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Cardio > Valvular Disorders - Part 1 - Exam 1 > Flashcards

Valvular Disorders - Part 1 - Exam 1 Flashcards

1
Q

What are the 6 clinical classification categories based on? What are they?

A

based on anatomy and symptoms

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2
Q

What are the risk factors for valvular disease?

A

congenital defects: bicuspid aortic valve

previous illness: endocarditis or rhematic fever

aging: calcification and degenerative disease

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3
Q

What are the 2 types of aortic stenosis? When do they typically appear?

A

congenital and acquired

congenital: bicuspid is the MC, present prior to age 50

acquired: Rheumatic fever, valve calcification, and degenerative stenosis, present after age 50

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4
Q

What does aortic stenosis lead to? What is the MC type of congenital aortic stenosis?

A

results in left ventricular hypertrophy

bicuspid congenital is the MC

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5
Q

What is degenerative/calcified AS a result of? Approx. 25% of patients over 65 and 35% over 75 have evidence of _____ on echo

A

calcium deposits on valve leaflets, MC in elderly pts

aortic sclerosis

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6
Q

What are risk factors for aortic stenosis?

A

HTN
hyperlipidemia
smoking

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7
Q

**What is the MC surgical valve lesion in developed countries?

A

aortic valve

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8
Q

What are the 3 cardinal symptoms of aortic stenosis? **What is the highlighted symptom?

A

angina
syncope/dizziness** especially on exertion
dyspnea

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9
Q

**What does a aortic stenosis murmur sound like? **Where is it best heard and where does it radiate? _____ extra heart sound may be present

A

Midsystolic, crescendo-decrescendo, medium pitch, harsh quality, often loud with a thrill

Best heard at the right 2nd interspace with the pt sitting and leaning forward

with radiation to the carotids

S4 gallop

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10
Q

**What is parvus et tardus? What valve condition is it associated with?

A

Slow rising carotid pulse contour

aortic stenosis

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11
Q

What is the imaging of choice for aortic stenosis? ______ confirms the presence of severe AS and any CAD

A

echo

cardiac cath

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12
Q

The CXR shows how enlarged cardiac silhouette, calcified aortic valve, dilated ascending aorta.

What am I?

A

aortic stenosis

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13
Q

What is a gradient? What is normal?

A

difference in pressure of the left ventricle in systole and the aorta in systole.

normal should be less than 15mmHg

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14
Q

What are the components of a echocardiography? What are the values of each for mild/moderate/severe?

A

**Know the severe criteria for each section at the very least

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15
Q

What is the tx for symptomatic pts with severe AS? What do you need to give to pts after tx?

A

aortic valve replacement

Mechanical valve → Warfarin +/- ASA 81 mg
TAVR → Plavix x 6 months; lifelong ASA 81 mg

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16
Q

______ is useful for patients who are poor/intermediate candidates for open heart surgery

A

Transcutaneous Aortic Valve Repair (TAVR) or TAVI

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17
Q

______ is useful for congenital AS, but not used often for degenerative AS due to complications and high restenosis rate. What is given to help slow the rate of progression?

A

Balloon valvuloplasty

No medical therapies proven to slow progression!!! statins to control plaque build up and therapies aimed at s/s

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18
Q

What is aortic regurgitation caused by? What does it lead to?

A

Caused by disease of the aortic leaflets, aortic root, or both

Chronic AR leads to LVH and dilation due to the need to accommodate for the additional regurgitant volume

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19
Q

What are some causes of aortic root problems?

A

aortic dissection, aortic root dilation and Marfan’s syndrome

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20
Q

aortic regurgitation presentation is determined by how quickly ______. Symptoms are typically due to increase in ______ leading to CHF. What are the 2 MC s/s?

A

regurg occurs

LV filling pressures

Exertional dyspnea and fatigue +/- angina

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21
Q

**What does an aortic regurgitation murmur sound like? Where is the best place to hear it? Where does the sound radiation to?

A

Early diastolic, decrescendo, blowing

High pitched, best heard in the 2nd to 4th left interspaces (left sternal border) with the pt sitting and leaning forward

radiation to the apex

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22
Q

What is widened pulse pressure (SBP-DBP) and “water hammer pulse” associated with? What additional heart sounds can be heard?

