Valvular heart disease Flashcards

1
Q

What are the four heart sounds?

A

S1
S2
S3
S4

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2
Q

What is the S1 heart sound?

A

closure of the mitral and tricuspid valve “lub”

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3
Q

What is the S2 heart sound?

A

closure of the aortic and pulmonic valve “dub”

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4
Q

What is the S3 heart sound?

A

suggests congestive heart failure

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5
Q

What is the S4 heart sound?

A

suggests poor ventricular compliance

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6
Q

Where should you listen for the aortic valve sounds?

A

right of sternal border at 2nd ICS

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7
Q

Where should you listen for the pulmonic valve sounds?

A

left of sternal border at 2nd ICS

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8
Q

Where should you listen for the mitral valve sounds?

A

left midclavicular line at 5th ICS

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9
Q

Where should you listen for the tricuspid valve sounds?

A

left of sternal border at 4th ICS

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10
Q

Which valvular diseases are associated with eccentric hypertrophy? (select 2)
a. mitral stenosis
b. mitral regurgitation
c. aortic stenosis
d. aortic regurgitation

A

b. mitral regurgitation
d. aortic regurgitation

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11
Q

The ____________________________ open to let blood flow from the atria to the ventricles

A

atrioventricular valves (mitral and tricuspid)

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12
Q

The ___________ open to let blood flow from the ventricles to the aorta and pulmonary artery respectively

A

semilunar valves (aortic and pulmonary)

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13
Q

Valvular stenosis is a ____________ to forward flow during systole

A

fixed obstruction

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14
Q

Stenosis results in

A

pressure overload–> concentric hypertrophy

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15
Q

Concentric hypertrophy means that the

A

sarcomeres are added in parallel

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16
Q

Valvular regurgitation occurs when the

A

valve is incompetent

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17
Q

Flow re-enters the chamber through the incompetent valve during

A

diastole

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18
Q

Regurgitation results in

A

volume overload–> eccentric hypertrophy

19
Q

Eccentric hypertrophy means that the

A

sarcomeres are added in series

20
Q

Which valves have chordae tendineae?

A

atrioventricular valves (mitral & tricuspid)

21
Q

Following aortic valve replacement for aortic stenosis, the left ventricular end-systolic volume will be:
a. increased due to afterload reduction
b. increased due to decreased transvalvular gradient
c. decreased due to a reduction in impedance to ventricular ejection
d. unchanged

A

c. decreased due to a reduction in impedance to ventricular ejection

22
Q

The smaller the aortic valve orifice, the more

A

pressure the ventricle must produce to eject its stroke volume

23
Q

Normal aortic valve orifice size is

A

2.5-2.5 cm2

24
Q

Severe aortic stenosis is

25
Etiologies of aortic stenosis include
a bicuspid aortic valve (most common) rheumatic fever infective endocarditis
26
Compensatory mechanisms for aortic stenosis include
increased thickness of the LV wall decreased compliance smaller chamber radius
27
The classic presentation of aortic stenosis includes
syncope angina dyspnea
28
___________ should be avoided in the patient with severe aortic stenosis due to risk of CV collapse
spinal anesthesia
29
In the patient with severe aortic stenosis, chest compressions during CPR are often
ineffective due to the high transvalvular pressure gradient required
30
The arterial waveform of aortic stenosis may show
pulsus tardus and pulsus parvus
31
Anesthetic goals for aortic stenosis for HR, heart rhythm, preload, afterload, contractility, and PVR.
Full, slow, constricted heart rate--> avoid tachycardia heart rhythm--> NSR (maintain atrial kick) preload--> increase afterload--> maintain or increase contractility--> maintain pulmonary vascular resistance--> normal
32
A mean transvalvular pressure gradient (LV to aorta) of ________________- is also diagnostic for severe AS
>40 mmHg
33
______________ occurs in up to 90% of patients with severe aortic stenosis.
Acquired von Willebrand disease--> b/c the von Willebrand molecule is damaged when it passes through the stenotic valve
34
What should be given if LV dysfunction occurs in the aortic stenosis patient?
inotropes to maintain contractility
35
Aortic insufficiency leads to
volume overload & eccentric hypertrophy
36
Aortic insufficiency can be an ______________ or ___________ problem
acute or chronic
37
The arterial waveform of aortic insufficiency shows
an increased pulse pressure with bisferiens pulse (biphasic peaks)
38
Before initiating cardiopulmonary bypass in the patient with aortic regurgitation,
cardioplegia must be injected retrograde (through the coronary sinus) or directly into each coronary ostia
39
Anesthetic goals for aortic insufficiency for heart rate, heart rhythm, preload, afterload, contractility, and pulmonary vascular resistance are:
full, fast, and forward heart rate--> elevate heart rhythm--> NSR preload--> maintain or increased afterload--> decrease contractility--> maintain pulmonary vascular resistance--> maintain
40
Acute aortic insufficiency leads to
rapid CV instability left ventricular failure can result from acute dilation leading to increased wall tension and impaired contractility
41
Acute AI is usually caused by
endocarditis can also result from aortic root dissection from aneurysm or trauma
42
Conditions associated with chronic AI include
valvular calcification Marfan syndrome Ehler-Danlos syndrome ankylosing spondylitis
43
Etiologies of aortic regurgitation include
incompetent valve or dilation of the aortic root or its supporting structures
44
Conditions that increase the regurgitant volume include:
1. bradycardia (longer diastolic filling time) 2. increased SVR (increased aorta-LV pressure gradient) 3. large valve orifice (larger area for the blood to return through)