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Nayla Foundations > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What do stenotic lesions lead to

A

pressure overload on upstream

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2
Q

What do regurgitant lesions lead to

A

Volume overload and dilation of chambers

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3
Q

What is Diastolic dysfunction

A

The inability of ventricle to relax/decreased wall compliance limiting filling during early passive diastole. Atria has to contract harder to get blood out

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4
Q

What does diastolic dysfunction lead to

A

Pressure in atria rises and backs up to the lungs- Pulmonary edema
Also- atrial arrhythmias

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5
Q

What are causes of LV diastolic dysfunction

A 
HTN
VH
fibrosis 
Infiltrative CM
Pericardial constriction
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6
Q

What are causes of RV diastolic dysfunction

A

rare
constrictive pericarditis
restrictive cardiomyopathy

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7
Q

What do right murmurs do

A

increase with inspiration

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8
Q

What are left HF symptoms

A 
dyspnea
pulmonary edema
crackles
PE
pallor/cyanosis
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9
Q

What are right HF symptoms

A

JVD
peripheral edema
Hepatomegaly
ascites

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10
Q

How can you grade a murmur

A

I: heard in quiet room by expert
VI: thrill with very loud murmur without steth

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11
Q

What murmurs warrant an echo

A

Systolic > grade II

any diastolic

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12
Q

What is the most common cause of aortic stenosis

A

calcified valve

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13
Q

What is the compensatory response to aortic stenosis

A

LVH, more pressure needed to overcome rigid valve.
Reduced EF
LA hypertrophy

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14
Q

What is the classic triad associated with aortic stenosis

A

Angina
Syncope
Heart failure

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15
Q

What are characteristics of aortic stenosis on exam

A

Delayed carotid upstroke
Sustained, diffuse apical impulse
Systolic murmur at RUSB, crescendo-decrescendo, radiating to neck

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16
Q

How should you treat a patient with severe AS that is not a surgical candidate

A

TAVR or medical therapy to control HF

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17
Q

What diagnostic test is contraindicated in AS

A

exercise stress test

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18
Q

What surgical treatments are available for AS patients

A 
#1: Mechanical or tissue valve replacement 
-Balloon valvuloplasty for peds, or as a bridge for adults (will restenose in 6 mo.)
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19
Q

What are the types of valves

A

Bioprosthetic: shorter lifespan (10-15 years)
Mechanical: lifelong anti-coag (warfarin) needed

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20
Q

What are the biggest issues with a TAVR

A

CVA
Complete heart block
paravalvular leak

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21
Q

What are the causes of aortic regurgitation

A

abnormalities of leaflets/aortic root

chronically progresses slowly over 10 years until LV dysfunction

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22
Q

What is the #1 cause of acute aortic regurgitation

A 
Aortic Dissection
(also endocarditis)
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23
Q

What happens during chronic AR

A
  • Increased LV EDV
  • Increased wall stress causes LVH
  • CO initially increased but decreases as disease progresses and aorta is less compliant
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24
Q

What will you see on PE for chronic AR

A
  • Water hammer pulse
  • Blowing Diastolic Decrescendo Murmur at LUSB
  • Signs of left HF
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25
Q

What can you see on chronic AR CXR

A

Aortic knob, cardiomegaly

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26
Q

Who is a candidate for surgical treatment for chronic AR

A

Symptomatic
ASx but having heart surgery
LV dysfunction
Aortic root dilation >5 cm (less for marfans)

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27
Q

What should nonsurgical candidates with chronic AR do

A

Take vasodilators, CCB, ACE

BB for aortic root enlargement

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28
Q

What is the cause of chronic aortic regurgitation

A

aortic root disease

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29
Q

What is dangerous with acute AR

A

no time to develop compensatory mechanisms; Hemodynamic emergency
Leads to cardiovascular decompensation

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30
Q

What are symptoms of acute aortic regurg

A

weakness, AMS, dyspnea, syncope

**CP=Aortic dissection

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31
Q

How are PE findings for acute aortic regurgitation

A

Hemodynamic compromise

Soft, thready, rapid diastolic murmur

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32
Q

How do you treat acute arctic regurgitation

A

surgical emergency!
Vasodilator and IV inotropes
Aortic dissection: BB

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33
Q

What causes Chronic mitral regurgitation

A

MVP
degeneration
rheumatic fever
dilated cardiomyopathy

34
Q

What happens during chronic mitral regurgitation

A

LV dilation
Decreased preload, decreased afterload
CO consistent during compensation
LV dilates until HF develops

35
Q

What are the symptoms of chronic mitral regurgitation

A

Asymptomatic
Then dyspnea, LHF
Pulmonary HTN and RHF

36
Q

What will you see on chronic mitral regurgitation PE

A

Displaced apical impulse
S3
HF Sx

37
Q

What is the Mitral Regurgitation murmur

A

Holosystolic, apical blowing murmur radiating to axilla

38
Q

What medical treatment is available for MR

A

HF therapy; Diuretics, vasodilators

If with AFib, warfarin

39
Q

What is the cause of acute MR

A

papillary infarct

chordae tendinae rupture

40
Q

What happens during acute mitral regurgitation

A

acute volume overload into LV (high EDV)

causes acute LHF and cariogenic shock

41
Q

What are symptoms of acute MR

A

LHF Sx (pulmonary edema, orthopnea, dyspnea, cariogenic shock)

