valvular heart disease Flashcards
1
Q
how to define valvular heart disease
A
- Defined by the valve
that is affected and
the functional
alteration
2
Q
what is stenosis
A
-Narrowing
of the valve orifice
impeding blood flow
through the valve.
3
Q
how does stenosis impair blood flow
A
- due to the smaller opening of the valve
- causes a pressure difference on both sides of the valve
- higher pressure going in direction of BF
- lower pressure on the other side
4
Q
what is regurgitation
A
- The valve does not close
completely and blood
flows backward.
5
Q
during systole what valves are opened
A
- open: semi lunar valves (aortic and pulmonic)
- this allows BF out of the vents
6
Q
during systole which valves are closed?
A
-mitral and tricuspid (AV valves)
7
Q
during diastole which valves are open
A
- mitral and tricuspid (AV valves)
- this allows blood to flow into the vents
8
Q
during diastole which vents are closed?
A
- semi lunar (aortic and pulmonic)
9
Q
what is mitral valve stenosis
A
- scarring of the valves = adhesions
- valve is thickened and shorter = no longer open good
- blood flow is blocked and pressure builds up in the left atrium (left vent wont fill all the way)
- pressure will increase in pulmonary vasculature and left atrium which causes symptoms
*mitral valve cannot open good during left atrial systole
10
Q
causes of mitral valve stenosis
A
- rheumatic (and congenital) heart disease
11
Q
manifestations of mitral valve stenosis
A
- exertional dyspnea
- loud S1
- low pitched diastolic murmur
- a-fib
- embolization for A-Fib
- decreased CO
12
Q
in mitral valve stenosis what causes exertional dyspnea
A
the pressure in the pulmonary vasculature which causes decreased lung compliance
-the pressure in the pul veins = hypertension = hemoptysis (spitting up blood)
13
Q
what causes the heart sounds in mitral valve stenosis
A
-sound of blood going somewhere its not supposed to be (too much blood in atria)
14
Q
what causes A-fib in mitral valve stenosis
A
- increased left atrial pressure
15
Q
what causes decreased CO in mitral valve stenosis
A
- from the l vent not filling
16
Q
when is diastolic murmur heard
A
- after s2
17
Q
when is systolic murmur heard
A
- after s1
18
Q
what causes rheumatic heart disease
A
- Strep A bacteria (strep throat) that isnt treated and progressed to rheumatic fever
- RF leads to rheumatic heart disease
19
Q
what does rheumatic heart disease cause
A
-Causes scarring and deformity of heart valves – typically
mitral valve
20
Q
who is at increased risk for RF
A
- children who are constantly infected with strep
21
Q
mitral valve prolapse
A
- Leaflets buckle into the left atrium during systole
- usually benign but can have serious
complications
22
Q
causes of mitral valve prolapse
A
- abnormality in the leaflet,
chordae tendineae, or papillary muscles - usually benign but can have serious
complications
23
Q
mitral valve prolapse is the leading cause of….
A
mitral valve regurgitation
24
Q
treatment for mitral valve prolapse
A
- usually benign but can have serious
complications - usually just monitored
- if have for a long time and symptomatic = mitral valve replacement
25
what is mitral valve prolapse characterized by
- systolic murmur (thats usually innocent)
| - lost of people have
26
what to avoid with mitral valve prolapse
- stimulants like caffeine
27
mitral valve regurgitation
- Mitral valve does not close completely during systole
- Blood flows backward from the left ventricle to the left atrium during systole = decrease in SV
- left atrial pressure will increase = deficient blood going to the body and increased LA pressure
- Left ventricle and Left atrium work harder to maintain CO
28
what caused the sounds in mitral valve regurgitation
- blood flowing backwards from left vent to left atrium
29
causes of mitral valve regurgitation
- defect in mitral valve or other cardiac
| structures that regulate blood flow
30
conditions that can lead to mitral valve regurgitation
- MI, Rheumatic
heart disease, mitral valve prolapse, papillary muscle
dysfunction, or endocarditis.
31
acute manifestations of mitral valve regurgitation
- thready peripheral pulse
- cool, clammy extremities
- pulmonary edema
- new systolic murmur
32
what usually causes an acute onset mitral valve regurgitation
- HF (post MI)
| * dangerous and poorly tolerated
33
manifestations of chronic mitral valve regurgitation
- fatigue
- palpitations
- SOB
- peripheral edema
- audible 3rd heart sound (heard at apex)
34
chronic mitral valve regurgitation pt may be...
