Valvular Heart Disease 2 Flashcards
aortic stenosis
- what is the most common etiology?
- which valves are most affected in pts 65?
- What is likely etiology if pt is <30?
- What is another common cause of aortic stenosis?
-Three etiologies: calcific degeneration (most common) -bicuspid aortic in 65 congenital-if pt is <30 rheumatic heart disease
Physiologically what is happening in aortic stenosis
aortic valve is much narrower, and blood cannot pass through as well… leading to a huge increase in LV systolic pressure (200s) and much less aortic pressure
5 basic diagnostic tools for valvular disease?
- PEx
- CXR
- EKG
- Echocardiogram
- cardiac cath
Aortic Stenosis
- physical exam findings?
- where can you hear the abnl, where does it radiate?
- What kind of murmur?
- pulse abnormalities?
- any split abnormalities?
- systained LV impulse; little LV displacement
- Pulsus Parvus et Tardus (AKA weak carotid pulses)
- absent A2 or paradoxical A2 split
- murmur is systolic with crescendo and decresendo
- heart at base of heart (R upper sternal border) and radiates to carotid
CXR findings of aortic stenosis
- slight LVH
- post stenotic dilation
- calcification of aortic valve.
EKG findings of aortic stenosis
Echo findings
Cath findings
- due to LVH, the leads pointing to LV will be much more in amplitude
- Thickened LV
- increased LV pressure as compared to the aortic pressure
Criteria for severe stenosis? (4)
Jet velocity >4
mean gradient >40
valve area <0.6
Aortic stenosis. When should you intervene?
-Options for intervention?
When pt has sx.
w/o intervention a pt with angina will survive 5 years, syncope 3 years, and CHF 2 years
-surgical replacement; percutaneous replacement
Class I requirements for aortic stenosis indicating the need to replace AV.
- Severe AS
- Severe AS pt undergoing CABG
- Severe AS pt undergoing other valvular surgery
- severe AS pt with significant L ventricular dysfunction
Aortic regurgitation
-2 general causes; 7 specific causes
- leaflet problems
- congenital problems
- endocarditis
- rheumatic heart disease - arotic root problems
- aneurysm
- dissection
- annuloaortic ectasia
- syphilis
Pathophysiology of aortic regurgitation
-what is the main problem?
- aortic valve is incompetent.
- results in volume overload of the L ventricle
acute aortic regurg
- size and compliance of LV?
- diastolic pressure?
- What is a serious complication?
aortic regurgitation is AN EMERGENCY
The size of the LV is normal and compliance is low
-Diastolic pressure increases quickly
-this could cause pulmonary edema and congestion
Chronic aortic regurgitation
- what happens to L ventricle size and compliance?
- What happens to L atrium and pulmonary vasculature?
chronically the LV will dilate and compliance will increase
L atrium and pulmonary vasculature will have LESS pressure because of compensatory actions of LV
aortic regurgitation
-sx presentation (4)
- dyspnea on exertion
- fatigue
- decreased exercise tolerance
- CP
-without surgery pt with angina will die in 4 years; pt with heart failure will die in 2
Aortic regurgitation
-Physical signs (4)
- Hyperdynamic pulses, head bobbing (Corrigan’s pulse in carotid) , water hammer pulse, “quincke’s pulse”, Duroziez murmur
- Widened pulse pressure =diastolic is less than 1/3 of systolic
- decrescendo diastolic murmur that is worsened with increased systemic pressure.
- Austin Flint murmur-diastolic rumble
Aortic regurgitation CXR findings (acute vs. chronic)
LVH in chronic
pulmonary congestion in acute
Aortic regurgitation
-treatment (acute vs. chronic)
acute: Surgical emergency
Chronic:
-if asymptomatic and nl LVEF (>50%): periodic f/u with echo; use calcium chan blockers or ACE inhibitors if pt is HTN
-If asymptomatic and low LVEF (<50%): valve replacement
-If symptomatic with nl LVEF: valve replacement
Mitral regurgitation
-2 general causes; 7 specific causes
Organic (primary)
- myxomatous disease
- rheumatic valve disease
- endocarditis
- congenital
Functional (Secondary)
-Ischemic CM
-Dilated CM
Hypertrophic CM
Patient general tolerance of mitral regurgitation
Volume overlaod of the heart
-pt usually tolerate it well until late periods with severe LV functional impairement
What is more important in mitral regurgitation? Rate or change or degree of change?
rate of change, because it doesn’t allow the heart to compensate
Acute Mitral regurgitation
-heart size/compliance?
-Pressure in heart?
what do you see upon catheterization
- ACUTE MITRAL REGURG IS AN EMERGENCY!!!
- size and compliance all normal
- pressure in LA is very high with possible pulmonary congestion/edema
- Prominent V waves are seen upon catheterization
Chronic Mitral regurgitation
- size of heart?
- Pressures of heart?
- Cardiac output
- What kind o heart sounds?
- Left Atrium is dilated with increased compliance. L ventricle increases as Cardiac output decreases.
- the pressure in L atrium and pulmonary circulation no longer acutely inceased.
- This eventually leads to severe L ventricular hypertrophy and ventricular dysfunction.
- HS: holosystolic murmur at apex of heart
Common symptoms of mitral regurgitation (1)
Exertional symptoms are common, but there are often no symptoms although heart is worsening.
Mitral regurgitation
management is based on
- presence of symptoms
- loss of L ventricular systolic function
