Valvular heart disease Flashcards
In a pressure-volume loop, this segment occurs during ejection
CD
In a pressure-volume loop, this segment occurs during isovolumic contraction
BC
In a pressure-volume loop, this segment occurs during ventricular filling.
AB
This segment occurs during isovolumic relaxation
DA
In a pressure-volume loop, this point represents the aortic valve closing.
D
In a pressure-volume loop, this point represents mitral valve (MV) opening.
A
In a pressure-volume loop, this point represents MV closing.
B
In a pressure-volume loop, this point represents aortic valve opening.
C
Stroke volume through the aortic valve
is the distance between which points?
C & D
End-systolic volume can be measured at the ___ point.
D
End-diastolic volume can be measured at the ___ point.
B
Most common cause of aortic stenosis?
Rheumatic heart disease
AS severity is graded on the basis of a variety of hemodynamic and natural history data using definitions of (3)?
1) Valve area
2) Mean pressure gradient
3) Aortic jet velocity
AS is mild if based on the 3 factors?
1) Valve area
2) Mean pressure gradient
3) Aortic jet velocity
1) Valve area (>1.5 cm2)
2) Mean pressure gradient (<25 mmHg)
3) Aortic jet velocity (<3)
AS is severe if based on the 3 factors?
1) Valve area
2) Mean pressure gradient
3) Aortic jet velocity
1) Valve area (<1 cm2)
2) Mean pressure gradient (>40 mmHg)
3) Aortic jet velocity (>4)
What are the indications for aortic valve replacement in aortic stenosis?
- Symptomatic
- EF < 50%
- Severe AS (CABG)
- Severe AS (Aortic or valvular surgery)
- Moderate AS (aortic or valvular surgery)
Most common cause of aortic insufficiency?
Rheumatic heart disease
What parameters can be used in echocardiography to characterize the severity of aortic insufficiency? (6)
- Color Doppler jet width
- Color Doppler vena contracta
- Regurgitant volume
- Regurgitant fraction
- Regurgitant orifice area
- Left ventricle size
Describe mild aortic insufficiency?
- Color Doppler jet width (<25%)
- Color Doppler vena contracta (<0.3)
- Regurgitant volume (<30)
- Regurgitant fraction (<30)
- Regurgitant orifice area (<0.1)
- Left ventricle size (Normal)
Describe severe aortic insufficiency?
- Color Doppler jet width (>65%)
- Color Doppler vena contracta (>0.6)
- Regurgitant volume (>60)
- Regurgitant fraction (>50)
- Regurgitant orifice area (>0.3)
- Left ventricle size (Increased)
What is the indication for aortic valve replacement in aortic stenosis? (4)
- Symptomatic
- Asymptomatic (EF <50%)
- Asymptomatic (CABG)
- Asymptomatic with EF <50% and severe LV dilatation (EDDimension >75 mm or ESD > 55mm)
Leading cause of mitral stenosis?
Rheumatic heart disease
Critical stenosis of the valve occurs ____ to ___ years after the initial rheumatic disease.
10 to 20
What parameters can be used in echocardiography to characterize the severity of mitral stenosis?
- Mean mitral valve pressure gradient
2, Valve area - Pulmonary artery systolic pressure
Define mild mitral stenosis
- Mean mitral valve pressure gradient (< 5 mmHg)
2, Valve area (>1.5 cm2) - Pulmonary artery systolic pressure (<30 mmHg)
Define severe mitral stenosis
- Mean mitral valve pressure gradient (>10 mmHg)
2, Valve area (<1 cm2) - Pulmonary artery systolic pressure (>50 mmHg)
Atrial contraction contributes about ___ % of the stroke volume
30
The primary causes of this valvular disease include MV prolapse, infective endocarditis, trauma, rheumatic heart disease, drugs (ergotamine, pergolide), and congenital valve cleft.
Mitral regurgitation
The secondary causes of this valvular disease include ischemic heart disease, LV systolic dysfunction, and hypertrophic cardiomyopathy.
Mitral regurgitation
This valvular disease becomes more common with age. This is because of the age-related wear and tear of the valve.
Mitral regurgitation
Study:
Chronic MR:
Left ventricular end-systolic volume is normal; thus the stroke volume is high, but part of the stroke volume escapes through the incompetent valve into the left atrium. Ejection fraction is usually high because of the low resistance against the regurgitation. An ejection fraction of 50% may indicate significant LV dysfunction.
Regurgitant chronic MR flow depends on (3)?
1) Regurgitant orifice size
2) Time available for regurgitant flow (bradycardia)
3) Transvalvular pressure gradient
Acute MR may occur in the setting of (3)
1) Flailed leaflet caused by MV prolapse
2) Infective endocarditis
3) Trauma
Chordae tendineae may rupture spontaneously or from trauma, infective endocarditis, or rheumatic fever. Papillary muscles may rupture because of acute myocardial infarction or trauma.
What parameters can be used in echocardiography to characterize the severity of mitral regurgitation?
- Color Doppler jet area
- Color Doppler jet area
- Color Doppler vena contracta
- Regurgitant volume
- Regurgitant fraction
- Regurgitant orifice area
- Left atrial end ventricular size
Describe mild MR with the following characteristics?
- Color Doppler jet area (<4 cm2)
- Color Doppler jet area (<20%)
- Color Doppler vena contracta (<0.3cm)
- Regurgitant volume (<30 mL)
- Regurgitant fraction (<30 mL)
- Regurgitant orifice area (<0.1)
- Left atrial end ventricular size (Normal)
Describe severe MR with the following characteristics?
- Color Doppler jet area (> 8 cm2)
- Color Doppler jet area (>40%)
- Color Doppler vena contracta (>0.7cm)
- Regurgitant volume (>60 mL)
- Regurgitant fraction (>50 mL)
- Regurgitant orifice area (>0.3)
- Left atrial end ventricular size (Enlarged)
