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Cardiology (Fall 2023) > valvular disorders part 1 > Flashcards

valvular disorders part 1 Flashcards

1
Q

what are the 2 types of valve disorers

A

regurgitation and stenosis

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2
Q

what are teh 6 clinical classification categories based on anatomy and symtpoms of valvular heart disease

A
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3
Q

what are the valvular heart disorders associated with congenital defects

A
  • aortic stenosis
  • pulmonic stenosis
  • bicuspid aortic valve
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4
Q

what are the valvular heart disorders associated with aging

A
  • degenerative valve disease
  • valve calcification
  • mediastinal radiation therapy
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5
Q

what are the risk factors for valvular heart disorders associated with other illnesses/disease

A
  • infective endocarditis
  • rheumatic fever
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6
Q

what are the 2 ways aortic stenosis typically occurs

A

congenital or acquired

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7
Q

what occurs with congenital aortic stenosis and when does it present.

A
  • unicuspid, bicuspid, or quadricuspid valve
  • symptoms classically present prior to age 50
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8
Q

what typically causes acquired aortic stenosis and when does it present

A
  • rheumatic fever, valve calcification, and degenerative stenosis
  • symptoms presenting after age 50
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9
Q

what do both congenital and acquired causes of aortic stenosis lead to

A

thickening and calcification of the valve leaflets which result in narrowed valve opening

this further leads to LVH which then leads to diastolic dysfunction then to systolic dysfunction (i gotta draw this out)

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10
Q

what is the cause of degenerative or calcified AS

A

results from calcium deposition on valve leaflets

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11
Q

who is degenerative or calcified AS MC in

A

elderly patients

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12
Q

what percent of patients over 65 and 75 have aortic sclerosis on echo? why is this so bad

A

25% over 65
35% over 75

10-20% can further progress to aortic stenosis in the next 10-15 years

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13
Q

what are risk factors for calcified AS

A

HTN
HLD
Smoking

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14
Q

what is the MC surgical valve lesion in developed countries

A

aortic stenosis

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15
Q

what are the cardinal symptoms of aortic stenosis

A
  • angina (underperfusion of endocardium)
  • syncope (↑LV pressure stimulates baroreceptors to induce peripheral vasodilation)
  • CHF
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16
Q

once cardinal symptoms of aortic stenosis occur, what happens to the prognosis of the patient

A

it drops 2-5 years unless surgical correction is made

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17
Q

what are PE findings for aortic stenosis

A
  • murmur
  • laterally displaced, sustained apical impulse
  • S4 gallop may be present
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18
Q

what does the murmur for aortic stenosis present like

A
  • medium pitch, harsh quality, loud with a thrill
  • midsystolic, crescendo-decrescendo
  • best heart at right 2nd interspace w radiation to carotids
  • heard best w patient sitting and leaning forward
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19
Q

what would an EKG demonstrate in a pt with aortic stenosis

A

may see LVH

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20
Q

what are the three diagnostic studies used for aortic stenosis

A

CXR
echo
cardiac catheterization

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21
Q

what would a CXR show in aortic stenosis

A
  • enlarged cardiac silhouette
  • calcified aortic valve
  • dilated ascending aorta
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22
Q

what would a echo show in aortic stenosis

A

honestly not sure whats happening here… plz interperet this as you will until i figure it out haha

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23
Q

what does cardiac catheterization show in aortic stenosis

A

confirms presence of severe aortic stenosis and any CAD

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24
Q

what can reduce transvalvular pressure gradient in an enchocardiography

A

reduced LV function due to low output

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25
Q

what is the treatment for symptomatic aortic stenosis patients

A

open aortic valve replacement
or
transcutaneous aortic valve replacement/implantation

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26
Q

what anti-coagulant would a patient who underwent an open AVR with a mechanical valve recieve

A

warfarin +/- aspirin

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27
Q

what anti-coagulant would a patient who underwent a TAVR recieve

A

plavix and aspirin

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28
Q

when would you use a TAVR (transcutaneous aortic valve implantation)

A

in patients who are poor candidates for open heart surgery or are of intermediate risk

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29
Q

when is balloon valvuloplasty used in aortic stenosis management

A

congenital AS but not degenerative AS due to high “restenosis” rate

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30
Q

what medication therapies have been proven to slow progression of aortic stenosis

A

NONE!!

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31
Q

what is included in medical therapies for sympotms of aortic stenosis

A

+/- statins

medications to reduce afterload and volume reducton (BB i think)

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32
Q

what is aortic regurgitation caused by

A

disease of the aortic leaflets, aortic root, or both

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33
Q

what are diseases that can affect aortic leaflets

A
  • rheumatic fever
  • congenital abnormalities
  • infective endocarditis
  • HTN
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34
Q

what are diseases that can affect the aortic root

A
  • aortic dissection
  • root dilation
  • marfan’s
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35
Q

what does chronic AR lead to?

