Valvular Heart Disease Clinical and Treatment

Question 1

name three causes of aortic stenosis

Answer 1

congenital
rheumatic fever
calcification/age related changes

Question 2

how does the LV respond to the aortic stenosis?

Answer 2

concentric hypertrophy

Question 3

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

Answer 3

increased pressures in the LV cause the LA to hypertrophy too

Question 4

in aortic stenosis, why is the coronary perfusion lower?

Answer 4

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

Question 5

name 3 common symptoms of aortic stenosis

Answer 5

dyspnea
exertional syncope
angina

Question 6

what type of murmur is associated with aortic stenosis?

Answer 6

crescendo decrescendo systolic

Question 7

where is the aortic stenosis murmur heard best?

Answer 7

at the base of the heart

Question 8

what changes with the carotid pulse with aortic stenosis?

Answer 8

it is weakened and delayed

Question 9

when do you initiate treatment of Aortic stenosis?

Answer 9

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

Question 10

what is the treatment for aortic stenosis?

Answer 10

aortic valve replacement

Question 11

what are the two abnormalities that can cause aortic regurgitation?

Answer 11

abnormalities of the leaflets of the valve

abnormalities of the aortic root

Question 12

what abnormalities of the aortic root can cause aortic regurgitation?

Answer 12

aortic aneurysm/dissection

syphilis

Question 13

name three leaflet changes that can lead to aortic regurgitation

Answer 13

congenital
rheumatic
endocarditis

Question 14

explain how aortic regurgitation leads to widened pulse pressure

Answer 14

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

Question 15

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

Answer 15

widened pulse pressures

Question 16

where is the aortic regurgitation murmur heard best?

Answer 16

at the left 4th intercostal space

Question 17

describe the aortic regurgitation murmur

Answer 17

diastolic decrescendo

Question 18

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

Answer 18

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

this is called the austin flint murmur

Question 19

why do patients experience angina with aortic regurgitation?

Answer 19

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

Question 20

name the two common symptoms of aortic regurgitation

Answer 20

left heart failure and angina

Question 21

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

Answer 21

vasodilators like calcium channel blockers or ACE inhibitors

Question 22

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

Answer 22

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

Question 23

name the two cutoffs for aortic regurgitation treatment

Answer 23

symptoms!

50/50

Question 24

name five cause of mitral stenosis

Answer 24

rheumatic
congenital 
endocarditis
calcification 
tumors

Question 25

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

Answer 25

4-6 sq cm | less than 2 sq cm

Question 26

what does mitral stenosis cause in LV?

Answer 26

less filling, so lower SV and CO

Question 27

how is dyspnea a symptom of mitral stenosis?

Answer 27

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

Question 28

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

Answer 28

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

Question 29

define passive pulmonary hypertension from mitral stenosis

Answer 29

when pressure in pulmonary arteries increases

Question 30

define reactive pulmonary hypertension from mitral stenosis

Answer 30

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

Question 31

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

Answer 31

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

Question 32

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

Answer 32

atrial fibrillation

Question 33

name the six possible symptoms of mitral stenosis

Answer 33

``` dyspnea hemoptysis pulmonary hypertension atrial fibrillation stroke right heart failure ```

Question 34

name four things you can hear with mitral stenosis

Answer 34

loud S1 soft S1 opening snap diastolic rumble

Question 35

why can you hear a loud S1 in mitral stenosis?

Answer 35

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

Question 36

why in late stage mitral stenosis is the S1 soft?

Answer 36

because leaflets are so extremely limited in their movement

Question 37

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

Answer 37

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

Question 38

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

Answer 38

earlier the snap, worse the stenosis is

Question 39

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

Answer 39

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

Question 40

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

Answer 40

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

Question 41

why is balloon valvuloplasty not used in other valve issues?

Answer 41

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

Question 42

what other surgical operation can you do for mitral stenosis?

Answer 42

valve replacement

Question 43

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

Answer 43

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

Question 44

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

Answer 44

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

Question 45

what is the regurgitation fraction?

Answer 45

volume of MR/total LV stroke volume

Question 46

describe the mitral regurgitation murmur

Answer 46

holosystolic plateau

Question 47

what is the common symptom of acute mitral regurgitation

Answer 47

pulmonary edema due to high LA pressure

Question 48

what are the symptoms of chronic mitral regurgitation

Answer 48

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

Question 49

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

Answer 49

huge left atrium

Question 50

what two drugs to give acute mitral regurgitation

Answer 50

vasodilators and diuretics

Question 51

why give diuretics with acute mitral regurgitation

Answer 51

to decrease fluid in pulmonary edema

Question 52

why give vasodilators in acute mitral regurgitation

Answer 52

to decrease SVR and encourage forward flow versus backflow

Question 53

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

Answer 53

intra aortic balloon to decrease afterload and encourage forward flow

Question 54

what are two more invasive surgical options for mitral regurgitation?

Answer 54

mitral valve repair | mitral valve replace

Question 55

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

Answer 55

rheumatic right heart failure

Question 56

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

Answer 56

usually due to enlarged LV large JVP

Question 57

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

Answer 57

congenital or carcinoid syndrome transcatheter balloon valvuloplasty

Question 58

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

Answer 58

congenital or severe pulmonary HTN surgery if severe Right heart failure is symptom