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HA > Valvular dz > Flashcards

Valvular dz Flashcards

1
Q

Valvular heart disease incidence

A

2.5% in US

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2
Q

Valve associated with stenosis and regurg

A

aortic stenosis = also regurgitant

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3
Q

What increases the mortality in pts with regur?

A

CAD w/ mitral or aortic valve disease

Mitral regurgitation d/t ischemic heart disease

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4
Q

New York Heart Association Functional Classification of Patients with Heart Disease

class 1

A

asymtomatic

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5
Q

New York Heart Association Functional Classification of Patients with Heart Disease

class 2

A

symptoms with ordinary activity but comfortable at rest

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6
Q

New York Heart Association Functional Classification of Patients with Heart Disease

class 3

A

symptoms with minimal activity but comfortable at rest

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7
Q

New York Heart Association Functional Classification of Patients with Heart Disease

class 4

A

symptoms at rest

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8
Q

Murmurs cause

A

-Turbulent blood flow across abnormal valves
-Increased flow across normal valves

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9
Q

Functional murmur

A

innocent/physiologic murmur due to a condition outside the heart
pregnancy

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10
Q

Pahtologic murmur

A

seomthing going on inside the heart itself

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11
Q

Identifying characteristics of the murmur

A

Timing of the murmur in the cardiac cycle is most important
location, radiation and intensity.

Midsystolic vs holosystolic and diastolic murmurs

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12
Q

midsystolic murmur

A

can be fucntional murmur

Occur between distinct S1 and S2 heart sounds
Crescendo–decrescendo pattern

hear at R sternal border, if goes to the carotids = aortic stenosis

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13
Q

Systolic murmur

A

Stenosis of the aortic or pulmonic valves
Incompetence of the mitral or tricuspid valves

Midsystolic or holosystolic

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14
Q

Holosytolic murmur

A

merges with S1 and S2

best heard at apex and radiates to the axilla = mitral regur

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15
Q

Diastolic murmur

A

Stenosis of the mitral or tricuspid valves
Incompetence of the aortic or pulmonic valves

follows s2.

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16
Q

aortic stenosis murmur location

A

R sternal border

radiates to cartoids, ejection clock, also diastolic murmur if aortic regur is present

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17
Q

Aortic regurg murmur location

A

L sternal border

may also have systolic murmur due to increased SV

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18
Q

mitral stenosis murmur location

A

apex.
opening snap after S2, loud S1, radiation to L axilla

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19
Q

mitral regurg murmur location

A

apex

radiates to the L axila

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20
Q

Common auscultatory sites

A

Aortic: 2nd ICS RSB
Pulmonic: 2nd ICS LSB

Tricuspid: 5th ICS LSB
Mitral: 5th ICS MCL

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21
Q

Valve disease ekg dx

A

Left atrial enlargement (notched p wave)
Left or right axis deviation (hypertrophy)
Dysrhythmias (afib)
Possible ischemia/previous MI

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22
Q

Valve dz cxray

A

Cardiomegaly
Left mainstem bronchus elevation
Valvular calcifications
aortic abnormalities

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23
Q

Mechanical valves

A

Metal or carbon alloy
Very durable… 20-30 years
Highly thrombogenic
Young pts
hemolysis

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24
Q

Bioprosthetic valve

A

Porcine or bovine
Shorter lasting… 10-15 years
Low thrombogenic potential
Elderly pts

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25
Q

DC warfarin

A

Discontinuation of warfarin
for Minor vs major surgery
bridge therapy
Rebound hypercoagulable state

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26
Q

Anticoagulation during pregnancy

A

Continue but warfarin can lead to spont termination of pregnancy in 2st trimester
ASA or lmwh

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27
Q

Mitral stenosis

A

Rare in the US
Rheumatic heart disease
Primarily affects women
Asymptomatic for 20-30 years

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28
Q

Normal mitral valve orifice area

A

Normal mitral valve orifice area is 4–6 cm2
Symptoms develop - < 2 cm2

29
Q

LV contractility remains normal in….

A

Mitral stenosis

30
Q

MS symptoms

A

Dyspnea on exertion
Orthopnea
Paroxysmal nocturnal dyspnea
Pulmonary edema
Pulmonary HTN
Atrial fibrillation

31
Q

MS CXR

A

Mitral calcification
Pulmonary edema or vascular congestion
Elevated left main bronchus
Straightening of left heart border

32
Q

MS EKG

A

Notched P waves
AFib

33
Q

MS Treatment

A

Rate control; β-blockers, calcium channel blockers, digoxin

Left atrial pressure; Diuretics

Anticoagulation - risk of stroke 7-15% per year
Arterial thromboembolism vs venous thrombosis

surgical correction

34
Q

MS maintains svr and bp using….

A

Phenylephrine, vasopressin

35
Q

Prevention and treatment of decreased cardiac output or pulmonary edema in MS pts by….

