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Cardiology Week 5 > Valvular Heart Disease Clinical and Treatment > Flashcards

Valvular Heart Disease Clinical and Treatment Flashcards

1
Q

name three causes of aortic stenosis

A

congenital
rheumatic fever
calcification/age related changes

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2
Q

how does the LV respond to the aortic stenosis?

A

concentric hypertrophy

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3
Q

in aortic stenosis, the LV hypertrophies and leads to what else hypertrophy? how?

A

increased pressures in the LV cause the LA to hypertrophy too

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4
Q

in aortic stenosis, why is the coronary perfusion lower?

A

with the hypertrophied LV…there is higher diastolic pressure and so there is less coronary perfusion

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5
Q

name 3 common symptoms of aortic stenosis

A

dyspnea
exertional syncope
angina

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6
Q

what type of murmur is associated with aortic stenosis?

A

crescendo decrescendo systolic

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7
Q

where is the aortic stenosis murmur heard best?

A

at the base of the heart

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8
Q

what changes with the carotid pulse with aortic stenosis?

A

it is weakened and delayed

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9
Q

when do you initiate treatment of Aortic stenosis?

A

as soon as patients become symptomatic or when there is progressive LV dysfunction

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10
Q

what is the treatment for aortic stenosis?

A

aortic valve replacement

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11
Q

what are the two abnormalities that can cause aortic regurgitation?

A

abnormalities of the leaflets of the valve

abnormalities of the aortic root

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12
Q

what abnormalities of the aortic root can cause aortic regurgitation?

A

aortic aneurysm/dissection

syphilis

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13
Q

name three leaflet changes that can lead to aortic regurgitation

A

congenital
rheumatic
endocarditis

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14
Q

explain how aortic regurgitation leads to widened pulse pressure

A

the aortic backflow causes increased pressure on LV, so dilate and eccentric hypertrophy…there is a decrease in pressure in aorta during diastole and an increase when the LV contracts and tries to force out more blood than normal with each beat…so you have lower diastolic and higher systolic

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15
Q

what is a very notable finding in physical exam for aortic valve regurgitation

A

widened pulse pressures

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16
Q

where is the aortic regurgitation murmur heard best?

A

at the left 4th intercostal space

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17
Q

describe the aortic regurgitation murmur

A

diastolic decrescendo

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18
Q

if you hear a second diastolic murmur with aortic regurgitation, what is the cause of it and what is its name?

A

backflow causes the mitral leaflets to vibrate…can make an extra sound

this is called the austin flint murmur

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19
Q

why do patients experience angina with aortic regurgitation?

A

the diastolic aortic pressure is dropping and that means the coronary perfusion is less and the heart is getting bigger so have greater demand and less supply..so angina

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20
Q

name the two common symptoms of aortic regurgitation

A

left heart failure and angina

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21
Q

what drugs can you give for Aortic regurgitation if no symptoms?

A

vasodilators like calcium channel blockers or ACE inhibitors

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22
Q

what is the 50/50 rule in aortic regurgitation treatment?

A

replace the valve when LV EF is under 50% or LV end diastolic volume is 50 mm…even without symptoms

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23
Q

name the two cutoffs for aortic regurgitation treatment

A

symptoms!

50/50

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24
Q

name five cause of mitral stenosis

A 
rheumatic
congenital 
endocarditis
calcification 
tumors
25
Q

how wide is open mitral valve normally? and how wide when have stenosis?

A

4-6 sq cm

less than 2 sq cm

26
Q

what does mitral stenosis cause in LV?

A

less filling, so lower SV and CO

27
Q

how is dyspnea a symptom of mitral stenosis?

A

the left atrium has high pressure from excess blood due to the stenosis and is therefore forced back down into the pulmonary area…

28
Q

what is another common symptom in mitral stenosis, besides dyspnea?

