Valvular Heart Disease Flashcards
What are the Major Factors that Affect Flow across any Valvular Lesion?
Valve Area
Sq Rt of Hydrostatic Pressure Gradient
Duration of Transvalvular Flow
What kind of Valvular Lesions would you want to increase factors that affect flow?
Stenotic Lesions, not Regurgitant Lesions
What are the Goals for Regurgitant Lesions?
Reduce regurgitant flow across Mitral Or Aortic Valve
What are the Goals for Stenotic Lesions?
Maximize flow across Mitral or Aortic valves
Which type of Valvular Lesions can respond to changes in Preload or Afterload?
Regurgitant Lesions
(Stenotic lesions are fixed and don’t respond to loading changes)
What are some causes of Aortic Stenosis?
Calification - Most Common
Congenital - Biscuspid
Endocarditis
Paget’s Disease
Lupus
What are symptoms of Severe Aortic Stenosis?
Angina
Syncope
CHF
What kind of Murmur would Aortic Stenosis produce?
Systolic Murmur
What is the Pathophysiology in patients w/ Severe Aortic Stenosis?
Aortic Stenois –> Obstructed LV Ejection –> Pressure Gradient across Valve –> Chronic LV Pressure Overload –> LV Hypertrophy
How does Severe Aortic Stenosis cause Cardiac Ischemia?
Hypertrophy of LV needs more O2 & Blood
↑Systolic Pressure/Afterload
Ejection Prolongation & Shortened Filling
↓Heart Capillary Density
Accompanying CAD
What is the most important Hemodynamic Goal for treating Severe Aortic Stenosis?
Avoid Hypotension
What are some causes of Aortic Regurgitation?
Endocarditis
Rheumatic Heart Disease
Congenital - Bicuspid
Aortic Root Dissection
Ascending Aortic Aneurysm
Trauma
Connective Tissue Disorder - Marfan’s
Dexfenfluramine (Appetite Suppressant)
Aortitis (Syphyllis)
What kind of Hypertrophy does Aortic Regurgitation cause?
Eccentric Hypertophy - bigger chamber & wall thickness
d/t chronic LV volume overload
What kind of Murmur would Aortic Regurgitation produce?
Diastolic Murmur
What factors contribute to Reduced Coronary Perfusion Pressure in pts w/ Aortic Regurgitation?
Lower Diastolic Pressure
Increased LVEDP
What are symptoms of Aortic Regurgitation?
Angina
CHF
What are the Hemodynamic Goals for Aortic Regurgitation?
↑Preload
↑HR
Avoid SVR/HTN
What are some causes of Mitral Stenosis?
Rheumatic Damage - Most Common
(Women 4x > Men)
Congenital
Rheumatoid Arthritis
Lupus
Carcinoid Syndrome
What type of Murmur would Mitral Stenosis produce?
Diastolic Murmur
What are the symptoms of Mitral Stenosis?
CHF & A-Fib
What is the Pathophysiology for Severe Mitral Stenosis?
- Obstructed LA Emptying –>
- ↑LA Pressure & Size –> A-Fib
- ↓LV Filling
- –>
- ↑Pulm Venous Pressure –> Pulm. Edema
- –>
- ↑PAP –> RV Overload
What is the most important Hemodynamic Goal for Severe Mitral Stenosis?
Avoid Tachycardia - slow down the HR to allow Ventricular filling
What are some causes of Mitral Regurgitation?
Damage to Leaflets, Chordae Tendineae, Papillary Muscles
Rheumatic Disease
Mitral Valve Prolapse
Mitral Annular Enlargment
Ischemia
MI
Trauma
Fenfluramine (Diet Suppressants)
What type of Murmur would Mitral Regurgitation produce?
Systolic Murmur
A pt w/ Mitral Regurgitation has a preop LVEF of 35%, how would a Mitral Valve Replacement affect the LVEF?
LVEF will decrease
Mitral Regurgitation causes LV to pump a lot of volume back into the LA d/t lower pressure
What is the Pathophysiology for Mitral Regurgitation?
- Backworld flow from LV to LA ->
- ↑LA Volume & Pressure –>
- Enlarged LA
- ↑Pulm Venous Pressure –> Pulm Edema
- ↑LV Filling –> ↑Stroke Volume
- ↑LA Volume & Pressure –>
What are the Hemodynamic Goals for Mitral Regurgitation?
Increased HR to decrease LV volume & increase forward flow
Increased Contractility
Decreased Afterload
What is Hypertrophic Cardiomyopathy?
Genetic Disorder of Cardiac Muscle
Autosomal Dominant
Abnormal Organization of Cardiac Cells & Fibrosis
What are the Characteristics of Hypertrophic Cardiomyopathy?
Left Ventricular Hypertrophy - Asymmetric in Septum
↓Diastolic Compliance - Stiff
Ventricular Arrythmias
Left Ventricular Outflow Tract Obstruction
SAM - Systolic Anterior Motion of Mitral Valve
(Mitral Valves moves towards septum & worsens LVOT obstruction)
What should be avoided in pts w/ Hypertrophic Cardiomyopathy?
AVOID anything that reduces LV Volume:
Decreased Preload
Increased Contractility
Decreased Afterload
What are the Hemodynamic Goals for Hypertrophic Cardiomyopathy?
Increased Preload
Decreased HR
Decreased Contractility
Increased Afterload