A

avoiding Excessive pre-op IV fluid or Trendelenburg position

36
Q

Mitral regurgitation

A

More common than MS
2% of the US population

37
Q

Mitral regurgitation associated with

A

IHD
Ruptured papillary muscle
Endocarditis
Mitral valve prolapse
Cardiomyopathy

38
Q

MR pathophysiology

A

Left atrial volume overload and pulmonary congestion
Transforms LV
Eccentric hypertrophy
Compliance of left atrium

39
Q

Mr Symptoms

A

History of IHD, endocarditis, papillary muscle dysfunction
Holosystolic murmur at apex
Radiates to axilla
Cardiomegaly
Atrial fibrillation

40
Q

MR EKG

A

Left atrial and LV hypertrophy
Atrial fibrillation

41
Q

MR CXR

A

Cardiomegaly
Left atrial and LV hypertrophy

42
Q

Mr treatment

A

Asymptomatic vs symptomatic pts
MV repair > MV replacement
EF < 30% little improvement with surgery
Transcatheter mitral valve repair; MitraClip
Vasodilators, biventricular pacing; ACE-I, β-blockers (carvedilol)

43
Q

HR for MR

A

Normal to slightly increased HR
avoid Bradycardia – LV volume overload

Avoid increased SVR
Vasodilators (nitroprusside)

44
Q

Aortic stenosis associated with

A

Calcific aortic stenosis- leaflets calcify/ get stenotic
Bicuspid aortic valve- seen in younger patients (30-50)

Develops earlier in life with BAV than with tricuspid aortic valve

45
Q

most common congenital valvular abnormality

A

bicuspid aortic valve in 1-2% of population

46
Q

normal aortic valve area

A

Normal valve area 2.5 - 3.5 cm2
Severe AS valve area < 1cm2

47
Q

As pathophysiology

A

Obstruction to ejection of blood into the aorta
Increased LV pressure

Always associated with AR

Concentric LV hypertrophy- subendocaridal compression

48
Q

As symptoms

A

Systolic or midsystolic murmur – right upper sternal border
Crescendo–decrescendo pattern
Radiates to neck, mimics carotid bruit

49
Q

Critical AS

A

Angina pectoris; Increased risk of peri-op mortality and MI
Syncope
Dyspnea on exertion - diastolic dysfunction = elevated LV filling pressures

50
Q

AS Symptoms correlate with…..

A

Symptoms correlate with an average time to death of 5, 3, and 2 years
75% of symptomatic pts die w/in 3 years w/o valve replacement

51
Q

AS cxr

A

Prominent ascending aorta
Aortic valve calcification

52
Q

AS ECG

A

LV hypertrophy
ST Depression
T wave inversion

53
Q

AS echo

A

Tri-leaflet vs bi-leaflet valve
Thickened and calcified leaflets
Valve area and transvalvular pressure gradients

54
Q

balloon valvotomy done with….

A

for adolescents/young adults with AS

> 65 do TAVR

55
Q

CPR is typically not effective with….

A

aortic stenosis

56
Q

Fluids with AS

A

Intravascular fluid volume - normal levels
Preload dependent

57
Q

tx of hypotension with AS

A

Hypotension - α-agonists (phenylephrine)

58
Q

tx of Junctional rhythm or bradycardia with AS

A
  • ephedrine, atropine, or glycopyrrolate
59
Q

Tx of tachycardia with AS

A

Tachycardia - β-blockers (esmolol)

60
Q

Aortic regurgitation caused by

A

Endocarditis
Rheumatic fever
Bicuspid aortic valve (BAV)
Anorexigenic drugs

61
Q

Acute aortic regurgitation caused by

A

Endocarditis or aortic dissection

62
Q

AR pathophysiology

A

Decreased CO d/t regurgitant SV
Combined LV pressure and volume overload
Usually slow onset

63
Q

Magnitude of aortic regurgitation depends on:

A

Time available for regurgitant flow (HR)
Pressure gradient across the aortic valve (SVR)

64
Q

(Austin-Flint murmur) heard in….

A

AR

Low-pitched diastolic rumble

65
Q

Hyperdynamic circulation causes

A

Widened pulse pressure
Decreased DBP
Bounding pulses

66
Q

s/s of LV failure

A

Dyspnea, orthopnea, fatigue and coronary ischemia

67
Q

AR on EKG/cxr / echo

A

LV enlargement and hypertrophy

Echocardiogram
Leaflet prolapse or perforation
Associated aortic abnormalities

68
Q

treatment for AR

A

Decrease systolic HTN, LV wall stress, and improve LV function; Diuretics, ACE-I, CCB

Surgical ; AVR, Aortic root replacement

69
Q

AR avoid….

A

Avoid bradycardia, HR: > 80 bpm
Avoid increased SVR
Minimize myocardial depression; Inotrope to increase contractility

HA (15 decks)

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