valvular disorders Flashcards
(151 cards)
1
Q
two types of valvular disorders
A
- regurgitation
- stenosis
2
Q
clinical classification categories of valvular disease
A
- A: at risk
- B: mild to moderate with no symptoms
- C1: severe with no symptoms and normal LV function
- C2: severe with no symptoms and abnormal LV function
- D: symptoms
3
Q
at what point should you refer a patient to cardiology?
A
severe disease
4
Q
examples of congenital defects that can cause valvular disease
A
bicuspid aortic valve
5
Q
examples of aging processes that can cause valvular heart disease
A
- degenerative valve disease
- valve calcification
6
Q
illnesses that can cause valvular heart disease
A
- infective endocarditis
- rheumatic fever
7
Q
congenital causes of aortic stenosis
A
more or less valve leaflets than normal
8
Q
congenital causes of aortic stenosis usually present at what age?
A
prior to 50
9
Q
acquired causes of aortic stenosis
A
- rheumatic fever
- valve calcification
- degenerative stenosis
10
Q
acquired causes of aortic stenosis usually present at what age?
A
after age 50
11
Q
regardless of the cause of aortic stenosis, it leads to …. and ….. of the valve leaflets and a ….. valve opening
A
thickening; calcification; narrowed
12
Q
aortic stenosis leads to the heart having to pump harder to push blood out into circulation, which results in …
A
LVH
13
Q
degenerative or calcifies aortic stenosis results from …..
A
calcium deposition on the valve
14
Q
A very large percentage of elderly patients have evidence of ….. on echo, which can progress into ….
A
aortic sclerosis; aortic stenosis
15
Q
most common surgical valve lesion in developed countries
A
degenerative aortic stenosis
16
Q
if the valves cant close normally, what will happen?
A
regurgitation
17
Q
cardinal symptoms for aortic stenosis
A
- angina
- syncope
- CHF
18
Q
why do you see angina in aortic stenosis?
A
ischemia because the heart isnt able to pump blood out the aorta into the coronary arteries that supply the myocardium of the heart
19
Q
why do you see CHF in aortic stenosis?
A
blood cannot be pumped out the aorta, so it backs up into the LA, lungs, RA, and RV
20
Q
murmur of aortic stenosis
A
- midsystolic
- harsh quality
- heard best at aortic post
- may radiate to the carotids
21
Q
….heart sound may also be present in aortic stenosis
A
S4
22
Q
why is the murmur for aortic stenosis midsystolic?
A
because S1 marks the beginning of systole (mitral valve is closed and aortic valve is open) and the blood is being pushed through the aortic valve during systole, so the murmur will be heard during systole.
23
Q
why do you hear S4 in aortic stenosis?
A
atria is trying to get that last bit of blood into the ventricle so it gives an extra kick which facilitates the S4 sound
24
Q
what can you see on EKG in aortic stenosis?
A
LVH
25
imaging modality of choice in aortic stenosis
echo
26
pressure gradient in aortic stenosis
there is often >50mmHg higher pressure in the LV than in the aorta because the blood is not able to go through the valve
27
management of aortic stenosis
surgery
28
what types of surgery can be used to treat aortic stenosis?
* open heart
* TAVR
* balloon valvuloplasty
29
risks associated with balloon valvuloplasty
can break off calcifications which can be dislodged and cause stroke or MI
30
t/f there are no medications that have been proven to slow the progression of aortic stenosis
true
31
what type of therapies can be given to the patient for their symptoms associated with aortic stenosis?
* diuretics to help with fluid buildup and preload
* blood pressure medications to treat afterload
32
chronic aortic regurgitation can lead to ... due to the need to accommodate the additional regurgitant volume
LVH
33
what causes symptoms in aortic regurgitation?
increase in LV pressure leading to CHF
34
murmur in aortic regurgitation
* early diastolic
* blowing sound
* best heard in the apex of the heart
* lean forward and exhale
35
why do you hear the aortic regurgitation murmur in early diastole?
S2 is the aortic valve closing but in aortic regurgitation, it doesn't fully close, so you hear the "blowing" all throughout diastole as the blood is falling back into the ventricle
36
why do you hear the murmur for aortic regurgitation in the apex of the heart?
because thats where the blood is backing up at
37
why would you see a widened pulse pressure in aortic regurgitation?
not going to have the same pressure in the aorta because the blood is pulling back in the ventricle which will cause it to have a higher pressure
38
Austin Flint murmur
diastolic murmur caused by aortic regurgitation
39
only valvular disorder that's murmur doesn't match up with the associated listening post
aortic regurgitation
40
diagnostic modality of choice for aortic regurgitation
echo
41
treatment for aortic regurgitation
* surgery
* vasodilator therapy
42
acute aortic regurgitation is a ....
medical emergency
43
what can cause an acute aortic regurgitation?
