Valvular Heart Disease Flashcards
What are the 2 AV valves?
- Tricuspid Valve
- - Mitral valve
How many leaflets does tricuspid valve have and where are they attached?
- 3 leaflets
- - Papillary attachments on septum and moderator bands
How many leaflets does mitral valve have and where are they attached?
- 2 leaflets
- - Smoother attachments and not attached to septum
What are the 2 determinants of coronary perfusion?
- -Supply
- -Demand
What determines of supply?
CPP
HR
PaO2
Coronary artery diameter
What determines demand ?
Myocardial O2 consumption HR LV wall tension Contractility Conduction Relaxation
What is the venous drainage of the heart?
Coronary sinus
Where is the coronary sinus located?
Just above the Tricuspid valve
What is known as the pressure gradient that drives coronary blood pressure
Coronary perfusion pressure (CPP)
CPP =
Aortic diastolic - LVEDP
CPP is altered by what?
Decrease in aortic pressure
Increase in LVEDP
Increase in HR
What is the average adults coronary blood flow at rest?
250 mL
During what phase does isovolumetric contraction occur?
Systole
What must occur for ejection to take place?
When pressure in LV has been achieved and overcomes SVR to open Aortic valve thus pushing blood forward
The gradient across what valve is the difference of pressure between LV and systolic BP?
Aortic valve
Aortic stenosis will do what to the gradient across the valve during ejection?
Increase the gradient
What murmur is heard when the mitral valve closes?
S1
What is happening when you hear S2?
Closing of the aortic valve
What are 2 types of systolic murmurs?
Crescendo
Holosystolic
What is considered a holosystolic murmur?
Occurs between S1 and S2
Heard with same intensity throughout (resembles a rectangle)
What is considered to be a crescendo systolic murmur?
Very harsh murmur
Occurs between S1 and S2
Gets louder with intensity then tapers off (resembles a diamond)
What murmurs are considered to be crescendo?
Aortic stenosis
What murmurs are considered to be holosystolic?
Mitral regurg
VSD
What is known to have a “blowing” kind of sound?
Mitral regurg
Which systolic murmur is different than all the rest and when does it occur?
Mitral stenosis
Combination of crescendo and holosystolic murmurs
Occurs after S2
What murmurs are late murmurs and usually attributed to MR because of aortic insufficiencies?
Diastolic murmurs (aortic regurg)
How much blood flow does atrial kick aid in ventricular filling in healthy young patients?
15-25%
How much atrial kick is provided in unhealthy elderly patients?
Up to 50%
What are contributing factors to valvular heart disease ?
Disease Generation Connective tissue disorders Rheumatic fever / disease Ischemic tissue
In general what causes aortic stenosis ?
Pressure overload
In general what causes mitral regurg?
Volume overload
Again CPP =
Pressure in aorta - cavatory pressure
What is an average LVEDP?
10-20 mmHg
What is an average CVP?
2-8 mmHg
What is an average PAP?
15-25 mmHg
What are some classic presentations of AS?
Angina even with good coronaries
CHF
Syncope
Transmission of sounds to carotids
What are signs of MR?
Heart failure- can be compensated or decompensated
What is the worst murmur / valve dysfunction to have?
Mitral stenosis
What are management techniques for MR?
Increase HR
Increase contractility
Decrease afterload
Maintain preload
What are management techniques for AS?
Decrease HR for myocardial perfusion
Maintain afterload
Increase preload
What are management techniques for AR?
Shorten diastole
Increase HR
Decrease afterload
Think inotropic agents
If placing an epidural / spinal, what can you expect to change cardiovascular?
Increase HR
Decrease afterload
