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AP Summer > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What are the 2 AV valves?

A
    • Tricuspid Valve

- - Mitral valve

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2
Q

How many leaflets does tricuspid valve have and where are they attached?

A
    • 3 leaflets

- - Papillary attachments on septum and moderator bands

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3
Q

How many leaflets does mitral valve have and where are they attached?

A
    • 2 leaflets

- - Smoother attachments and not attached to septum

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4
Q

What are the 2 determinants of coronary perfusion?

A
  • -Supply

- -Demand

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5
Q

What determines of supply?

A

CPP
HR
PaO2
Coronary artery diameter

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6
Q

What determines demand ?

A 
Myocardial O2 consumption
HR
LV wall tension
Contractility
Conduction
Relaxation
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7
Q

What is the venous drainage of the heart?

A

Coronary sinus

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8
Q

Where is the coronary sinus located?

A

Just above the Tricuspid valve

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9
Q

What is known as the pressure gradient that drives coronary blood pressure

A

Coronary perfusion pressure (CPP)

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10
Q

CPP =

A

Aortic diastolic - LVEDP

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11
Q

CPP is altered by what?

A

Decrease in aortic pressure
Increase in LVEDP
Increase in HR

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12
Q

What is the average adults coronary blood flow at rest?

A

250 mL

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13
Q

During what phase does isovolumetric contraction occur?

A

Systole

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14
Q

What must occur for ejection to take place?

A

When pressure in LV has been achieved and overcomes SVR to open Aortic valve thus pushing blood forward

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15
Q

The gradient across what valve is the difference of pressure between LV and systolic BP?

A

Aortic valve

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16
Q

Aortic stenosis will do what to the gradient across the valve during ejection?

A

Increase the gradient

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17
Q

What murmur is heard when the mitral valve closes?

A

S1

18
Q

What is happening when you hear S2?

A

Closing of the aortic valve

19
Q

What are 2 types of systolic murmurs?

A

Crescendo

Holosystolic

20
Q

What is considered a holosystolic murmur?

A

Occurs between S1 and S2

Heard with same intensity throughout (resembles a rectangle)

21
Q

What is considered to be a crescendo systolic murmur?

A

Very harsh murmur
Occurs between S1 and S2
Gets louder with intensity then tapers off (resembles a diamond)

22
Q

What murmurs are considered to be crescendo?

A

Aortic stenosis

23
Q

What murmurs are considered to be holosystolic?

A

Mitral regurg

VSD

24
Q

What is known to have a “blowing” kind of sound?

A

Mitral regurg

25
Q

Which systolic murmur is different than all the rest and when does it occur?

A

Mitral stenosis
Combination of crescendo and holosystolic murmurs
Occurs after S2

26
Q

What murmurs are late murmurs and usually attributed to MR because of aortic insufficiencies?

A

Diastolic murmurs (aortic regurg)

27
Q

How much blood flow does atrial kick aid in ventricular filling in healthy young patients?

A

15-25%

28
Q

How much atrial kick is provided in unhealthy elderly patients?

A

Up to 50%

29
Q

What are contributing factors to valvular heart disease ?

A 
Disease
Generation
Connective tissue disorders
Rheumatic fever / disease
Ischemic tissue
30
Q

In general what causes aortic stenosis ?

A

Pressure overload

31
Q

In general what causes mitral regurg?

A

Volume overload

32
Q

Again CPP =

A

Pressure in aorta - cavatory pressure

33
Q

What is an average LVEDP?

A

10-20 mmHg

34
Q

What is an average CVP?

A

2-8 mmHg

35
Q

What is an average PAP?

A

15-25 mmHg

36
Q

What are some classic presentations of AS?

A

Angina even with good coronaries
CHF
Syncope
Transmission of sounds to carotids

37
Q

What are signs of MR?

A

Heart failure- can be compensated or decompensated

38
Q

What is the worst murmur / valve dysfunction to have?

A

Mitral stenosis

39
Q

What are management techniques for MR?

A

Increase HR
Increase contractility
Decrease afterload
Maintain preload

40
Q

What are management techniques for AS?

A

Decrease HR for myocardial perfusion
Maintain afterload
Increase preload

41
Q

What are management techniques for AR?

A

Shorten diastole
Increase HR
Decrease afterload
Think inotropic agents

42
Q

If placing an epidural / spinal, what can you expect to change cardiovascular?

A

Increase HR

Decrease afterload

AP Summer (24 decks)

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