* infective endocarditis
* trauma (MI)
44
why is acute aortic regurgitation considered a medical emergency?
the heart cannot manage the stretch that fast and everything will get backed up very fast
45
s/s of acute aortic regurgitation
* cardiogenic shock
* pale, cool, weak, rapid pulse
46
murmur in acute aortic regurgitation
low pitched, early diastolic
47
why is the murmur for acute aortic regurgitation low pitched?
the valve is open so there it is not going to be going through with as much pressure
48
diagnostic modality for acute aortic regurgitation
echo
49
treatment of acute aortic regurgitation
* want to decrease preload and afterload so give diuretics and vasodilators
* urgent valve replacement
50
when does mitral stenosis occur?
when thickening and immobility of the mitral leaflets impede the flow from the left atrium to the left ventricle
51
most common cause of mitral stenosis
rheumatic fever
52
mitral stenosis can lead to backup of blood and .......
left atrial enlargement
53
buildup of blood in the left atria can lead to ......
pulmonary congestion
54
......can occur due to the left sided heart failure causing a backup of blood in the lungs and the pulmonary veins
right sided HF
55
as the stenosis progresses, filling of the LV becomes impaired, ....
reducing SV and CO
56
when do patients with rheumatic fever mitral stenosis develop symptoms?
40-50 years
57
symptoms of mitral stenosis
* dyspnea/orthopnea
* AFIB
* hemoptysis
* embolism
* compression of the left recurrent laryngeal nerve leading to hoarseness
58
why would you see AFIB in mitral stenosis?
electricity is trying to push blood from the atria into the ventricle and freaks out since it cant
59
why would you see an embolism in mitral stenosis?
blood sits in the left atria and clots and then is pushed out into the body
60
why would we see compression of the left recurrent laryngeal nerve in mitral stenosis?
backup of blood in the LA causes hypertrophy and compression
61
murmur of mitral stenosis
* rumbling
* low pitched
* diastolic murmur
* best heard at the apex and mitral post
62
why do you hear the murmur at diastole for mitral stenosis?
during diastole, the blood should be flowing through the mitral valve, but the stenosis allows for only a little bit of blood to get through at a very high pressure, so the intense pressure of the blood hitting the ventricle produces the sound
63
what other heart sounds may you hear in mitral stenosis?
opening snap following S2
64
quality of heart sounds in mitral stenosis
S1 is loud in early mitral stenosis due to hard valve, but it softens over time because the valve becomes immobile and doesn't fully close
65
why do you hear an opening snap in mitral stenosis?
you can hear the mitral valve open because it is hard
66
what side of the stethoscope should we use to assess mitral stenosis?
bell. its used to hear low pitched sounds
67
EKG findings of mitral stenosis
* AFib
* RV hypertrophy
68
diagnostic modality for mitral stenosis
echo
69
characteristic findings of mitral stenosis on echo
hockey stick sign
70
treatment of mitral stenosis
* mild to moderate can be managed with meds for symptom control (BB and diuretics)
* moderate to severe needs surgery
71
why do mitral stenosis patients need beta blockers?
their heart recognizes that there is a lack of blood being pumped through the circulation, so it picks up the rate to compensate, but its only making the problem worse because there is no blood in the ventricle to pump. as the heart does more work, it can lead to LVH and more problems
72
mitral regurgitation results from...
abnormalities of the leaflets, annulus, chordae tendonae, and papillary muscles
73
symptoms of mitral regurgitation
* fatigue
* dyspne
* peripheral edema
74
murmur of mitral regurgitation
* holosystolic
* best heard at the apex
* radiates to axilla and back
75
why is the murmur for mitral regurgitation holosystolic?
the valve is staying open, so when the heart is contracting, the blood is flowing right back up into the atria and there is a constant flow
76
why does the mitral regurgitation murmur radiate to the axilla and back?
blood shoots backup and causes noise going back into the atria
77
EKG for mitral regurgitation
* LVH
* AFib
78
diagnostic modality for mitral regurgitation
echo
79
what can a cardiac catheterization give us?
filling pressures
80
treatment for mitral regurgitation
* diuretics to decrease fluid and vasodilators to try to decrease the amount of pressure that the blood is pushing against, making more blood likely to pump into circulation instead of regurgitating
* surgery
81
patients with mitral regurgitation should have _____ echos to monitor LV size and fxn
annual
82
development of .... or ... may be a surgical indication
* afib
* pulmonary HTN
83
t/f MV repair is possible in many patients with mitral regurgitation instead of a full replacement
true
84
acute mitral regurgitation
LA cannot dilate enough to accommodate the rapid regurgitation of blood leading to increase in LA size and pulmonary congestion
85
causes of acute mitral regurgitation
* endocarditis
* trauma (MI)
86
s/s of acute mitral regurgitation
* cardiogenic shock:
* tachycardia
* hypotension
* pallor
* diaphoretic
87
murmur in acute mitral regurgitation
* low pitched
* early systole
88
treatment of acute mitral regurgitation
urgent valve replacement
89
mitral valve prolapse
leaflet is pushed up into the atria, leading to no closure of the mitral valve and regurgitation
90
mitral valve prolapse may be associated with ..... or .....
systemic or connective tissue disorders
91
MVP syndrome
nonspecific symptoms like chest pain, palpitations, anxiety
92
auscultation of mitral valve prolapse
* mid systolic click
* late systolic murmur
93
why do you hear a mid-systolic click in MVP?
