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critical care > Valvular Disorders > Flashcards

Valvular Disorders Flashcards

1
Q

valves

A

open and close in response to blood pressure change during each cardiac cycle (heart contraction and relaxation: creates pressure change)

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2
Q

chordae tendineae

A

fibrous tissue that anchor valve leaflets to papillary muscles of the ventricles

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3
Q

regurgitation

A

when valves do not completely when they are supposed to close

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4
Q

stenosis

A

when valves do not open completely when they are supposed to open

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5
Q

mitral valves anterior leaflet

A

longer

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6
Q

mitral valve prolapse

A
  • needs to close during systole, aortic valve should be open and blood can move to the body
  • enlargement of one or both of the leaflets of mitral valve
  • the annulus often dilates, chordae tendineae and papillary muscles may elongate or rupture
  • a portion of one or both of the mitral valve leaflets balloons back into the atrium during systole –> blood regurgitates from the left ventricle back into the left atrium
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7
Q

mitral valve prolapse clinical manifestations

A

most never have symptoms
a few have fatigue, SOB, lightheaded, dizziness, syncope, palpitations, chest pain, anxiety

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8
Q

mitral valve prolapse assessment and diagnostic findings

A

extra heart sound: mitral click
murmur of mitral regurgitation may be heard if the valve opens during systole and blood flows back into the left atrium
echoo used to diagnose and monitor progression of MVP

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9
Q

mitral valve prolapse medical management

A

control symptoms
- eliminate caffeine, alcohol, tobacco
- antiarrhythmic medications
- chest pain –> nitrates, CCB, BB
- HF management
- severe: mitral valve repair or replacement

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10
Q

what other heart disease are you more at risk for with MVP

A

endocarditis due to extra tissue

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11
Q

MVP and pregnancy

A

if they have MVP without regurgitation or other complications can complete pregnancies with vaginal deliveries

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12
Q

treatment recommendations for high risk patients with MVP

A

antibiotic prophylaxis amoxicillin

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13
Q

mitral regurgitation (insufficiency)

A

blood flowing back from the left ventricle into the left atrium during asystole
due to the thickness and fibrosis of the chordae tendineae
they pull on the leaflet so that it can’t close

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14
Q

mitral regurgitation causes in developing countries

A

rheumatic heart disease

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15
Q

mitral regurgitation causes developed countries

A

degenerative changes of the mitral valve due to age

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16
Q

mitral regurgitation clinical manifestation

A

often asymptomatic
acute mitral regurtitation is usually from a MI manifests as severe CHF
most common dyspnea, fatigue, and weakness
clots and stroke

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17
Q

mitral valve regurgitation assessment and diagnostic findings

A

systolic murmur: high pitched blowing sound at the apex that may radiate to the axilla
may have irregular pulses
echo is used to diagnose and monitor

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18
Q

mitral valve regurgitation medical management

A

same for HF (reduce after load)

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19
Q

mitral valve regurgitation surgical management

A

mitral valvuloplasty (trimming)
valve replacement

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20
Q

mitral stenosis

A

obstruction of the blood flowing from the left atrium to the left ventricle due to the narrowing of the mitral valve orifice leads to pulmonary congestion, right side heart failure, reduced cardiac output

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21
Q

mitral stenosis clinical manifestations

A

Dyspnea on exertion
enlarged left atrium change pressure on the left bronchial tree resulting in dry cough or wheezing which leads to a fib
hemoptysis
palpitations
orthopnea
parozymal nocturnal dyspnea
repeated infections

22
Q

mitral stenosis assessment

A

weak and irregular pulse in the presence of a fib
should be opening during diastole but it isn’t
low pitched rumbling diastolic murmur
may have signs and symptoms of HR

23
Q

mitral stenosis medical management

A

anticoagulants
beta blockers
digoxin
calcium channel blocker

24
Q

patient teaching (things to avoid) with mitral stenosis

A

avoid strenuous activities, competitive sports, and pregnancy

25
Q

mitral stenosis surgical intervention

A

percutaneous transluminal balloon valvuloplasty great outcome
valve replacement

26
Q

percutaneous transluminal balloon valvuloplasty

A

used for child bearing aged women if they develop mitral stenosis from fibrotic tissue changes
not good outcome for elderly because it recalcifies
stretch stenotic mitral valve opens
wall between atriums may not heal properly

27
Q

aortic regurgitation

A

flow of blood back to the left ventricle from the aorta during diastole
the left ventricle dilates in an attempt to accommodate the increased volume of blooda

28
Q

aortic regurgitation clinical manifestations

A
  • no symptoms in most patients
  • some may be aware of a forceful heartbeat especially in the head or neck
  • marked arterial pulsations visible or palpable carotid or temporal
29
Q

Aortic regurgitation assessment

A
  • high pitched blowing diastolic murmur at the third or fourth intercostal space at the left sternal border
  • widened pulse pressure
30
Q

patient teaching (things to avoid) with aortic regurgitation

A

avoid physical exertion
competitive sports
isometric exercise

31
Q

aortic regurgitation medical management

A

after load reduction
sodium restriction and avoid fluid overload

32
Q

aortic regurgitation surgical management

A

valve replacement or valvuloplasty
surgery is recommended for anyone with left ventricular dilation, regardless of the presence or absence of symptoms

33
Q

aortic stenosis murmur

A

loud
hard systolic murmur heard over the aortic area and may radiate to the carotid arteries and apex of the left ventricle
low pitched crescendo decrescendo
rough
rasping
vibrating

34
Q

aortic stenosis prevention

A

focused on controlling risk factors for proliferative and inflammatory responses such as diabetes, hypertension, hyperlipidemia, avoid tobacco products

34
Q

commissurotomy valvuloplasty

A

procedure preformed to celebrate the fused leaflets

34
Q

closed valvuloplasty

A

balloon valvuloplasty
beneficial for mitral valve stenosis in younger patients with complex medical conditions

35
Q

contraindications for closed valvuloplasty

A

those with left atrial or ventricular thrombus
severe valvular calcifications
thoracolumbar scoliosis
rotation of the great vessels
cardiac conditions that require open heart surgery

36
Q

annuloplasty

A

repair of the valve annulus

37
Q

elongated leaflet repair

A

folded over onto itself and suture

38
Q

short leaflet repair

A

chordoplasty (repair of chordae tendinae)

39
Q

leaflet repair holes

A

pericardial or synthetic patch may be used

40
Q

valvuloplasty

A

repair of cardiac valve
no need for anticoagulation
only mitral valve can be repaired well, other valves better to be replaced

41
Q

when would you replace rather than repair

A

valvuloplasty is not a viable alternative
- when the annulus or leaflets of the valve are immobilized by
- calcifications
- severe fibrosis
- fusion of leaflets, chordae tendineae, or papillary muscles

42
Q

mitral balloon valvuloplasty complications

A

mitral regurgitation
bleeding from the catheter insertion sites
emboli
atrial septic defect

43
Q

aortic balloon valvuloplasty

A

aortic regurgitation
bleeding from the catheter insertion sites
emboli
ventricular perforation, rupture of the aortic valve annulus, ventricular dysrhythmia

44
Q
A
45
Q

prognosis of aortic valve valvuloplasty

A

restenosis is 50% 6 months later

46
Q

mechanical valve replacement

A

more durable
less likely to be infected
need anticoagulations

47
Q

bioprosthesis tissue valve replacement

A

pigs, cows, horses

48
Q

homograft tissue valve replacement

A

human valves

49
Q

tissue vs mechanical thromboembili risk

A

tissue less likely to generate and long term anti coagulation is not required

critical care (8 decks)

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