Valvular Heart Disease

Question 1

What is mitral valve stenosis?

Answer 1

A narrowing of the mitral valve results in an increased volume and pressure in the left atrium, which results in atrial hypertrophy and dilation. This ultimately can increase pressure and volume in the pulmonary circulation and cause pulmonary edema. This will lead to pulmonary HTN and right ventricular failure.

Question 2

What is mitral valve stenosis caused by?

Answer 2

It is caused by rheumatic fever and is more common in women

Question 3

What are the clinical manifestations of mitral valve stenosis?

Answer 3

Atrial enlargement, JVD, a-fib, dysphagia, pulmonary HTN, dyspnea, and hemoptysis.

Question 4

What is mitral valve regurgitation?

Answer 4

Incomplete closure of the mitral valve. As a result, blood in the left ventricle backs up into the left atrium during ventricular systole. Over this time, this will lead to atrial dilation/hypertrophy, increased pulmonary vascular pressure, and pulmonary edema.

Question 5

What is mitral valve regurgitation caused by?

Answer 5

Mitral valve prolapse, ruptured papillary muscle dysfunction, infective endocarditis, and dilated cardiomyopathy.

Question 6

What are the clinical manifestations of mitral valve regurgitation?

Answer 6

Rales and pan systolic murmur with S3 and S4 heart sounds.

Question 7

What is mitral valve prolapse?

Answer 7

A type of mitral valve regurgitation that occurs more commonly in women where they tend to experience a sticking type of chest pain.

Question 8

What is aortic valve stenosis?

Answer 8

The narrowed aortic valve prevents the outflow of the left ventricle. This results in left ventricular hypertrophy, which leads to increased pressure/volume in the left atrium and ultimately causes pulmonary edema and hypertension. Forward flow out of the aorta may decrease which can result in syncope and chest pain.

Question 9

What are the causes of aortic valve stenosis?

Answer 9

1. Aortic valve calcification
2. Congenital bicuspid valve
3. Inflammatory damage from rheumatic heart disease

Question 10

What is a clinical manifestation of aortic valve stenosis?

Answer 10

A crescendo decrescendo systolic heart murmur heartbeat at the second ICS that radiates to the neck.

Question 11

What are causes of aortic valve regurgitation?

Answer 11

Aortic root dilation, ineffective endocarditis, rheumatic fever, aortic dissection, aortitis from syphilis, appetite suppressant medications, trauma, or ankylosing spondylitis.

Question 12

How does aortic valve regurgitation occur?

Answer 12

The incompetent closure of the aorta results in a back flow of blood into the left ventricle

Question 13

What happens in acute aortic valve regurgitation?

Answer 13

LVEDP increases, a decrease in SBP, stroke volume, and cardiac output.

Question 14

What happens in chronic aortic valve regurgitation?

Answer 14

The LVEDP normalizes, left ventricular hypertrophy occurs, SBP is increased and DBP decreases. Ultimately the volume and pressure back up into the left atrium and pulmonary circulation.

Question 15

What is endocarditis?

Answer 15

Infective and inflammatory condition of the endocardium which mainly affects the heart valves.

Question 16

What are risk factors for getting endocarditis?

Answer 16

Prosthetic valves, congenital lesion which causes turbulent blood flow, valvular heart disease, IV drug use, long-term indwelling IV catheters, and a cardiac pacemaker.

Question 17

What is the pathogenesis of endocarditis?

Answer 17

1. infection causes damage to endothelium which leads to turbulent blood flow that causes damage to the heart valves.
2. The damage exposes the endothelial basement membrane which attracts platelets to form a thrombus and triggers the inflammatory process.
3. A bacteria or other organism enters the blood stream, adheres to the endothelium, and infiltrates the thrombus. This activates the clotting cascade which accelerates fibrin formation to form the vegetation which is associated with endocarditis.
4. The vegetation may break off and form an embolus and cause the formation of an abscess and is responsible for characteristic skin changes associated with endocarditis.

Question 18

What are clinical manifestations of endocarditis?

Answer 18

Skin changes that include petechiae, splinter hemorrhages on the nail beds, and Janeway lesions which are nonpainful hemorrhagic lesions on the palms and soles. Other signs include cardiac murmur, sepsis, Osler nodes (painful, red nodules on the fingers and toes), back pain, night sweats, and arterial emboli which impair circulation to organs.