Valvular disorders - Newman

Question 1

3 major symptoms of Aortic Stenosis

Answer 1

1. Heart failure/dyspnea
2. Angina
3. Syncope

Question 2

Murmur heard with aortic stenosis best described as what?

Answer 2

Sounds like someone clearing their throat in between S1 and S2
S1 (Lub) - “Clear your throat” - S2(Dub)

Question 3

Will an EKG show aortic stenosis?

Answer 3

Yes

Question 4

Why is a cardiac cath done to establish aortic stenosis?

Answer 4

Done to establish gradient

Question 5

What 2 variables are important in determining if stenotic valve needs replacement

Answer 5

1. Cardiac output (flow)

2. Gradient (difference in pressure on both sides of valve)

Question 6

3 most common causes of mitral regurgitation? Which is most common?

Answer 6

1. Mitral valve prolapse (most common)
2. MI (resulting in papillary muscle rupture)
3. Left ventricular dilation (due to left heart failure)
   Know the other causes (rheumatic fever, bacterial endocarditis)

Question 7

Normal aortic valve opening size? When is it considered stenotic?

Answer 7

Normal = 3 cm^2 (pathoma says 4)
Stenotic = .5 cm^2 (pathoma says 1)

Question 8

Besides 3 common causes of mitral regurgitation, what are other causes?

Answer 8

Rheumatic fever, bacterial (infective) endocarditis

Question 9

2 requirements for bacterial endocarditis?

Answer 9

1. Bacteria in the blood

2. Damaged heart valve

Question 10

2 complications of bacterial endocarditis?

Answer 10

1. Pulmonary embolism

2. Damaged/destroyed heart valve

Question 11

Aortic regurgitation is leakage of blood from where to where?

Answer 11

Aorta to left ventricle (upstream)

Question 12

Mitral regurgation is leakage of blood from where to where

Answer 12

Left ventricle to Left atrium (upstream)

Question 13

Stenosis requires what cardiac adaptation?

Answer 13

Concentric hypertrophy = increased thickness (mass); normal volume and chamber size
- Hypertrophy required to overcome PRESSURE OVERLOAD

Question 14

Regurgitation requires what cardiac adaptation?

Answer 14

Eccentric hypertrophy (aka dilated ventricle)  = enlarged chamber; normal mass and thickness
-Dilatation required to overcome VOLUME OVERLOAD

Question 15

Interventricular septum normal size?

Answer 15

1 cm thick

Question 16

3 key features of ACUTE regurgitation?

Answer 16

1. Murmur
2. No adaptation (hypertrophy)
3. Sudden increase in pressure upstream (i.e. if aortic regurg, increase in LV diastolic pressure)

Question 17

Chest pain is most notable in what valvular disorder? Why?

Answer 17

Aortic stenosis, Normal left systolic blood pressure is 120 mm Hg. With stenotic valve, require increased systolic blood pressure (250-300) to pump out now. causes chest pain

Question 18

Mitral regurgitation, what defining feature heard on murmur?

Answer 18

Holosystolic, high-pitched “Blowing murmur”

Lub - Newman blowing (don’t pass out) - dub

Question 19

1st heart sound (S1) correlates with what pulse?

Answer 19

Carotid pulse

Question 20

Aortic regurgitation, systolic or diastolic murmur?

Answer 20

Diastolic murmur, S1—–S2-“blowing”

Question 21

Valvular disorder(s) during diastole?

Answer 21

Aortic regurgitation

Question 22

Valvular disorder(s) during systole?

Answer 22

Aortic stenosis

Mitral regurgitation

Question 23

Relationship between loudness(intensity) of murmur and severity of valvular disorder?

Answer 23

There is no relationship, can have severe valve disorder with quiet murmur.

Question 24

Concentric ventricular hypertrophy is a risk factor for?

Answer 24

coronary disease

Question 25

Echocardiogram tells you what 3 features?

Answer 25

1. Diseased valves 2. Hypertrophy 3. study flow of blood

Question 26

Angina refresh. What are the 2 main precipitating events of Angina?

Answer 26

1. increased myocardial O2 demand | 2. decreased O2 supply

Question 27

Eccentric hypertrophy seen in?

Answer 27

Acute cor pulmonale, regurgitation

Question 28

Describe EF in stages of aortic/mitral regurgitation?

Answer 28

Initially, increased preload due to (normal flow + extra flow due to valve regurge) in left ventricle, causing EF to increase to 75-80% or so. Over time, hypertrophy/fibrosis of ventricle ensues and EF will start dropping.

Question 29

Mitral stenosis most common cause?

Answer 29

Rheumatic fever

Question 30

Complications of mitral stenosis?

Answer 30

Left atrium dilation followed by pulmonary congestion>hypertension> eventual right sided heart failure (with ascites). Also atrial fibrillation with increased risk of mural thrombi

Question 31

Mitral stenosis can causee atrial fibrillation, increasing risk for?

Answer 31

Mural thrombus

Question 32

Ascites = how many liters of fluid

Answer 32

30L

Question 33

Jugular venous distention = how many liters of fluid?

Answer 33

3 L

Question 34

Mitral regurgitation can result in what 3 findings?

Answer 34

1. Diseases affecting supporting structures 2. Diseases affecting leaflets 3. Dilation of annulus

Question 35

Features of Chronic mitral regurgitation?

Answer 35

1. Dilation of Left ventricle and atrium 2. Less HTN upstream than mitral stenosis 3. Increased Preload, Decreased Afterload, Increased Stroke volume and ejection fraction

Question 36

Features of Acute mitral regurgitation?

Answer 36

1. Sudden rise in atrial pressure 2. no hypertrophy 3. Murmur

Question 37

Causes of acute mitral regurgitation?

Answer 37

Infection, ischemia

Question 38

Delayed arterial pulse = ?

Answer 38

Tardus

Question 39

Weakened arterial pulse = ?

Answer 39

Parvus

Question 40

Aortic regurgitation causes widening or narrowing of pulse pressure?

Answer 40

Widening in pulse pressure (i.e. 200/40) due to increased preload + "venting" of aorta (lower afterload)