A

aortic regurgitation

S3 or S4 gallops may be present

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23
Q

**What is an Austin Flint murmur? What cardiac dz is it associated with?

A

A low-pitched, diastolic mitral murmur, may be heard at the apex

aortic regurgitation

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24
Q

What is the imaging modality of choice for aortic regurgitation?

A

Echocardiography (TTE)

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25
Q

What is the tx for aortic regurgitation? What is the criteria? What medication is recommended? Why?

A

aortic valve replacement for patients with symptomatic severe AR or with LV changes

Recommend AVR prior to progression to LV dilation > 5.0 cm or reduction in EF to < 50%

vasodilators (hydralazine, minoxidil, nitrates, and nitroprusside and/or normal BP meds)

to unload the ventricle but does NOT slow down the progression of aortic regurgitation

26
Q

What is a normal ejection fraction?

A

normal ejection fraction is greater than 50%

27
Q

What is acute aortic regurgitation caused by? What is it a result of? What does it lead to?

A

Infective endocarditis, traumatic rupture of aortic leaflets, aortic root dissection, and acute dysfunction of a prosthetic aortic valve

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

aka blood backs up into the lungs and they cant breathe then they die

cardiogenic shock (pale, cool extremities, weak, rapid pulse, low pitched early diastolic murmur)

28
Q

What is the tx for acute aortic regurgitation? What is the tx of choice?

A

Medical treatment includes vasodilator therapy and diuretics if BP is stable. Inotropic agents and vasopressors may be necessary

need to take pressure off heart

urgent aortic valve replacement!!!

29
Q

**What is the MC cause of mitral stenosis? 2/3rd of patients are _____. What does it lead to?

A

rheumatic fever

women!!

Fusion of the leaflet commissures and thickening, fibrosis, and calcification of the mitral leaflets and chordae

30
Q

Initial hemodynamic changes with mitral stenosis include elevated ____ pressure, causing ___ enlargement. This is transmitted back to the pulmonary venous system and may result in _______. Chronic elevations in pulmonary venous pressure leads to ______

A

left atrial

Left atrium

pulmonary congestion

right ventricular failure

31
Q

As mitral valve stenosis becomes severe, _____ filling is impaired, reducing the _____ and _____

A

left ventricle

stroke volume and cardiac output

32
Q

When do patients with mitral stenosis start developing symptoms? What are the s/s related to?

A

40s-50s

pulmonary vascular congestion and right ventricle failure

33
Q

What are the MC s/s of mitral stenosis?

A

Fatigue, exertional dyspnea, orthopnea (SOB when lying flat)

may have peripheral edema

34
Q

**_____ is also common in mitral stenosis. What does it lead to?

A

atrial fibrillation

leads to blood clots

35
Q

**What is Ortner syndrome? **What valve dz is it associated with?

A

Compression of the left recurrent laryngeal nerve from a severely dilated LEFT ATRIUM may result in hoarseness

mitral stenosis

36
Q

**What does a mitral stenosis murmur sound like? Where is the best place to hear it? What pt position?

A

Low-pitched, rumbling, diastolic murmur

best heard at the apex with patient in left lateral decubitus position

37
Q

______ extra heart sound is heard in mitral stenosis. Why?

A

opening snap following S2

valve has to push itself open

38
Q

What happens in mitral stenosis if pulmonary artery pressures are elevated?

A

a palpable P2 (light tap felt over pulmonary artery/vein) may be detected at the upper left sternal border, also associated with a prominent pulmonic component of S2 on auscultation

39
Q

**Characteristic rheumatic deformity observed is doming ______ of the anterior mitral valve leaflet. What is this due to?

A

“hockey stick” in mitral stenosis

This is secondary to fusion of the commissures and tethering of the leaflet tips

40
Q

What is the tx for mild/moderate mitral stenosis? Give the reason why with each

A

Beta Blockers for HR control

Diuretics are used to relieve pulmonary congestion and signs of RV failure

BP control for afterload reduction

41
Q

What is the tx for moderate/severe mitral stenosis and severe symptoms? What is considered moderate/severe s/s?

