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Acute Care Seminar 1 > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

SVC & IVC

A

-Brings blood back to the heart

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2
Q

Pulmonary Artery

A

only artery that has venous blood

-goes to lungs to receive oxygen

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3
Q

Pulmonary Vein

A
  • bring back to LA

- oxygenated blood

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4
Q

LV

A
  • Pushes blood to aorta to the rest of body
  • oxygenated blood
  • work horse of the heart
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5
Q

Atrioventricular valves

A

between atria and ventricles

  • Tricuspid & mitral
  • S1 created w/ closure
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6
Q

Semiulnar

A
  • Aortic & pulmonic
  • S2 w/ closure
  • in ventricular outflow tracts
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7
Q

Aortic Valve

A
  • Calcified and degenerates
  • Most common to have issues over time
  • 3 leaflet valve
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8
Q

S1

A

softer than S2 at the base; often louder at apex

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9
Q

S2

A

normal splitting of S2 with inspiration; disappears with expiration; may be normal in younger, healthy patients & children

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10
Q

S3

A

gallop; heard just after S2; ”Kentucky” or lub- dub-ta; due to extra fluid striking a compliant left ventricle

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11
Q

S4

A

heard just before S1; “Tennessee” or ta-lub-dub; associated with a thickened ventricle (hypertension) or aortic stenosis

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12
Q

Regurgitation or Insufficiency

A

benign or pathological

-Backward flow

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13
Q

Stenosis

A
  • narrowing or impedence in flow

- Always pathological

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14
Q

Systole

A 
-occurs between S1 & S2; feel with pulse
Innocent & Physiologic murmurs
Aortic stenosis
Mitral Regurgitation
Tricuspid Regurgitation
Pulmonary Stenosis
Hypertrophic Cardiomyopathy
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15
Q

Diastole

A

(always pathological) – occurs after S2 before S1
Mitral Stenosis
Aortic Regurgitation

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16
Q

Common Systolic murmurs: Aortic Stenosis

A
  • Aortic stenosis (most common of aging)
  • Harsh murmur
  • Right, 2nd ICS
  • Crescendo-decrescendo (diamond shaped)
  • Intensity correlates with severity of obstruction
  • Carotid upstroke may be decreased and/or delayed (parvus tardus)
17
Q

Aortic Stenosis

A

Causes:
Aging- Degenerative calcification of aortic cusps
Congenital- Bicuspid Aortic Valve (BAV)
Rheumatic Heart Disease (RHD)

Risk Factors
Elevated LDL & lipoprotein a, DM, smoking, CKD, metabolic syndrome

18
Q

Aortic Stenosis Symptoms

A
  • Usually no symptoms until disease is severe
  • Onset age 60-80s in chronic degenerative AS
  • Onset age 40-50s in BAV
  • Fatigue, DOE most common
  • —Triad: Angina, Heart Failure, exertional Syncope for critical AS
19
Q

Management of AS

A
  • Treat heart failure with diuretics
  • Treat LV dysfunction
  • Cautious use of nitrates and Ace inhibitors in Severe AS
  • Avoid strenuous activity when AS is moderate or greater (esp. weight lifting)
  • Aortic Valve Replacement (SAVR)
  • Transcutaneous Aortic Valve Replacement (TAVR)
20
Q

Common systolic murmurs: Mitral Regurgitation

A
  • Mitral valve leaflets don’t meet, allowing backflow of blood into atrium during systole in LA
  • Holosystolic
  • Apex
  • High-pitched; blowing
  • Intensity is related to pressure gradient across the valve from left atrium to left ventricle
  • May radiate to axilla or into back as gradient worsens
  • Intensity increases with hand grip
  • Happening in systole not as harsh as AS
21
Q

MR

A

Acute Causes

  • Acute Myocardial Infarction (with papillary muscle rupture)
  • Ruptured chordae tendineae
  • Infective Endocarditis
  • Chest trauma

Chronic causes
-RHD; MVP; calcification; congenital; HOCM; dilated CMP

22
Q

MR Symptoms

A

Acute
-pulmonary edema
Chronic
-fatigue, DOE, orthopnea (late symptoms)

23
Q

MR management

A

Treat heart failure with diuretics
Treat LV dysfunction
If Atrial Fibrillation, anticoagulation needed
Follow serial echocardiograms based on progression of disease and symptoms
Timing of surgical repair
MitraClip percutaneous device for severe inoperable MR

24
Q

Mitral Valve Prolapse

A

Heard best at the apex
Systolic “click” murmur
May be followed by high-pitched late systolic crescendo-decrescendo murmur at apex
Most common in women ages 15-30 years old

