Valvular Heart Disease Flashcards by Sarah King

pressure overload and volume overload cause ___

hemodynamic burden

How well did you know this?

Not at all

Perfectly

long term consequences of hemodynamic burden

muscle dysfunction
myocardial cell hypertrophy
CHF
sudden death

How well did you know this?

Not at all

Perfectly

left sided valvular lesions

aortic stenosis
mitral stenosis
non-ischemic mitral regurgitation
aortic insufficiency

How well did you know this?

Not at all

Perfectly

aortic stenosis etiology

acquired >65 yrs

idiopathic disease: degeneration and calcification of trileaflet valve
active inflammatory process- linked to increased LDL, HTN, Diabetes

congenital: 4th and 5th decade
- bicuspid aortic valve
- also can unicuspid or quadricuspid

How well did you know this?

Not at all

Perfectly

most frequent severe valvular disease of the western countries

aortic stenosis

How well did you know this?

Not at all

Perfectly

I aortic stenosis, pressure overload of the left ventricle causes ___ and results in muscular dysfunction, high end diastolic pressure.

hypertrophy

How well did you know this?

Not at all

Perfectly

3 cardinal symptoms of aortic stenosis

Angina
Syncope
CHF

How well did you know this?

Not at all

Perfectly

why is there angina in aortic stenosis?

reduced coronary reverse flow, increased myocardial oxygen demand

How well did you know this?

Not at all

Perfectly

why do you have syncope with aortic stenosis?

when a patient with AS tries to exercise, they can not increase their cardiac output so their blood pressure drops and cardiac output drops to dry and maintain blood pressure. if you can not raise your cardiac output then your blood pressure drops and you have a syncope episode

How well did you know this?

Not at all

Perfectly

on the physical exam for aortic stenosis, what will you find?

systolic ejection murmur radiating to neck
pulses parvus tardus
S2 may be single or paradoxically split

How well did you know this?

Not at all

Perfectly

what is pulses parvus trades?

small, delayed carotid pulse

How well did you know this?

Not at all

Perfectly

what is used for Diagnosis of Aortic stenosis

echo
cardiac cath
coronary angiography

How well did you know this?

Not at all

Perfectly

aortic stenosis characteristics in females

thicker LV wall which reduces wall stress
increased ejection fraction
requires higher volume to maintain cardiac ouput= more sensitive to diuretics

How well did you know this?

Not at all

Perfectly

what is aortic stenosis?

obstruction of left ventricular outflow of blood across the aortic valve

How well did you know this?

Not at all

Perfectly

in aortic stenosis, what might you find on an echo

small aortic orifice during systole
LVH
Thickened/calcified aortic valve

How well did you know this?

Not at all

Perfectly

in aortic stenosis what might you find on the EKG

LVH

How well did you know this?

Not at all

Perfectly

whats the only curative treatment for AS

valve replacement

How well did you know this?

Not at all

Perfectly

aortic regurgitation etiology

leaflet abnormality- endocarditis, RH fever
aortic root dilation- annuloaortic ectasia associated with aging, HTN, bicuspid valve, marina’s dissection, collagen vascular disease, and syphillis

How well did you know this?

Not at all

Perfectly

in chronic aortic regurgitation, there is left ventricular volume overload which results in ___

eccentric hypertrophy, hyper dynamic LVEF

How well did you know this?

Not at all

Perfectly

left ventricular volume overload
increased stroke volume, systemic HTN
increased pulse pressure
diastolic blowing murmur
Austin flint murmur

chronic aortic regurgitation

How well did you know this?

Not at all

Perfectly

when do symptoms in aortic regurgitation typically occur?

when LV dysfunction occurs

How well did you know this?

Not at all

Perfectly

aortic regurgitation Peripheral Signs

¥ QUINCKE’S PULSES
¥ CORRIGAN’S PULSE (Bounding full carotid with rapid down stroke)
¥ MUSSET’S SIGN (head bobbing)
¥ HILL’S SIGN (Systolic pressure in leg >30mm Hg higher than in arm)

How well did you know this?

Not at all

Perfectly

diagnostic studies used fir aortic regurgitation

ECHO, MRI

How well did you know this?

Not at all

Perfectly

when should surgery be done on a patient with aortic regurgitation

when they are symptomatic
when they are asymptomatic- rule of 55
- before LVEF is less than 55%
- BEFORE LVESD >55mm

How well did you know this?

Not at all

Perfectly

medical therapy for aortic regurgitation

after load reduction with vasodilators (nifedipine)

in aortic regurgitation, there is Incomplete aortic valve closure during diastole --> _______--> LV volume overload--> LV dilation--> CHF

regurgitation of blood to LV

most common cause of mitral stenosis

rheumatic heart disease

first symptoms of mitral stenosis in pregnancy

a-fib | HF in second trimester= think rheumatic heart disease

left heart failure symptoms in mitral stenosis

DOE Orthopnea hemoptysis hoarseness edema

will their be neck vein distension in someone with mitral stenosis?