-asymptomatic for years
35
Aortic stenosis
- blood is not getting to the body due to the stiffening of the aortic valve = decreased CO, decreased SV = HF signs
- Blood flow is obstructed to the aorta from the
left ventricle during systole = not enough blood entering the aorta
- Left ventricle must work harder to push blood through narrow valve= hypertrophy
- Leads to decreased cardiac output and heart
failure
36
causes of aortic stenosis
- congenital
- acquired: rheumatic heart disease
- age (> 65)
37
aortic stenosis manifestations
```
1. Signs of Left
Ventricular failure:
-Angina
-Syncope
-Exertional Dyspnea
2. Systolic Murmur w/
absent S2
* Poor prognosis if
obstruction is not
fixed
```
38
What is hard about the presentation of aortic stenosis?
-can look like heart attack but if you give nitro that will decrease their bp even more = BAD
39
aortic regurgitation
-Backward blood flow from the aorta into the Left
ventricle during diastole = decreased SV and CO
-Volume overload in left ventricle = hypertrophy
-Blood backs up into the left atrium and pulmonary
vasculature
40
acute manifestations of aortic regurgitation
- Severe chest pain
- Dyspnea
- Hypotension
41
Chronic manifestations of aortic regurgitation
- Water hammer pulse
- Early diastolic murmur
- Fatigue
42
water hammer pulse
- strong quick beat immediately collapses
| - pulse with kick your hand and then collapses
43
acute aortic regurgitation
-life threatening due to
| cardiovascular collapse
44
chronic aortic regurgitation
- patients may be asymptomatic for
| years
45
history assessment
Rheumatic heart disease, IE, congenital defects, MI, cardiomyopathy, strep infections. Pt may be asymptomatic for years.
46
physical exam: ss of HF
- (L): crackles, wheezes, orthopnea, dyspnea, hemoptysis, fatigue.
- (R): hepatomegaly (from backup of blood in liver= increased liver enzymes), edema (peripheral)
47
physical exam: ss of A fib
-pulse irregularly irregular, S/S of stroke, palpitations, ECG changes
48
physical exam: ss of cardiac
-S3, murmur (systolic or diastolic)
49
Dx
- echo or TEE
- cardiac cath
- ECG
- CXR
- CT scan
50
echo or tee for DX
-Regular Echo typically ordered first, may also get TEE.
| TEE reveals valve structure, function and size of atria and ventricles.
51
cardiac cath for DX
Looks at pressure changes in the heart chambers,
measures pressure changes across the valves, measures valve
openings.
52
ECG for DX
- Changes in rhythm can show chamber enlargement and
| ischemic changes, a-fib
53
CXR for DX
- Pulmonary congestion, enlargement of pulmonary arteries,
| enlarged heart chambers
54
CT scan for DX
Evaluates the for aortic disorders
55
treatment
-depends on valve involved and severity. (chronic= wait and see. acute = replacement immediately)
-The heart and compensatory mechanisms can
compensate, but pt. may eventually become
symptomatic.
- Medical management is first line in treatment of S/S;
surgical intervention may be required.
-Prevent exacerbations of HF, pulmonary edema,
thromboembolism, IE. Prevent recurrence of rheumatic
heart disease and IE.
56
MEDICAL MANAGEMENT
-Heart Failure the most common reason for ongoing medical care.
-Treat Heart Failure: Vasodilators, B-blockers, diuretics, low Na diet, inotropic drugs
- Anticoagulation therapy in presence of a-fib (Dysrhythmias are common especially atrial)
-Treat with antidysrhythmic drugs, cardioversion. Meds used to control
ventricular rate with a-fib
57
Surgical management
- Monitor patient heart size, and ejection fraction (ECHO)
- Essentially, when heart size increases, and EF decreases, consider surgery for valve replacement.
- Other signs: HF, angina, syncope
- Percutaneous Transluminal Balloon Valvuloplasty (PTBV) -Transcutaneous Aortic Valve Replacement (TAVR)
- Prosthetic Valves
58
ptbv ( Percutaneous Transluminal Balloon ValvuloplastY)
- ALTERNATIVE TO VALVE REPLACEMENT
- bandaid
- for mitral or aortic stenosis
- balloon tip cath placed into the valve --> inflate and deflate to loosen valve up
59
Transcutaneous Aortic Valve Replacement (TAVR)
-fed up through femoral artery and replace valve w/out opening heart
60
Prosthetic Valves
- Most patients are required to take anticoagulation medication
- Thromboembolism form easily on artificial valves