A

LVH and dilation due to ned to accommodate for the additional regurgitant volume

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36
Q

what are the symptoms of aortic regurgitation

A
  • may be asymptomatic for years
  • exertional dyspnea
  • fatigue
  • angina (d/t low perfusion)
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37
Q

what are the symptoms determined and caused by in aortic regurgitation?

A
  • Presentation is determined by how quickly regurg occurs
  • due to increase in V filling pressures which leads to CHF
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38
Q

what are the PE findings associated with aortic regurgitation

A
  • murmur
  • widened pulse pressure
  • S3 or 4 gallop
  • Austin flint murmur
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39
Q

what does an austin flint murmur sound like and when is it heard

A

heard in aortic regurgitaiton

a low pitched, diastolic mitral murmur, heard at apex

40
Q

what is the description of the murmur for aortic regurgitation

A
  • early diastolic decrescendo blowing in nature
  • high pitched, best hear in the 2nd to 4th left interspaces with radiation to the apex
  • best heard with the patient sitting and leaning forward
41
Q

what causes widened pulse pressure in aortic regurgitation

A

Due to elevated stroke volume during systole and falling diastolic pressure as a result of the incompetent aortic valve

( in notes at the bottom of 28)

42
Q

what causes the austin flint murmur in aortic regurgitation?

A

As a result of the incomplete opening of the mitral leaflets due to increased LV pressures or impingement of the AR jet on the anterior mitral leaflet

(at bottom of slide of 28)

43
Q

didagnostic modality of choice for AR

A

echooooo

44
Q

what is the tx for aortic regurgitation

A
  • AVR surgery for patients with symptomatic severe or LV changes (LV dilation >5cm or EF<50%)
  • medical tx with vasodilator (BB) to unload ventricle (does NOT slow progression)
45
Q

what may be seen on EKG in aortic regurgitation

A
  • LVH

(notes on slide 30)

46
Q

what may be seen on CXR for aortic regurgitation

A

cardiomegaly w LV prominence

(notes on slide 30)

47
Q

what might a CT or MRI be used for when assessing aortic regurgitation

A

aortic root size and severity

(notes under 30)

48
Q

in patients with marfans syndrome that have aortic regurgitation, what medication is preferred for vasodilation

A

ARBs instead of BBs

(slide 30 notes)

49
Q

what is acute aortic regurgitation caused by

A
  • infective endocarditis
  • traumatic rupture of aortic leaflets
  • aortic root dissection
  • acute dysfunction of prosthetic aortic valve
50
Q

what does acute aortic regurgitation result in?

A

Results in hemodynamic instability because the LV is unable to accommodate the increased diastolic volume

this is an emergency!!!!!

51
Q

What are s/s of cardiogenic shock

A
  • pale, cool extremities
  • weak, rapid pulse
  • low pitched, early diastolic murmur
52
Q

what is the diagnostic study used for acute aortic regurgitation

A

STAT echo

53
Q

what is seen on EKG for acute aortic regurgitation

A

LVH

54
Q

what is seen on CXR in acute aortic regurgitation

A

cardiomegaly with LV prominence on CXR

55
Q

what is medical treatment for acute aortic regurgitation

A

vasodilator therapy and diuretics if BP is stable

inotropic agents and vasopressors may be necessary

56
Q

what is the teratment of choice for acute aortic valve regurgitation

A

urgent aortic valve replacemet

57
Q

what is occuring during mitral stenosis

A

thickening and immobility of the mitral leaflets impede the flow from the left atrium to the left ventricle

58
Q

what are the causes of mitral stenosis

A
  • rheumatic fever (MC)

the following are rare:
* congenital abnormalities
* connective tissue disorders
* left atrial tumors
* overly aggressive surgical repair MR

59
Q

what is the MC group affected by mitral stenosis

A

2/3 women

60
Q

what is the pathophysiology of MS due to rheumatic fever

A
  • pathologic changes occur over many years before dysfunction becomes hemodynamically important
  • gradually leads to fusion of leaflets and thickening, fibrosis, and clacification of mitral leaflets and chordae
61
Q

what are initial hemodynamic changes in MS

A

elevated left atrial pressure causing LA enlargement

(may result in pulmonary congestion)

62
Q

what occurs with chronic elevations in pulmonary venous pressures in MS

A
  • increase in pulm vascular resistance and pulm arterial pressures
  • this further leads to RV failure
63
Q

compare mild/moderate MS to severe MS in relation to LV impairement

A
  • mild/mod - LV filling pressures may be normal or low
  • severe - LV filling is impaired reducing SV and CO!!!

