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Acute Care I > Valvular Heart Disease: Aortic and Mitral > Flashcards

Valvular Heart Disease: Aortic and Mitral Flashcards

1
Q

As stenosis develops:
Resistance to flow ____
Pressure must ____ to maintain flow
If pressure cannot be ____, then flow will ____

A

increase
increase
increased; decrease

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2
Q

Compensatory Mechanisms for Valve Stenosis include?

A

Hypertrophic remodeling
Increased contractility

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3
Q

As regurgitation develops:
Flow of blood will occur towards the area of?
Hemodynamic consequences depend on?

A

least resistance
chamber compliance

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4
Q

Valve Regurgitation Compensatory mechanisms include?

A

Chamber dilation to increase compliance and decrease pressure
Increase total stroke volume in order to maintain forward stroke volume

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5
Q

Consequences of Valve Dysfunction
Chamber remodeling results in?

A

enlargement and hypertrophy

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6
Q

Consequences of Valve Dysfunction
Pressure Overload occurs from which valve dysfunction?
Causes what type of hypertrophy?

A

Pulmonic Stenosis and Aortic Stenosis
Concentric ventricular hypertrophy

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7
Q

Consequences of Valve Dysfunction
Volume overload occurs from which valve dysfunction?
Causes what type of hypertrophy?

A

Tricuspid Regurgitation and Mitral Regurgitation
Eccentric Ventricular Hypertrophy

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8
Q

Consequences of Valve Dysfunction
Cardiac ____
Pulmonary ____
Clinical symptoms of?

A

fibrosis
hypertension
heart failure

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9
Q

Bicuspid Aortic Valve occurs in what % of the population?
These patients are more prone to?
This condition is associated w/?

A

1-2%
endocarditis
aortopathy and coarctation

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10
Q

Aortic Stenosis Symptoms
Heart failure

A

SOB/DOE
D/t diastolic dysfunction from hypertrophied LV there is increased pulmonary venous pressure; eventually leading to systolic dysfunction

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11
Q

Aortic Stenosis Symptoms
Angina

A

Increased LVEDP & Decreased coronary perfusion pressure in setting of LVH leads to subendocardial ischemia,
Concomitant CAD

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12
Q

Aortic Stenosis Symptoms
Occurs due to decreased blood flow to brain?

A

Syncope

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13
Q

Aortic Stenosis PE
Asymmetric BP in young patients could suggest?
Pulsus tardus et parvus means?

A

Coarctation w/ a bicuspid valve
Delayed/weak carotid upstroke

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14
Q

Aotric Stenosis PE
Auscultation:
Systolic murmur where?
Murmur intensity correlates w/?
Gallavardin phenomenon is when?
Soft or absent S2 sounds occurs when?

A

at base radiating to neck
severity
dissociation of the harsh and musical components of murmur
severe

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15
Q

Aortic Stenosis - Diagnostic Testing
Echocardiogram:
Transthoracic shows?
Transesophageal shows?

A

AVA, Pressure gradients, leflet number, LV function, LVH, Pulmonary HTN
Clarify leaflet number, measure aortic dimension

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16
Q

Aortic Stenosis - Diagnostic Testing
EKG shows?

A

LVH
LAE
may develop Afib

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17
Q

Aortic Stenosis - Diagnostic Testing
Lab work to collect?

A

BNP

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18
Q

Aortic Stenosis - Diagnostic Testing
Cardiac Cath shows?

A

evaluate CAD & hemodynamics

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19
Q

Aortic Stenosis Treatment
Indications for surgery

A

Severe AS w/ Symptoms
Severe AS w/ EF < 50%
Severe AS undergoing another cardiac surgery

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20
Q

Aortic Stenosis Treatment
Medical Therapy

A

No medical therapy specifically for AS
Treat concomitant HTN, CAD, Afib

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21
Q

Less invasive option for AVR is?

A

TAVR - Transcatheter Aortic Valve Replacement

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22
Q

Acute AR - Presentation
Hx includes

A

Dissection
Endocarditis
Severe dyspnea
Respiratory distress

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23
Q

Acute AR - Presentation
PE includes

A

Pulmonary Edema
LV heave w/ hyperdynamic precordium
Soft diastolic murmur at left lower sternal border; may not be audible
Physical signs of endocarditis or dissection

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24
Q

Chronic AR - Presentation
Hx includes

A

Symptoms will depend on LV function
DOE, fatigue, HF

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25
Q

Chronic AR - Presentation
PE includes

A

Wide pulse pressure
Diastolic decrescendo murmur heard best at left lower sternal border at end-expiration (severity is inversely proportional to duration)
Systolic murmur due to increased flow

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26
Q

AR diagnostic testing
Echocardiogram
Transthoracic shows?
Transesophageal shows?

A

Severity of AR, leaflet number, LV function, LV chamber dimensions
Clarify leaflet number, measure aortic dimension, dissection, endocarditis

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27
Q

AR diagnostic testing
EKG shows?

28
Q

AR diagnostic testing
CXR shows

A

cardiomegaly
widened mediastinum
pulmonary edema

29
Q

AR diagnostic testing
Lab work to collect

A

BNP
blood cultures

30
Q

AR diagnostic testing
CT or MRI shows

A

assess AR severity, aorta size

31
Q

AR diagnostic testing
Caridac Cath

A

evaluate CAD
aortogram

32
Q

AR treatment
Acute Severe AR requires

A

Emergency Surgery
Attempt medical stabilization w/ afterload reduction

33
Q

AR treatment
Chronic Severe AR requires

A

Surgery for symptoms, LV dilation, LV dysfunction (EF <50%)
Medical Therapy is limited
Treat HTN
Consider vasodilators if inoperable

34
Q

MS - Pulmonary HTN
Increased LA pressure is transmitted where?

