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Spring 2020 - Physiology 1 > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What are the Major Factors that Affect Flow across any Valvular Lesion?

A

Valve Area

Sq Rt of Hydrostatic Pressure Gradient

Duration of Transvalvular Flow

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2
Q

What kind of Valvular Lesions would you want to increase factors that affect flow?

A

Stenotic Lesions, not Regurgitant Lesions

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3
Q

What are the Goals for Regurgitant Lesions?

A

Reduce regurgitant flow across Mitral Or Aortic Valve

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4
Q

What are the Goals for Stenotic Lesions?

A

Maximize flow across Mitral or Aortic valves

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5
Q

Which type of Valvular Lesions can respond to changes in Preload or Afterload?

A

Regurgitant Lesions

(Stenotic lesions are fixed and don’t respond to loading changes)

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6
Q

What are some causes of Aortic Stenosis?

A

Calification - Most Common

Congenital - Biscuspid

Endocarditis

Paget’s Disease

Lupus

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7
Q

What are symptoms of Severe Aortic Stenosis?

A

Angina

Syncope

CHF

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8
Q

What kind of Murmur would Aortic Stenosis produce?

A

Systolic Murmur

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9
Q

What is the Pathophysiology in patients w/ Severe Aortic Stenosis?

A

Aortic Stenois –> Obstructed LV Ejection –> Pressure Gradient across Valve –> Chronic LV Pressure Overload –> LV Hypertrophy

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10
Q

How does Severe Aortic Stenosis cause Cardiac Ischemia?

A

Hypertrophy of LV needs more O2 & Blood

↑Systolic Pressure/Afterload

Ejection Prolongation & Shortened Filling

↓Heart Capillary Density

Accompanying CAD

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11
Q

What is the most important Hemodynamic Goal for treating Severe Aortic Stenosis?

A

Avoid Hypotension

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12
Q

What are some causes of Aortic Regurgitation?

A

Endocarditis
Rheumatic Heart Disease
Congenital - Bicuspid
Aortic Root Dissection
Ascending Aortic Aneurysm
Trauma
Connective Tissue Disorder - Marfan’s
Dexfenfluramine (Appetite Suppressant)
Aortitis (Syphyllis)

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13
Q

What kind of Hypertrophy does Aortic Regurgitation cause?

A

Eccentric Hypertophy - bigger chamber & wall thickness

d/t chronic LV volume overload

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14
Q

What kind of Murmur would Aortic Regurgitation produce?

A

Diastolic Murmur

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15
Q

What factors contribute to Reduced Coronary Perfusion Pressure in pts w/ Aortic Regurgitation?

A

Lower Diastolic Pressure

Increased LVEDP

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16
Q

What are symptoms of Aortic Regurgitation?

A

Angina

CHF

17
Q

What are the Hemodynamic Goals for Aortic Regurgitation?

A

↑Preload

↑HR

Avoid SVR/HTN

18
Q

What are some causes of Mitral Stenosis?

A

Rheumatic Damage - Most Common
(Women 4x > Men)

Congenital

Rheumatoid Arthritis

Lupus

Carcinoid Syndrome

19
Q

What type of Murmur would Mitral Stenosis produce?

A

Diastolic Murmur

20
Q

What are the symptoms of Mitral Stenosis?

A

CHF & A-Fib

21
Q

What is the Pathophysiology for Severe Mitral Stenosis?

A
  • Obstructed LA Emptying –>
    • ↑LA Pressure & Size –> A-Fib
    • ↓LV Filling
    • –>
      • ↑Pulm Venous Pressure –> Pulm. Edema
      • –>
        • ↑PAP –> RV Overload
22
Q

What is the most important Hemodynamic Goal for Severe Mitral Stenosis?

A

Avoid Tachycardia - slow down the HR to allow Ventricular filling

23
Q

What are some causes of Mitral Regurgitation?

A

Damage to Leaflets, Chordae Tendineae, Papillary Muscles
Rheumatic Disease
Mitral Valve Prolapse
Mitral Annular Enlargment
Ischemia
MI
Trauma
Fenfluramine (Diet Suppressants)

24
Q

What type of Murmur would Mitral Regurgitation produce?

A

Systolic Murmur

25
Q

A pt w/ Mitral Regurgitation has a preop LVEF of 35%, how would a Mitral Valve Replacement affect the LVEF?

A

LVEF will decrease

Mitral Regurgitation causes LV to pump a lot of volume back into the LA d/t lower pressure

26
Q

What is the Pathophysiology for Mitral Regurgitation?

A
  • Backworld flow from LV to LA ->
    • ↑LA Volume & Pressure –>
      • Enlarged LA
      • ↑Pulm Venous Pressure –> Pulm Edema
      • ↑LV Filling –> ↑Stroke Volume
27
Q

What are the Hemodynamic Goals for Mitral Regurgitation?

A

Increased HR to decrease LV volume & increase forward flow

Increased Contractility

Decreased Afterload

28
Q

What is Hypertrophic Cardiomyopathy?

A

Genetic Disorder of Cardiac Muscle

Autosomal Dominant

Abnormal Organization of Cardiac Cells & Fibrosis

29
Q

What are the Characteristics of Hypertrophic Cardiomyopathy?

A

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)

30
Q

What should be avoided in pts w/ Hypertrophic Cardiomyopathy?

A

AVOID anything that reduces LV Volume:

Decreased Preload

Increased Contractility

Decreased Afterload

31
Q

What are the Hemodynamic Goals for Hypertrophic Cardiomyopathy?

A

Increased Preload

Decreased HR

Decreased Contractility

Increased Afterload

Spring 2020 - Physiology 1 (24 decks)

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