(must give BB or this will eventually kill the patient. said in notes on 43)

64
Q

when do patients with MS typically develope symptoms

A

the 4th-5th decade of life
(approx 20-40 years following illness)

65
Q

what are the symtpoms a result of in MS

A

pulmonary vascular congestion and RV failure

66
Q

what are the symptoms seen in MS

A
  • Fatigue, exertional dyspnea, orthopnea (MC)
  • afib
  • hemoptysis (d/t rupture of bronchial veins)
  • blood tinged sputum (d/t pulm edema)
67
Q

what are additional findings that could be seen in MS

A
  • peripheral emolism from Left atrial thrombus
  • peripheral edema
  • compression of left recurrent laryngeal nerve from a severely dilated LA may result in hoarsness (ortner syndrome)
68
Q

what is the murmur description for MS

A
  • low-pitched, rumbling, diastolic murmur best heard at apex in LLD position
  • S1 loud in early MS, then softens as leaflets become more calcified and immoble
  • opening snap heard following S2
69
Q

what are EKG findings assocaited with MS

A
  • LA abnormality
  • Afib
  • RV hypertrophy pattern
70
Q

what does the echo show for MS

A

characteristic rheumatic deformity is doming “hockey stick” of the anterior MV leaflet

71
Q

what type of echo may be used in MS? what does it interperet

A

TTE or TEE to measure extent of valvular calcification and severity of stenosis.

normal MV is 4-6cm
critical is <1cm

72
Q

what is measured during cardiac catheterization in evaluation of MS

A

measurement of cardiac output and transvalvular gradient

73
Q

what is the treatment for MS

A
  • mild/mod - medically managed for symptom control, not reversible. use BB for HR and diuretics for pulm congestion and RV failure
  • mod-severe = percutaneous or surgical intervention
74
Q

when is percutaneous balloon valvuloplasty recommended in MS

A
  • pliable, noncalcified leaflets and chords
  • minimal MR
  • no evidence of LA thrombus

NOT A DEFINITIVE TX. only definitive is valve replacement

75
Q

what is the cause of mitral regurgitation

A
  • LV dilation (cardiomyopathy)
  • Posterior wall MI
  • Rheumatic fever
  • Endocarditis
  • MV prolapse
76
Q

what does mitral regurgitation result in

A

regurgitant blood flow from the LV to the LA during systole

this eventually can lead to pulm congestion due to inceased LA pressure

77
Q

what are symptoms for mitral regurgitation

A
  • fatigue
  • dyspnea on exertion
  • peripheral edema

note: MR remains asymptomatic for many years, once symtpoms occur its due to depressed LV systolic function

78
Q

what is the murmur description for mitral regurgitation

A
  • Holosystolic murmur best heard at the apex and radiates to the axilla and back
  • Mid-systolic click may be present if MVP present
79
Q

what would an EKG present as for mitral regurgitation

A
  • LA abnormality, LVH pattern
  • Afib may be present
80
Q

what can be used to assess severity of MR and LV function

A

echo and cardiac cath

81
Q

when is a coronary angiography reccommended in mitral regurgitation

A

if male patient >40 or menopausal female w/RF

82
Q

what is pharmalogical treatment for mitral regurgitation

A
  • afterload reduction with vasodilators (ACEI or hydralazine)
  • diuretics also for pulm congestion/edema and to reduce volume overall
83
Q

what is surgical treatment for mitral regurgitation

A
  • MV repair
  • MV replacement (only if repair not feasible)
84
Q

when is surgery indicated for mitral regurgitation

A
  • development of afib or pulm HTN
  • BEFORE irreversible myocyte damage and LV remodeling occurs
85
Q

when is MV repair NOT indicated

A

if MV is heavily calcified or disrupted secondary to papillary muscle disease/endocarditis

86
Q

what is acute mitral regurgitation

A

A life-threatening condition that may result from abnormalities with the papillary muscles, chordal structures or leaflets

LA does not dilate to accommodate the regurgitant volume

Results in abrupt increase in LA and pulmonary venous pressures

leads to pulm congestion!!!!!!

87
Q

what are causes of acute mitral regurgitation

A
  • Acute MI
  • Trauma
  • Endocarditis
  • Tachyarrhythmia in patient with chronic MR
  • MVP – papillary muscle / chordae tendineae dysfunction
88
Q

what are symptoms of acute mitral regurgitation

A
  • signs of cardiogenic shock such as:
  • hypotension
  • tachycardia
  • syncope
  • pale
  • diaphoresis
  • SOB
89
Q

what is the description of the murmur for acute mitral regurgitation

A

soft, low-pitched sound in early systole

90
Q

what is the treatment for acute mitral regurgitation?

A

Urgent valve replacement surgery

91
Q

what is MVP?

A

Defined as superior displacement in ventricular systole of one or both mitral valve leaflets across the plane of the mitral annulus toward the left atrium

92
Q

what is the epidemiology of MVP

A

present in 1-3% of population, more common in women.

can be inherited as autosomal dominant trait!!

93
Q

what are the symptoms of MVP

A
  • Most patients asymtpomatic
  • Nonspecific symptoms include:
  • chest pain
  • palpitations
  • dizziness
  • anxiety
  • fatigue

(AKA MVP syndrome)

94
Q

what are PE findings in MVP

A

auscultation reveals mid-systolic click, followed by late systolic murmur

95
Q

what can help with MVP syndrome

A

SSRI/SNRIs and BBs (in notes)

96
Q

what is the treatment for MVP

A
  • most patients with mild prolapse and are asymptomatic require no treatment
    nicceeeeee
97
Q

okay bye!:)

A

Cardiology (Fall 2023) (45 decks)

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