A

hemoptysis…same reason as dyspnea except pressure so high you actually get bronchial veins rupturing

29
Q

define passive pulmonary hypertension from mitral stenosis

A

when pressure in pulmonary arteries increases

30
Q

define reactive pulmonary hypertension from mitral stenosis

A

when pressure so great the tunica media hypertrophy and tunica intima has fibrosis that counteracts the new higher pressures

31
Q

what can mitral stenosis cause with the right side of the heart? how?

A

right heart failure…high pressure of pulmonary system transmitted back through the atrium and ventricle of the right heart

32
Q

name a common finding that originates in the LA from mitral stenosis?

A

atrial fibrillation

33
Q

name the six possible symptoms of mitral stenosis

A 
dyspnea
hemoptysis
pulmonary hypertension
atrial fibrillation
stroke
right heart failure
34
Q

name four things you can hear with mitral stenosis

A

loud S1
soft S1
opening snap
diastolic rumble

35
Q

why can you hear a loud S1 in mitral stenosis?

A

because mitral leaflets are still wide open at the start of systole…so they bang closed

36
Q

why in late stage mitral stenosis is the S1 soft?

A

because leaflets are so extremely limited in their movement

37
Q

why do you hear an opening snap in mitral stenosis? when does the opening snap occur?

A

there is so much pressure in the LA when the LA pressure finally exceeds the LV pressure it causes it to snap open…making a click

just after S2

38
Q

if you have a really early snap, what does that mean about the mitral stenosis?

A

earlier the snap, worse the stenosis is

39
Q

what drugs might be given to aid in treatment of mitral stenosis? what symptoms are these each for?

A

diuretics for increased fluid and vascular congestion
ca blockers or beta blockers for a fib risk
anticoags for thrombosis risk

40
Q

what is the most common surgical treatment for Mitral stenosis, and why is this effective?

A

percutaneous balloon valvuloplasty for rheumatic mitral stenosis because this leads to breaking of the cusp fusion

41
Q

why is balloon valvuloplasty not used in other valve issues?

A

because they do not have the cusp fusion like you have in rheumatic mitral stenosis

42
Q

what other surgical operation can you do for mitral stenosis?

A

valve replacement

43
Q

what is the usual cause of primary mitral regurg compared to secondary?

A

primary is from degeneration of the valve and secondary is from left heart failure

44
Q

how does the heart account for the blood lost to mitral regurgitation to maintain SV?

A

the frank starling mechanism as the lV pressure increases and more stretch/preload occur

45
Q

what is the regurgitation fraction?

A

volume of MR/total LV stroke volume

46
Q

describe the mitral regurgitation murmur

A

holosystolic plateau

47
Q

what is the common symptom of acute mitral regurgitation

A

pulmonary edema due to high LA pressure

48
Q

what are the symptoms of chronic mitral regurgitation

A

fatigue and weakness due to low CO
LV systolic failure…Left heart failure
Right heart failure

49
Q

what can you see on an X-ray in mitral regurgitation?

A

huge left atrium

50
Q

what two drugs to give acute mitral regurgitation

A

vasodilators and diuretics

51
Q

why give diuretics with acute mitral regurgitation

A

to decrease fluid in pulmonary edema

52
Q

why give vasodilators in acute mitral regurgitation

A

to decrease SVR and encourage forward flow versus backflow

53
Q

what is a less invasive surgical option for mitral regurgitation? why does it work?

A

intra aortic balloon to decrease afterload and encourage forward flow

54
Q

what are two more invasive surgical options for mitral regurgitation?

A

mitral valve repair

mitral valve replace

55
Q

what is a cause of tricuspid valve stenosis and what is the main symptom?

A

rheumatic

right heart failure

56
Q

what is a cause of tricuspid valve regurgitation and what is the main symptom?

A

usually due to enlarged LV

large JVP

57
Q

what is the most common cause of pulmonic valve stenosis and what is the treatment?

A

congenital or carcinoid syndrome

transcatheter balloon valvuloplasty

58
Q

what is cause, treatment and and symptom of pulmonic valve regurgitation?

A

congenital or severe pulmonary HTN

surgery if severe

Right heart failure is symptom

Cardiology Week 5 (10 decks)

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