A

Pulmonary Vasculature (passive HTN)

35
Q

MS - Pulmonary HTN
Chronically Increased pulmonary venous pressures leads to?

A

remodeling of pulmonary vasculature ( reactive pulmonary HTN, smooth muscle cell proliferation, vasoconstriction)

36
Q

MS - Pulmonary HTN
RV dysfunction occurs due to?

A

pressure overload

37
Q

MS - Pulmonary HTN
Pulmonary Vasculature changes may be?

A

irreversible

38
Q

MS - Symptoms

A

DOE
Chest pain
Embolization event
Hemoptysis
R Heart Failure (edema, hepatomegaly, abdominal fullness)
Symptoms may develop d/t factors that increase the transvalvular gradient

39
Q

MS and Afib
Increased LA size and fibrosis leads to?

A

abnormal electrical activity predisposing to Afib

40
Q

MS and Afib
Deleterious sequelae includes?

A

Tachycardia increases gradient
Decreased LV filling w/ loss of atrial kick
Thrombus formation leads to embolization

41
Q

MS - PE
Soft, low pitched
duration reflects severity?

A

Diastolic rumbler

42
Q

MS - PE
Only audible if valve is pliable
Marker of severity: decreased timing between S2 and OS as Decreased MVA?

A

Opening snap (OS) follows S2

43
Q

MS - PE
P2 is loud in the setting of?
May have systolic murmur from?
May have sings of?

A

pulmonary HTN
MR
R Heart failure

44
Q

MS Diagnostic Testing
Echocardiogram
Transthoracic shows?
Transesophageal shows?

A

Severity of MS and MR, etiology, LA size, Pulmonary HTN, RV function
Clarify etiology, leaflet and subvalvular mobility and calcification, MR severity, LA clot

45
Q

MS Diagnostic Testing
EKG shows?

A

LAE
Afib
R axis deviation

46
Q

MS Diagnostic Testing
CXR shows

A

LAE
Enlarged pulmonary arteries

47
Q

MS Diagnostic Testing
Cardiac Cath shows

A

invasive hemodynamics
evaluation of CAD

48
Q

MS - Treatment
Medical?

A

Antibiotics to prevent recurrent rheumatic fever
Afib: anticoagulation and rate control

49
Q

MS - Treatment
Nonmedical

A

Generally performed for moderate or severe MS w/ concomitant pulmonary HTN and/or symptoms
percutaneous
surgical

50
Q

Percutaneous mitral balloon valvuloplasty
Balloon dilation of the?
Treatment of choice when?
Generally only for?

A

mitral valve
available
rheumatic MS (not calcific)

51
Q

Percutaneous mitral balloon valvuloplasty
Contraindications include?

A

Valve anatomy unfavorable (too immobile, tethered, and/or calcified)
Moderate or severe MR
LA clot

52
Q

MVR is generally for those who?

A

are not candidates for balloon valvuloplasty

53
Q

An abnormality of which components of the mitral valve may cause mitral regurgitation?

A

Leaflets (anterior and posterior); scallops
Annulus
Chordae Tendinae
Papillary muscles (anterolateral, posteromedial)
LV

54
Q

Acute MR
Hx includes

A

Rapid onset of significant SOB, which may cause respiratory failure
Recent infarct (ruptured papillary muscle), ruptured chord, or endocarditis possible precipitants

55
Q

Acute MR PE

A

Tachypneic w/ respiratory distress
Tachycardic
Systolic murmur at the apex (may be absent)
Pulmonary edema
Apical impulse may be hyperdynamic

56
Q

Chronic MR
Hx includes

A

Long asymptomatic period as MR progresses
As compensatory mechanisms fail the patient experiences DOE
SOB w/ less activity, palpitations (afib), CHF sx

57
Q

Chronic MR PE

A

Apical holosystolic murmur at axilla
In MVP, there may be a midsystolic click heard before the murmur
May have irregularly irregular rhythm (afib)
Other signs of HF

58
Q

MR - Diagnostic Testing
Echocardiogram
Transthoracic shows?
Transesophageal shows?
Exercise Echo shows?

A

Severity and mechanism of MR, LV chamber size, LV function, LA size, Pulmonary HTN
Clarify severity and mechanism of MR, 3D imaging
MR severity and pulm HTN

59
Q

MR - Diagnostic Testing
EKG shows

60
Q

MR - Diagnostic Testing
CXR shows

A

LAE
Enlarged pulmonary arteries

61
Q

MR - Diagnostic Testing
Cardiac Cath shows

A

Vetriculogram
evaluates CAD

62
Q

Acute MR Treatment
Surgery is indicated often?
While awaiting surgery, aggressive what?
Although Tachycardic, avoid what?

A

urgently or emergently
afterload reduction w/ medications or balloon pump can diminis MR and promote Forward flow
attempts to slow HR as they are often HR dependent ofr adequate forward CO

63
Q

Chronic MR - Treatment
Surgical

A

Valve repair is preferable to replacement

64
Q

Chronic MR - Treatment
Surgical indications

A

Severe MR w/:
Symptoms
LV dysfunction (EF < 60%)
Dilating LV
Afib or pulm HTN

65
Q

Chronic MR - Treatment
Treatment is aimed at improving what?
Medical treatment for LV dysfunction / CHF includes?

A

the ventricle
ACE-I, Beta Blockers, Aldosterone antagonists

66
Q

Chronic MR - Treatment
Biventricular pacing if?
Revascularization if?
Surgery to repair or replace the valve may be considered, but unclear if this will? Consider?

A

appropriate
indicated
improve QOL and/or survival; percutaneous option

Acute Care I (30 decks)

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