Causes:
unknown
may be genetic; often associated with Marfan’s Syndrome or other connective tissue disorders

25
Mitral Valve Prolapse: Symptoms
``` Symptoms: Often asymptomatic Palpitations, presyncope/syncope (with associated arrhythmias) Chest pain ``` Classification/Pathophysiology: May progress to Severe Mitral Regurgitation (MR) Most common cause of isolated severe MR requiring surgical intervention in North America
26
MV prolapse management
Treat arrhythmias In Atrial Fibrillation, anticoagulation needed With history TIA/stroke, use Aspirin or Warfarin Follow serial echocardiograms on patients MR or progressive symptoms
27
TR
-Systolic Murmur heard when severe --Primary Tricuspid Regurgitation: RHD Congenital – Ebstein's Anomaly, TV Prolapse Endocarditis Carcinoid tumors Device lead impingement Iatrogenic (RV biopsy) -Secondary Tricuspid Valve Regurgitation: Functional (Sev LV failure, Pulm HTN) 90% cases
28
TR Symptoms
PE findings / Symptoms: -Prominent V waves, DOE, dyspnea at rest with severe HF, liver congestion, early satiety, LE edema, anasarca Classification/Pathophysiology: - Severe TR leads to right heart failure, venous system congestion & decreased CO. - Poor outcomes and high mortality
29
TR Management
Manage Right HF with diuretics Treat LV dysfunction Anticoagulate patients with Atrial Fibrillation Often requires frequent hospitalizations May be surgically repaired in some cases Device lead impingements FORMA percutaneous device
30
Common Systolic murmurs: Hypertrophic Cardiomyopathy
- Harsh, systolic murmur - Through precordium - Worsens with Valsalva - Lessens with standing or squatting - Due to thickened ventricular septum restricting ventricular outflow track - Genetic disease < 200,000 cases/year
31
Common Diastolic murmurs: Aortic Regurgitation
- High pitched - Decrescendo - Left 4th ICS - Intensity related to amount of blood that reflexes back into left ventricle during diastole - Instruct patient to lean forward & hold breath - Intensifies with hand grip
32
AR Symptoms
Symptoms: Fatigue, dyspnea, syncope PE Findings: Increased arterial pulse pressure; “Water hammer” pulse; head bobbing Thrill and heave may be palpable Thrill may radiate into carotids
33
AR Management
Follow with echocardiogram every 3-12 months Treat heart failure Treat LV dysfunction Surgery Consider symptoms, LV function, assessment of end-diastolic and systolic dimensions, response to exercise Patients are not usually symptomatic until LV function deteriorates Operate in asymptomatic patients when severe AR with LV dysfunction < 50% and LV end SD > 55 mm & end DD > 75 mm. Delayed surgical treatment often does not restore LV function
34
Common Diastolic Murmurs: Mitral Stenosis
``` -Low-pitched Rumble -Use Bell of stethoscope applied lightly at apex -Turn patient on left side -May be accompanied by opening snap -Intensifies with light exercise ```
35
Guidelines for anticoagulation
WARFARIN ONLY – NO DOACS Bioprosthetic Valves: Typically for 4-6 weeks post-operatively Mechanical Valves: Dependent upon position Mitral position is most thrombogenic Consider other comorbid conditions
36
Mitral Stenosis classifcation
-Normal valve area 4 - 6 cm2 - Mild - Valve area < 2 cm2 - --causes an increased atrioventricular pressure gradient to maintain CO - --PVP and PAP increase (dyspnea) - Moderate - Valve area 1 - 1.5 cm2 - ---LVEF normal at rest & rises suboptimally with exertion - Severe - Valve area < 1 cm2 - ----LVEF may be suboptimal at rest and fail to rise with exertion
37
Mitral Stenosis Management
Treat heart failure with diuretics Anticoagulate patients with Atrial Fibrillation Balloon Valvotomy or Repair before LVEF can increase with exertion
38
Valve Replacements
Bioprosthetic: Traditionally for patients > 65 yo Technology is improving Mechanical: Traditionally for patients < 65 years old Require life-long anticoagulation with Warfarin (Coumadin) -ABX treatment before dental procedures (SBE prophylaxis)
39
Spontaneous Bacterial Endocarditis (SBE) Prophylaxis: Oral
Amoxicillin Ampicillin or Cefazolin or Ceftriaxone Allergic to penicillin's or ampicillins: Cephalexin or Clindamycin or Azithromycin or clarithromycin

Acute Care Seminar 1 (31 decks)

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