A

refer for sx

s/s when sitting down not moving/doing anything

42
Q

Why is percutaneous balloon valvuloplasty not a common tx option for mitral stenosis?

A

because of the valve location. Have to go through atrial septum to access the valve

NOT a definitive tx, only used in pliable, noncalcified leaflets and chords

43
Q

What is the definitive tx for mitral stenosis?

A

Valve Replacement Surgery is otherwise definitive treatment with bioprosthetic or mechanical valve replacement

44
Q

mitral regurgitation is the result of abnormalities of the _____, _____, _____ or ______. What are some common causes?

A

MR results from abnormalities of the mitral leaflets, annulus, chordae, or papillary muscles

MV prolapse
LV dilation (cardiomyopathy)
Posterior wall MI
Rheumatic fever
Endocarditis

45
Q

What does mitral regurgitation result in?

A

Results in regurgitant blood flow from the LV to the LA during systole

46
Q

complication of mitral regurgitation, _____ and ______ dilate to compensate for increased volume

A

left atrium and left ventricle

47
Q

In mitral regurgitation, what does left ventricle dilation cause? then what happens?

A

LV dilation continues causing elevation in diastolic filling pressures and a reduction in LV systolic function

LA pressures build and pulmonary venous pressures increase resulting in pulmonary congestion
LA and LV dilate to compensate for the increased volume

48
Q

What is the presentation of mitral regurgitation?

A

most remain asymptomatic and well-compensated for many years

s/s will appear due to depressed left ventricle systolic function (fatigue, dyspnea on exertion, peripheral edema)

49
Q

**What does a mitral regurgitation murmur sound like? Where is the best place to hear it? What can also be heard if there is mitral valve prolapse?

A

Holosystolic murmur

best heard at the apex and radiates to the axilla and back

Mid-systolic click may be present if mitral valve prolapse present

50
Q

______ is the diagnostic modality of choice to dx mitral regurgitation. What is the monitoring recommendations? What is also recommended to asses severity?

A

TTE echo

TTE monitoring every 3-5 years for mild, 1-2 years for moderate, and 6 mos for severe depending on symptom severity may be useful

cardiac cath

51
Q

What is the medical management of mitral regurgitation?

A

ACE/ARB or BB to reduce afterload

diuretics to treat pulmonary congestion and reduce overall volume

52
Q

What is the definitive tx for mitral regurgitation? ______ or ______ may also indicate the need for intervention regardless of left ventricular size and function

A

sx BEFORE irreversible myocyte damage and left ventricular remodeling occurs

Afib or pulonary HTN

53
Q

What are the different types of mitral regurgitation surgeries?

A

MV repair:
annuloplasty, when a prosthetic ring is sewn in

or mitral valve replacement

54
Q

When is mitral valve repair NOT indicated?

A

Not indicated if the MV is heavily calcified or disrupted secondary to papillary muscle disease or endocarditis

55
Q

Why is acute mitral regurgitation considered life threatening? What does it result in?

A

because the left atrium does NOT dilate to accommodate the regurgitant volume

Results in abrupt increase in LA and pulmonary venous pressures which leads to pulmonary congestion

56
Q

What are the causes of acute mitral regurgitation?

A

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

57
Q

What are the s/s of acute mitral regurgitation? What does the murmur sound like? What is the tx?

A

hypotension
tachycardia
syncope
pale
sweating
SOB

soft, low-pitched sound in early systole

urgent valve replacement sx

58
Q

mitral valve prolapse is MC in ______. What is it defined as?

A

MC in women

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

59
Q

Nonspecific symptoms of chest pain, palpitations, dizziness, anxiety, fatigue. Most patients are asymptomatic

What am I?
**What will auscultation reveal?

A

mitral valve prolapse

mid-systolic click usually followed by late-systolic murmur

60
Q

What is the diagnostic imaging of choice for mitral valve prolapse? What is the tx? What if severe mitral regurgitation is present?

A

echo

Most patients with mild prolapse and insignificant MR are asymptomatic and require no intervention

mitral regurgitation present: MV repair or replacement is indicated

61
Q

Consider looking at this flow chart again :) maybe idk idk

A
62
Q
A

Cardio (9 decks)

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