42
Q

Whats the acute MR murmur

A

Holosystolic apical murmur radiating to axilla or back

43
Q

What is the treatment for acute MR

A

IV Nitro to reduce after load

IABP as a bridge to repair/replace

44
Q

What are causes of mitral valve stenosis

A

mostly rheumatic fever

rarely congenital

45
Q

What happens with mitral valve stenosis

A

stenotic valve decreases preload=decreased CO

LA has increased pressure causing pulmonary HTN=right HF

46
Q

What is the biggest risk in mitral valve stenosis with associated A-Fib

A

High thromboembolic risk

TIA/CVA

47
Q

What are the symptoms of mitral valve stenosis

A

asymptomatic for decades
Dyspnea–>PND, orthopnea
Hemoptysis (bronchial vessel rupture under pressure)
Hoarseness (large LA on recurrent laryngeal)
Endocarditis

48
Q

What will you see on Mitral stenosis PE

A

high JVP
Cyanosis (low CO)
apical diastolic thrill

49
Q

What murmur is heard with mitral valve stenosis

A

Low rumbling mid-diastolic murmur

Heard with bell in LLD position

50
Q

What diagnostic studies would you get with Mitral stenosis

A

Stress echo or L/R cath if symptoms don’t match echo results

TEE to look for thrombi before surgical intervention

51
Q

What is the treatment for mitral valve stenosis

A

diuretics and Na restrict for dyspnea. BB to improve exercise capacity
Anti-Coag with WARFARIN to control AFib

52
Q

What is surgical intervention for Mitral stenosis

A

Percutaneous balloon valvuloplasty if moderate/wanna become preggers/pulm HTN
Open replacement if severe

53
Q

What causes tricuspid stenosis

A 
RARELY isolated- usually with TR, aortic/mitral disease
Due to rheumatic valve disease
carcinoid disease
congenital HD
endocarditis
54
Q

What happens during tricuspid stenosis

A

decreased preload= decreased CO= systemic venous congestion

55
Q

What are symptoms of tricuspid stenosis

A

Fatigue (chronic low CO)

RUQ/abd pain (venous congestion)

56
Q

What will you see on tricuspid stenosis PE

A

RHF Sx

57
Q

What is the tricuspid stenosis murmur

A

Diastolic murmur over LSB (on inspiration)

58
Q

When would a cardiac cath be needed in tricuspid stenosis

A

if concerned for other valve abn. or open repair planned

59
Q

What is surgical intervention for tricuspid stenosis

A

Only repair if repairing others.
Balloon valvuloplasty w/ no other lesions
Open bioprosthesis replacement

60
Q

What are the causes of tricuspid regurgitation

A

Mostly, dilated RV (dilates valve ring)

61
Q

What happens during Tricuspid regurgitation

A

Volume overload in RV= increased systemic venous pressure= RHF

62
Q

What are Tricuspid regurg symptoms

A

Usually asymptomatic

RHF Sx

63
Q

What is the tricuspid regard murmur

A

Pan systolic murmur at 3-4 ICS at LSB, heard on inspiration

64
Q

How would you treat Tricuspid regurgitation

A

Medical therapy for RHF if present. If not, nothing (asymptomatic)

65
Q

When would tricuspid regard require surgery

A

If severe and organic cause, surgical repair

if repairing another valve and has pull HTN

66
Q

What are causes of pulmonic stenosis

A

1- congenital

67
Q

What happens during pulmonic stenosis

A

RVH

68
Q

What are the symptoms of pulmonic stenosis

A

Cyanosis in newborns

RHF/dyspnea in 40’50’s

69
Q

What murmur is heard with pulmonic stenosis

A

Harsh systolic crescendo-decrescendo at 3-4 ICS

70
Q

What is the treatment for pulmonic stenosis

A

balloon valvuloplasty if symptomatic or severe

71
Q

What causes pulmonary regurgitation

A

Pulmonary HTN dilates valve ring

rarely endocarditis

72
Q

What is the pathophysiology of pulmonary regurgitation

A

RV volume overload

73
Q

What are symptoms of pulmonary regurgitation

A

RHF
Dyspnea
septic pulmonary emboli and fever (if caused by IE)

74
Q

What is the Pulmonary Regurg murmur

A

Low pitch diastolic murmur at 3-4 left ICS

75
Q

What is therapy for Pulmonary Regurg

A

treat primary cause

valve replacement or bioprosthetic repair

76
Q

What is tetralogy of fallot

A

Ventricular septal defect
Pulmonic stenosis
Overriding aorta
RVH

77
Q

What are symptoms of tetralogy of fallot

A

Cyanosis
Tet spells while crying/after feeding
poor growth
clubbing

78
Q

What relieves Tetralogy of fallot symptoms

A

Squatting- it increases PVR and decreases RV to LV shunt

79
Q

What is the murmur associated with tetralogy of fallot

A

Harsh systolic murmur due to VSD

80
Q

How do you diagnose Tetralogy

A

Echo

81
Q

What is the treatment for Tetralogy

A

surgical repair w/in 1st year

place shunt if unable to undergo surgery

Nayla Foundations (18 decks)

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