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Cardio > Valvular Heart Disease 2 > Flashcards

Valvular Heart Disease 2 Flashcards

1
Q

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?
A 
-Three etiologies: 
calcific degeneration (most common)
-bicuspid aortic in 65
congenital-if pt is <30
rheumatic heart disease
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2
Q

Physiologically what is happening in aortic stenosis

A

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

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3
Q

5 basic diagnostic tools for valvular disease?

A
  • PEx
  • CXR
  • EKG
  • Echocardiogram
  • cardiac cath
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4
Q

Aortic Stenosis

  • physical exam findings?
  • where can you hear the abnl, where does it radiate?
  • What kind of murmur?
  • pulse abnormalities?
  • any split abnormalities?
A
  • 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
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5
Q

CXR findings of aortic stenosis

A
  • slight LVH
  • post stenotic dilation
  • calcification of aortic valve.
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6
Q

EKG findings of aortic stenosis
Echo findings
Cath findings

A
  • 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
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7
Q

Criteria for severe stenosis? (4)

A

Jet velocity >4
mean gradient >40
valve area <0.6

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8
Q

Aortic stenosis. When should you intervene?

-Options for intervention?

A

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

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9
Q

Class I requirements for aortic stenosis indicating the need to replace AV.

A
  1. Severe AS
  2. Severe AS pt undergoing CABG
  3. Severe AS pt undergoing other valvular surgery
  4. severe AS pt with significant L ventricular dysfunction
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10
Q

Aortic regurgitation

-2 general causes; 7 specific causes

A
  1. leaflet problems
    - congenital problems
    - endocarditis
    - rheumatic heart disease
  2. arotic root problems
    - aneurysm
    - dissection
    - annuloaortic ectasia
    - syphilis
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11
Q

Pathophysiology of aortic regurgitation

-what is the main problem?

A
  • aortic valve is incompetent.

- results in volume overload of the L ventricle

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12
Q

acute aortic regurg

  • size and compliance of LV?
  • diastolic pressure?
  • What is a serious complication?
A

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

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13
Q

Chronic aortic regurgitation

  • what happens to L ventricle size and compliance?
  • What happens to L atrium and pulmonary vasculature?
A

chronically the LV will dilate and compliance will increase

L atrium and pulmonary vasculature will have LESS pressure because of compensatory actions of LV

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14
Q

aortic regurgitation

-sx presentation (4)

A
  • 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

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15
Q

Aortic regurgitation

-Physical signs (4)

A
  • 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
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16
Q 
Aortic regurgitation 
CXR findings (acute vs. chronic)
A

LVH in chronic

pulmonary congestion in acute

17
Q

Aortic regurgitation

-treatment (acute vs. chronic)

A

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

18
Q

Mitral regurgitation

-2 general causes; 7 specific causes

A

Organic (primary)

  • myxomatous disease
  • rheumatic valve disease
  • endocarditis
  • congenital

Functional (Secondary)
-Ischemic CM
-Dilated CM
Hypertrophic CM

19
Q

Patient general tolerance of mitral regurgitation

A

Volume overlaod of the heart

-pt usually tolerate it well until late periods with severe LV functional impairement

20
Q

What is more important in mitral regurgitation? Rate or change or degree of change?

A

rate of change, because it doesn’t allow the heart to compensate

21
Q

Acute Mitral regurgitation
-heart size/compliance?
-Pressure in heart?
what do you see upon catheterization

A
  • 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
22
Q

Chronic Mitral regurgitation

  • size of heart?
  • Pressures of heart?
  • Cardiac output
  • What kind o heart sounds?
A
  • 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
23
Q

Common symptoms of mitral regurgitation (1)

A

Exertional symptoms are common, but there are often no symptoms although heart is worsening.

24
Q

Mitral regurgitation

management is based on

A
  • presence of symptoms

- loss of L ventricular systolic function

25
Q

In mitral regurgitation

Is repair or replacement more desirable?

A

repair is better because of the complex nature of mitral valve.

26
Q

management of acute mitral regurgitation

A
  1. Stablize patient with diuretics, vasodilators… consider emergent surgery
27
Q

management of chronic mitral regurgitation

A

If asymptomatic–continue to monitor
If asymptomatic with severe mitral regurgitation–>repair or replace
If severe L ventricular dysfunction–>NOT GOOD. too late. Game over.

28
Q

papillary muscle anatomy f the mitral valve

  • what are the names of the papillary m
  • where do they attach
  • what arteries supply them?
A
  • anterolateral-supplies the anterior-lateral edge of both valves
  • posteromedial-supplies the posterior-medial edge of both valves
  • They attach via chordae
  • R coronary artery alone supplies the posteromedial papillary m
  • The anterolateral receives branches form both the LCA and RCA
29
Q

Mitral Stenosis
most common cause
Other causes?

A 
Rheumatic heart disease is most common
-others
congenital
calficication of mitral annulus
endocarditis with large vegetation mass
30
Q

Mitral valve Stenosis

normal vs pathologic valve area?

A

nl 3-4 cm2

pathologic <2 cm2

31
Q

Mitral Stenosis leads to what changes in the heart overtime?

A

mitra stenosis causes pressure to rise in the LA and Pulmonary vasculature–leading to R ventricular hypertrophy. Eventually could result in R heart failure

32
Q

Symptoms of mitral stenosis

A
  • Dyspnea and reduced exercise capacity
  • mild mitral stenosis: symptom only with increased heart rate
  • severe mitral stenosis: SOB at rest with possible failure sx such as orthopnea/paroxysmal nocurnal dyspnea
  • Signs of R side heart failure: jugular venous distention, hepatomegaly, ascites, edema, hoarseness, hemoptysis
33
Q

Mitral Stenosis
PEx findings (early and late mitral stenosis)
Echo findings
Cath findings

A

opening snap murmur (early mitral stenosis)
opening snap murmur with RV lift (late mitral stenosis)

-echo: mean gradient >10, mitral valve area 10, mitral valve area <1

34
Q

criteria for severe mitral stenosis

A

MV area 10 mmHg

35
Q

treatment of mitral stenosis
3 considerations for treatment
when to consider surgical treatment?

A

If vascular congestion: give diruretics
If afib: give beta blockers, calc chan blockers (verapamil, diltiazem), digoxin
Also give anticoag if afib is present
If there’s significant pulmonary HTN, you need surgical intervention to do 1. balloon valvuloplasty 2. valve replacement

36
Q

What can exacerbate mitral stenosis?

A

anything increasing HR… including pregnancy

Cardio (6 decks)

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