the pressure in the ventricle in systole causes the prolapsed valve to open up mid systole, resulting in the click
94
why do you hear the late systolic murmur in MVP?
after the click which is the opening of the prolapsed valve, it allows for some regurgitation in late systole
95
diagnostic modality for MVP
echo
96
management of MVP
Mild: no intervention
severe: repair or replacement
97
tricuspid stenosis is generally an _______ valvular disorder
uncommon
98
tricuspid stenosis is rarely isolated and is often accompanied by __________
aortic stenosis or mitral stenosis
99
causes of tricuspid stenosis
* rheumatic heart disease
* carcinoid disease
100
what can we expect to happen physiologically and clinically when we see a patient with tricuspid stenosis?
peripheral edema due to backup of blood into the vena cava
101
how does tricuspid stenosis affect overall heart failure?
it causes right sided heart failure which can lead to reduced LV output
102
clinical presentation of tricuspid stenosis
* ascites
* peripheral edema
* JVP
* fatigue
103
murmur in tricuspid stenosis
mid diastolic
104
where can you hear the tricuspid stenosis murmur best?
left sternal boarder (tricuspid post)
105
______ sided murmurs are heard better in inspiration and _______ sided murmurs are heard better in expiration
Left
Right
106
why may opening snap be heard in tricuspid stenosis?
hardened tricuspid valve clicks open
107
PE of tricuspid stenosis
palpable liver pulsation
108
diagnosis modality for tricuspid stenosis
echo
109
what may you see on an EKG for tricuspid stenosis?
tall t waves because you have right atrial enlargement
110
what may you see on CXR for tricuspid stenosis?
cardiology
111
management of tricuspid stenosis
* treat HF
* diuretics
* eventual valve replacement
112
what type of diuretic are best for treating HF in tricuspid stenosis?
loops
113
what type of diuretics are best for treating liver congestion and ascites in HF due to tricuspid stenosis?
aldosterone antagonists
114
what usually causes tricuspid regurgitation?
dilation of the right ventricle
115
what can cause RV dilation?
pulmonary HTN
116
presentation of tricuspid regurgitation
RHF
-fatigue
-ascites
-JVD
-peripheral edema
117
murmur in tricuspid regurgitation
holosystolic (pansystolic)
118
where is the tricuspid regurgitation murmur best heard?
left sternal boarder
119
diagnostic modality of tricuspid regurgitation
echo
120
management of tricuspid regurgitation
* treat underlying conditions and HF
-repair/replace valve
121
cause of pulmonic stenosis
congenital defect
122
what anatomically causes stenosis in pulmonic stenosis?
fused pulmonary leaflets
123
presentation of critical pulmonic stenosis
cyanotic at birth
124
presentation for normal pulmonic stenosis
* usually asymptomatic until adolescence and progresses as they get older
* fatigue and dyspnea
* RHF symptoms
125
murmur in pulmonic stenosis
mid systolic
126
where is the murmur best heard in pulmonic stenosis?
left upper sternal boarder (pulmonic post)
127
diagnostic modality of choice for pulmonic stenosis
echo
128
management of mild pulmonic stenosis
asymptomatic and requires no intervention
129
management for moderate to severe pulmonic stenosis
surgery
130
Cause of pulmonic regurgitation
dilation of the pulmonic valve annulus
131
what causes dilation of the pulmonic valve annulus?
pulmonary HTN
132
symptoms of pulmonic regurgitation
right sided heart failure
133
murmur for pulmonic regurgitation
holo-diastolic
134
where is the pulmonic regurgitation murmur best heard?
pulmonic post
135
treatment of pulmonic regurgitation
* treat pulmonary HTN
* surgery
136
characteristics of mechanical heart valves
* extremely durable
* high clot risk, so they would have to be on warfarin for life
137
goal INR of warfarin with mechanical heart valve
2.5-3.5 (blood needs to be thinner than DVT INR)
138
characteristics of tissue replacement heart valve
-lower risk of clot
-less durable
-daily ASA
139
Rheumatic Heart Disease
develops secondary to abnormal immunologic response to GABHS and the heart freaks out
140
why has prevalence of RHD dropped?
antibiotic availability
141
what characterizes RHD?
pancarditis
142
pancarditis
diffuse inflammation of the heart
143
histologic finding of RHD
aschoff body
144
aschoff body
collection of monocytes and macrophages surrounding fibrous tissue
145
what is the most common valve affected by RHD?
mitral
146
presentation of RHD?
acute febrile illness 2-4 weeks after strep throat
147
major criteria for diagnosing RHD
-carditis
-polyarthritis
-choreiform movements
-erythema marginatum
-subcutaneous nodules
148
minor criteria for RHD
* fever
* arthritis
* prior rheumatic fever or known RHD
149
how can you make a diagnosis of RHD?
* 2 major criteria OR 2 minor criteria and 1 major
* documented strep infection
* confirm with echo
150
treatment of RHD
PCN
151
prophylaxis for RHD
PCN G injections monthly for 10 years
