Valvular Heart Disease Lecture Powerpoint Flashcards
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Imaging study of choice for most valvular diseases
-Echocardiogram
Primary symptom of most valvular diseases regardless of whether its insufficiency or stenosis, mitral or aortic
Dyspnea
Left vs right cusps and corresponding coronary artery
Left cusp is over the left atrium and guards the left main coronary artery
Right cusp is over the right ventricle and guards the right coronary artery
Most common structural anatomic congenital disease in patients
VSD
Most common valvular anatomical congenital disease in patients
Bicuspid aortic valve
Bicuspid aortic valves are associated with these conditions (3)
- cystic medial degeneration (tunica media degenerates and forms aneurysm)
- aneurysmal dilation of ascending aorta
- subvalvular and supravalvular aortic stenosis (rare)
Rating of stenotic valves (4)
Mild, moderate, severe, or critical
3 symptoms of aortic stenosis
-syncope
-angina (coronary steal syndrome, blood not coming back during diastole)
-dyspnea
(SAD)
Most common cause of acquired aortic stenosis
Senile degenerative calcification (most common with age)
Dobutamine stress testing and pseudo AS
When undergoing testing with dobutamine does not see increase in gradient difference, indicating failure of muscle rather than valve problem
Unless symptomatic, ____ is not recommended for treatment of AS because…
heart surgery
…if asymptomatic, no increase in life expectancy by doing so
Acquired Aortic Stenosis prognosis and treatment (3)
-good until symptoms develop (then 3 year mortality is 50%)
-Treatment is artificial valve replacement (bioprosthetic or mechanical) or TAVR
or balloon valvuloplasty in extreme cases
Acquired aortic insufficiency causes (3)
- senile degenerative calcification
- systemic hypertension
- idiopathic annuloaorticectasia (no known cause)
Acquired aortic insufficiency symptoms (3)
- dyspnea on exertion
- orthopnea
- CHF
Aortic insufficiency can sequallae into…
….LV dilation from diastolic overload
Mussett’s sign
Slight head bobbing rare but occasionally seen in end stage valvular diseases
Acquired aortic insufficiency prognosis and treatment (3)
- poor with progression of signs and symptoms or CHF
- Vasodilator therapy, afterload reduction with diuretics, or AVR surgery
Aortic insufficiency is not a pressure dysfunction, but rather a…
….volume overload
Chordae tendinae
attached to papillary muscles in the left ventricle and the mitral valve that pull the valve open and let it shut during ventricular filling and emptying
Myxomatous mitral valve disease
Inherited mitral valve prolapse
Mitral valve stenosis etiologies (2)
- rheumatic carditis
- degenerative calcification
Anything that causes increased pressure in the left atrium can result in…
…atrial fib
Mitral valve stenosis symptoms
- palpitations
- dyspnea on exertion
Classic triad of signs for mitral stenosis
- right bundle branch block
- right axis deviation
- biatrial enlargement
Mitral valve stenosis treatment of choice
balloon valvuloplasty
1st vs 2nd acquired mitral regurgitation
primary - problem with valve itself
secondary - due to a separate cardiomyopathy
Mitral valve regurgitation symptoms (3)
- dyspnea upon exertion
- fatigue
- CHF
Mitral regurgitation physical exam findings (3)
- holosystolic murmur (heard everywhere)
- S1 and S2 obliterated
- PMI laterally displaced
Acquired mitral regurgitation prognosis and treatment (3)
- prognosis is VERY poor when signs develop
- afterload reduction pharmacological drugs, surgical repair of mitral valve or replacement
Golden moment for mitral valve regurgitation
Determines if it is time to undergo surgery if 2/5 criteria are met
Aortic valve disease ___, mitral valve disease ___ because ____
replace, repair, chordae tendinae preservation
Epstein anomaly
Congenital defect where tricuspid valve is displaced apically otward bottom of right ventricle so right atrial becomes significantly larger, often associated with ASD
Primary acquired defects in tricuspid valve disease
- infective endocarditis
- rheumatic
- trauma
2ndary acquired defects in tricuspid valve disease
- primary right ventricle disease
- left to right shunt (eisenmenger - irreversible)
Tricuspid regurgitation physical findings(3)
- ascites
- JVD
- peripheral cyanosis
Tricuspid treatment
- Surgical
- TVR only if not possible
Tetralogy of Fallot
-VSD that overrides the aorta resulting in pulmonary valve narrowing and thickening of the right ventricle**
Right sided endocarditis most often involves the ____ valve, very rarely the ___ valve
Tricuspid, pulmonic
Greater the pressure gradient between ventricle and aorta correlates ____ to the level of stenosis of the aortic valve
directly
Normal S1 but diminished S2 indicates….
Aortic stenosis, the valve is not slamming shut as it should during diastole
Aortic sclerosis murmur
Creates a systolic murmur due to valve hardening and not opening completely
Aortic insufficiency murmur
Creates a diastolic murmur due to backflow of blood
Aortic insufficiency first line of treatment
-ACE or ARB
Rheumatic fever most often affects this valve
Mitral
2 out of 5 of these indications require surgical intervention for mitral regurgitation (Golden moment)
- LV output <55%
- Ventricular dilation at end systole
- Pulmonary hypertension
- Afib
- symptomatic
