Valvular Heart Disease Flashcards
discuss mitral stenosis
MC cause id RF
hallmark:
- BF from LA to LV only if inc pressure gradient
- LA pushes harder
- atrial muscle go to HF since thinner
normal mitral valve
4-6 cm2
significant MS
< 2 cm2
severe MS
<1 cm2
LA pressure of ~25 mmHg to fill LV
discuss rheumatic MS
fishmouth valve - thickened by fibrous tissue or calcific deposits
chordae tendinae fuse and shorten
inc risk for thrombus and embolus d/t:
- calcific valve
- pooling of blood
- irreg heartbeat
can have atrial fibrillations
MS clinical manifestations
sx develop p 2 decades
most begin disability in 4th decade
death in 2-5 yrs p onset
dyspnea and cough d/t
- sudden change in HR, volume status and CO
progress to - ADLs diff, orthopnea and PND
severe MS ssx
atrial fib
hemaptysis
emboli
pulmo infection
infective endocarditis
MS management
follow up and close monitoring
valvotomy
commisurotomy
mitral valve replacement
mechanical valve
for moderate or severe mitral stenosis
risk of the valves gathering infective endocarditis and blood clots
biprosthetic valves
pig and cow - much safer than mech
no need for anticoagulant
last 10 yrs only - replace p
discuss mitral regurg
prob in one or more of the 5:
- leaflets
- annulus
- chordae tendinae
- papillary muscle
- subjacent myocardium
acute mitral regurg
from:
- AMI c papillary muscle rupture
- blunt trauma chest wall
- infective endocarditis
AMI - MC posteromedial pappilary muscle
occurs transiently c bouts of ischemia or angina pectoris
can cause “acute on chronic MR”
chronic mitral regurg
severe and progressive - vicious cycle
enlarge LA - more tension on post mitral leaflet
LV dilation - chordal rupture
= more regurg
MR clinical manifestation
chronic mild-to-moderate isolated MR- asymptomatic
palpitation - signify onset og AF
severe: fatigue, exertional dyspnea, orthopnea
R sided HF and acute pulmonary edema
mitral valve prolapse
usually common and mild
excess mitral leaflet tissue - post leaflet more affected
inc acid mucopolysaccharide
type 3 collagen disorders - marfan, osteogenesis imperfecta, ether-danlos
assoc c high arched palate and straight back syndrome
MVP clinical features
15-30 yo females
benign or asymptomatic
usually:
- palpitations and chest pain
worse:
- light-headed and syncope
- sudden death is rare
- TIA
- infective endocarditis
discuss aortic stenosis
males
symptomatic - 6 to 8th decade
caused:
- degen calcification
- congenital - bicuspid AV
- rheumatic inflammation
inc velocity of 2.5 m/s from LV to aorta
AS pathophysio
obstructs LV outflow
LVH and dilation
dec SV and CO
elevated LV and end diastolic pressure
HF
inc MVO2
ischemia
AS symptoms
3 cardinal sx:
- exertional dyspnea
- angina pectoris on exertion
- syncope
SCD - 10 to 20%
sx appear if less than 1 cm - severe
progress by 0.1 cm / yr
discuss death in AS
death common 7-8th decade
angina pectoris: p 3 yrs
syncope: p 3 yrs
dyspnea: p 2 yrs
CHF: 1.5-2 yrs
primary valve disease - AR
rheumatic, males
thickening, deformity and shortening of AV cusps
- congenital bicuspid
- infection
- trauma
primary aortic root disease - AR
marked aortic dilatation without involvement of the valve leaflets
acute AR
from infective endocarditis, aortic dissection, trauma
LV cannot dilate
LV dias pressure rises
pulmonary edema and/or cardiogenic shock
chronic AR
long latent period - 10 to 15 yrs
palpitation on lying down - early
exertional dyspnea to orthopnea and PND
anginal chest pain
systemic fluid accumulation
corrigan pulse
malaka pulse tas bigla baba sa diastole kasi dii malalabas mag regurg
quinke pulse
tapat light on nail bed mag blink
capillary pulsations
traube sign
pistol shot sound over auscultation of femoral arteries
duroziez sign
to and fro murmur if femoral artery compressed c steth
normall diff of SBP and DBP
normal 40 mmHG
widened: AR
discuss tricuspid stenosis
less prevalent
more in females and rheumatic origin
lagi kasama MS
pathophysio of TS
RA pressure higher than RV
systemic venous congestion
CO depressed and fails to rise
TS ssx
pulmonary congestion d/t MS
little dyspnea
fatigue secondary to low CO
R sided HF
atrial fibrillation
discuss tricuspid regurg
usually functional
dilation to tricuspid annulus
reversible if pulmonary HTN is relieved
discuss pulmonic valve disease
from carcinoid syndrome
rare from RF or infective endocarditis
discuss pulmonic regurg
can cause severe pulmonary HTN
discuss pulmonic stenosis
mostly congenital
carcinoid heart disease if acquired
exertional dyspnea
chest pain
fatigue
cyanosis
right sided HF
