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Cardio Module > Valvular heart disease intro (Felner) > Flashcards

Valvular heart disease intro (Felner) Flashcards

1
Q

For Aortic stenosis name:

  • primary lesion
  • etiology
  • valve morphology:
  • hemodynamic effect
  • severity
  • complications
  • co-existing lesions
  • LV size and function
A
  • aortic stenosis
  • bicuspid valve
  • calcified
  • LVPO
  • moderate-severe
  • heart block
  • aortic regurgitation
  • hypertrophied with normal EF
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2
Q

Name three types of aortic stenosis

A
  1. valvular (MAJORITY)
  2. subvalvular
  3. supravalvular
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3
Q

aortic stenosis produces a _____ murmur

how do you tell whether AS is mild or severe based on murmur?

A
  • systolic; medium-pitch (harsh) with a diamond-shaped
  • early peak is mild
  • late peak is severe
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4
Q

Give the aortic valve etiology at ages:

0-15
30-60
60-90
50-80

A
  • unicuspid
  • bicuspid (AORTOPATHY included.. dilation and aneurysm)
  • tricuspid (degenerative)
  • tricuspid (rheumatic)
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5
Q

What happens to systolic gradient with aortic stenosis

A
  • decrease gradient
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6
Q

What is hemodynamic effect of AS and what is the compensatory response? what is a consequence to this?

A
  • LV pressure overload
  • concentric LVH
  • diastolic dysfunction
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7
Q

What is result of concentric LVH initially? how about later?

A
  • initially, we need this adaptation to keep systolic wall-stress normal, while SV/EDV is normal to low… the CO is maintained at rest, but not exercise

Later though, the hypertrophy causes a decreass then LV compliance leading to diastolic dysfunction

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8
Q

What is Laplace’s law

A
  • PR/(2*wall tension)
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9
Q

what are the 3 classic LV outflow tract obstruction ? apply this to aortic stenosis

A
  1. Angina – subendocardium
  2. effort syncope – fixed orifice
  3. DOE ( dyspnea upon exertion) –> increased pulmonary capillary wedge pressure causing congestive heart failure
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10
Q

physical findings of aortic stenosis

A
  1. smaller carotid pulse; the BP is decreased, which gives a narrow pulse pressure
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11
Q

talk about apical impulse location for aortic stenosis

How is it different?

A
  • normal location and size… you have Left ventricular hypertrophy, but no dilation
  • takes a lot time to get out the blood because of the hypertrophy and diastolic dysfunction.. WE SEE A SUSTAINED IMPULSE with an S4 sound
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12
Q

How do you know you have a bicuspid valve?

A
  • Ejection sound
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13
Q

S4 indicates ______ why?

A
  • diastolic dysfunction; we’re having problems with filling and getting blood into the ventricle, so we have to kick that shit in
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14
Q

recap of ausculatory sounds for aortic stenosis

A
  • systolic murmur

ES

S2A

S4

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15
Q

what is LV-Ao pull back pressure tracing and what does it show in AS

A
  • pull catheter from LV through aorta out… shows the pressure gradient (high systolic at lV, low at aorta) MAKES THE MURMUR
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16
Q

what are the 5 fingers of determinants of clinical severity for AS

A
  1. Carotid pulse – hypokinetic/late peaking
  2. apex impulse (palpable S4, sustained)
  3. Ausculation: URSE, late peaking SEM, decerased S2A
  4. mean gradient >40
  5. valve area <0.9
17
Q

what is common cause of aortic coarctation… what does this do for aortic stenosis

A
  • Turner’s syndrome; 50% of cases is BICUSPID`
18
Q

3 associated abnromalities with aortic stenosis

A
  1. coarctation
  2. mitral annular calcification
  3. asortic dissection
19
Q

What are two forms of aortic regurgitation?

A
  • chronic(common) and acute ( emergency)
20
Q

what are two etiologies of aortic regurg

A
  1. intrinsic valve disease

2. aortic root disease (pulls leaflets apart as part of disease)

21
Q

what are he etiologies of chronic aortic regurg

A

intrinsic valve: bicuspid valve, rheumatic HD, cusp prolapse

aortic root: marfan, aortic aneurysm, aorititis (syphilis)

22
Q

What is etiology of acute AR

A
  • intrinsic: endocarditis and trauma

- aortic root disase: aortic dissection/transection

23
Q

what is pathophysilogy of aortic regurg

A
  • retrograde diastolic flow
  • chronic type causes 90% LV volume overload, but also increases afterload a bit
  • you get a run off lesion in the aorta… pressure decreases because you’re losing fluid (and therefore pressure) back to left ventricle… so by the time you get to distal aorta, you get decreased afterload
24
Q

pulse pressure for AR is _____, while for AS it is ______

A

WIDE

NARROW

25
Q

Give the compensatory mechanisms for AR and its result o ncompliance and sv

A
  • eccentric hypertrophy due to increased LV end diastolic volume, leading to dilation
  • increased LV compliance, resulting in an increased Stroke volume to maintain the CO
26
Q

what is the difference between LVH in AR and AS

A
  • AR: eccentric (plus dilation)

- AS: concentric (no dilation)

27
Q

Name symptoms of aortic regurg

A
  1. chronic vasodilation (warm skin and diaphoresis)

2. high output state (head bobbing and neck pulsations)

28
Q

Systolic blood pressure in AR ______

A

increases

29
Q
  • name two bedside findings of AR.. what is happening with carotid pulse?
A
  • corrigan uplse
  • neck pulsations
  • bifid carotid pulse due to the HIGH OUTPUT STATE
30
Q

what is the apex location of AR… describe the apex impulse

A
  • inferolateral and enlarged due to dilation

- apex impulse is actually normal in how long it lasts

31
Q

what would ejection fraction be potentially in AR

A
  • normal to increased
32
Q

AR is a ______ murmur; characterize it… what other murmur would we potentially hear?

A
  • holodiastolic murmur
  • high pitched (blowing), descrescendo

can potentially see systolic murmur because of the high output state (relative aortic stenosis)

33
Q

Ejection sound indicates _________

A

bicuspid valve instead of tricuspid

34
Q

what is relative aortic stenosis

A
  • basically an “artifact” of aortic regurg; we have problems dealing with high output state, so we see a murmur even though you have a normal valve
35
Q

name signs of severe aortic regurg

A
  1. diastolic murmur + holosystolic murmur
  2. Austen-flint rumble at the apex… we get mitral valve that’s starting to close because of re-filling and increased pressure… but diastole is still occurring, so we hear the rumble as blood comes across some decrease in space

Cardio Module (25 decks)

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