammer” (CORRIGAN) pulse
- DuMusset sign (head bobbing)
• Duroziez sign (systolic + diastolic femoral
arterial BRUIT)
AR results in a high frequency ___, and a __ _murmur after s2.
high frequency decrescendo.
- DIASTOLIC MURMUR BEGINS ARE S2.
although chronic AR results in increased SV because the ventircle has engaged in globular hypertrophy, why does SV decrease in acute AR?
if there is a sudden occurrence of regurgitation into LV, the LV has not had time to enlarge.
- the forward stroke volume is dramatically reduced and there is an acute increase in LV pressure (therefore LA pressure, pulmonary pressurs, leading to effusion)
causes of acute AR
- dissection
- trauma
- endocarditis
- prosthetic valve failure
medical tx for chronic AR
- afterload reduciton
- diuretics to reduce volume
- appropriate clinical imaging follow up
- appropriate timing aortic valve replacement or repair.
T/f you can medically treat acute severe MR
false. the ventrical will not distent/hypertrophy in time to compensate for the increased preload. you need immediate surgery. there is a high ortality rate in acute AR
if there is pulmonic stenosis, ___ heart failure occurs.
- you will hear a __ P2. Why?
right sided heart failure occurs.
Soft P2 because the pulmonary valve is stenosed and it will shut quieter.
causes of pulmonary regurgitation
congenital
- secondary to pulmonary hypertension
- endocarditis