yes

what is used to diagnose mitral stenosis

echo can use EKG and chest x-ray as well

therapy for mitral stenosis in a pt with mild symptoms

diuretics

therapy for pt with mitral stenosis that has a fib

digoxin, BB, diltiazem | anticoagulant therapy

therapy for pt with mitral stenosis that has moderate symptoms, pulmonary hypertension

mechanical relief of obstruction | balloon valvuloplasty

treatment of choice for mitral stenosis

balloon valvuloplasty

patients with mitral stenosis who ate not candidates for balloon valvuloplasty

heavy calcification subvalvular distortion more than mild MR

some characteristics of mitral regurgitation

S1 soft holosystolic murmur S3 LF lift

Hemodynamic of mitral regurgitation

¥ Volume overload of LV ¥ Hyperdynamic LV systolic function Normal EF= >60%

medical therapy for mitral regurgitation

vasodilators to stop pressure and decrease resistance

in mitral regurgitation, is surgical repair of the valve or surgical replacement of the valve preferred?

surgical repair

what might you see on an echo on a pt with mitral regurgitation

hyperdynamic LV

____ is the obstruction of outflow of blood from the right ventricle to the pulmonary artery

Pulmonic stenosis

More than 90% of pulmonic stenoses are ______- can be associated with Carcinoid Syndrome or Tetralogy of Fallot. Valvular pulmonic stenosis is a benign disease, which only rarely progresses

congenital

symptoms in pt with Mild pulmonic stenosis:

Asymptomatic

symptoms in pt with Moderate to severe pulmonic stenosis:

Fatigability, Dyspnea on exertion, Chest pain

symptoms in pt with Severe pulmonic stenosis in the neonate:

Poor feeding, Tachypnea, Cyanosis

Principal finding on examination of pulmonary stenosis

SEM- ejection systolic murmur, loudest at the left upper sternum and radiating towards the left shoulder

Severe _____ is characterised by a loud harsh murmur, an inaudible pulmonary closure sound (P 2 ), an increased right ventricular heave, prominent a waves in the jugular pulse,

pulmonary stenosis

EKG findings on pt with pumonary stenosis

ECG evidence of right ventricular hypertrophy

chest x ray findings on pt with pumonary stenosis

post-stenotic dilatation in the pulmonary artery on the chest X-ray.

in pulmonary stenosis, _______is the definitive investigation.

Doppler echocardiography

Severe pulmonary stenosis (resting gradient > 50 mmHg with a normal cardiac output) is treated by ______ or, if this is not available, by surgical valvotomy

percutaneous pulmonary balloon valvuloplasty

This is rare in isolation and is usually associated with pulmonary artery dilatation due to pulmonary hypertension.

Pulmonary Regurgitation

Pulmonary Regurgitation may complicate mitral stenosis, producing an early diastolic decrescendo murmur at the left sternal edge that is difficult to distinguish from _____ (Graham Steell murmur).

aortic regurgitation

Tricuspid stenosis is usually ____ in origin and is rare in developed countries.

rheumatic

_____ disease occurs in fewer than 5% of patients with rheumatic heart disease and then nearly always in association with mitral and aortic valve disease.

Tricuspid

Tricuspid stenosis and regurgitation are features of the ____syndrome.

carcinoid

tricuspid stenosis symptoms

Although the symptoms of mitral and aortic valve disease predominate, tricuspid stenosis may cause symptoms of right heart failure, including hepatic discomfort and peripheral edema.

tricuspid stenosis main clinical features

The main clinical feature is a raised JVP. There is also a mid-diastolic murmur, best heard at the lower left or right sternal edge.

tricuspid stenosis treatment

: In patients who require surgery to other valves, either the tricuspid valve is replaced or valvotomy is performed at surgery. Balloon valvuloplasty can be used to treat rare cases of isolated tricuspid stenosis.

Tricuspid regurgitation is common, and is most frequently ‘functional’ as a result of right _____. Refers to an abnormal retrograde flow of blood from the right ventricle to the right atrium

ventricular dilatation

Tricuspid Regurgitation | causes

Primary: Rheumatic heart disease, Endocarditis (particularly in injection drug-users), Ebstein's congenital anomaly Secondary : Right ventricular dilatation due to chronic left heart failure (‘functional tricuspid regurgitation’), Right ventricular infarction, Pulmonary hypertension (e.g. cor pulmonale)

Tricuspid Regurgitation symptoms

usually non-specific, with tiredness related to reduced forward flow, and edema and hepatic enlargement due to venous congestion caused by accompanying right-sided heart failure (e.g., jugular venous distention, peripheral edema, parasternal lift, ascites, right-sided S 3 ).

Tricuspid Regurgitation signs

The most prominent sign is a jugular venous pulse. Other features include a pansystolic murmur at the left sternal edge and a pulsatile liver.

echo findings in tricuspid regurgitation

Echocardiography may reveal dilatation of the RV. If the valve has been affected by rheumatic disease, the leaflets will appear thickened and, in endocarditis, vegetations may be seen.

_____ is a congenital abnormality in which the tricuspid valve is displaced towards the right ventricular apex, with consequent enlargement of the RA. It is commonly associated with tricuspid regurgitation.

Ebstein's anomaly

tricuspid regurgitation treatment

Tricuspid regurgitation due to right ventricular dilatation often improves when the cause of right ventricular overload is corrected, with diuretic and vasodilator treatment of congestive cardiac failure.