Valvular Heart Diseases Flashcards
Tx of MVP
Valve replacement
Physical exam signs of pulmonary HTN related to MS and what does this mean in terms of severity?
1) RV heave: Can feel RV as it beats bc it is wrking hard against pulmonary HTN
2) Loud P2: Pulmonic pressure is so high that it closes pulmonic valve with more force.
Both these means that MS is severe.
What is an Austin flint murmur? When is it seen and how is it casued?
Seen in aortic regurgitation. Presents as a low frequency mid diastolic rumble. Due to retrograde force of aortic regurgitation blood that hits the mitral valve and causes a murmur.
How is MR related to the Frank-Starling curve in compensated vs. decompensated phase?
Compensated: due to increased volume in both LA and LV, they both dilate, going up the starling curve and optimizing tension. As a result, stroke volume increases.
Decompensated: After awhile, the volume increases too much for the LA and LV and it overdilates, falling off the starling curve, as the optimal length is surpassed. As a result, this results in a decrease in strove volume and ultimately heart failure.

Mitral regurg
What are rare causes of mitral stenosis?
infective endocarditis with large vegetations that obstruct valve orifice, calcification of mitral annulus that extends onto leaflets
When is S4 heard and what condition does this indicate?
S4 is heard in late diastole, coninciding with contractino of aorta. This is generated when atria are ejecting blood into a stiffened ventricle, seen in decrease in ventricular compliance (stiffness) due to hypertrophy. Most commonly seen in aortic stenosis.
What does this picture represent

MR
LA and LV changes in AS
LV undergoes concentric hypertrophy due to pressure overload and decreased compliance.
LA also hypertrophies to fill noncompliant LV.
What are complications of MVP?
Severe mitral regurgitation, infectious endocarditis, arrhythmias.

Aortic regurg
What type of factors bring on dyspnea of early/mild phase of mitral stenosis and why?
In mild MS, dyspnea may be absent at rest. However, factors that decrease diastolic filling time/ increase HR (e.g. exercise, emotional stress, infection/fever, anemia, hyperthyroidism, Afib) can bring on dyspnea. This is because with faster HR, diastolic filling time decreases and LA cannot push blood fast enough to the ventricle due to the stenosis. As a result, blood gets backed up causing pulmonary congestion and dyspnea.
“Morphology” of presystolic/ late diastolic murmurs and examples that cause this
Flow occurs after S2, just before S1 during period of ventricular filling that follows atrial conrtaction.
Ex: MS, TS, left or right atrial myxoma
What is Mitral valve prolapse?
Ballooning of mitral valve into left atrium during systole (w/ or w/o MR)
What is a complication of chronic rheumatic herat disease?
Infectious endocarditis
“Morphology” of mid-diastolic murmurs and examples that cause them
“Diastolic rumble”; occur after S2 when ventricle is filling and ends before S1, when ventricle is done filling. Rumbling due to disproportion between small valve orifice size and larger diastolic blood flow volume.
Ex: MS, TS.
Why does LV hypertrophy in aortic stenosis?
it initially reduces LV wall stress (Wall stress= Pxr/2h) by thickening. Over time, however, it reduces compliance of the ventricle, making it more “stiff.”
Heart sounds in aortic regurgitation
Eary diastolic “Blowing” murmur at upper left stenral border.
How does chronic valve disease manifest?
Results in stenosis with a classic “fish-mouth” appearance. It almost always affects the mitral valve, leading to thickening of chordae tendinae and cusps, leading to stenosis. Occsionally it involves the aortic valve, which leads to fusion of the commissures, which reduces orifice of the valve, causing stenosis.
Pathophysiology of MR
Reflux of blood from LV to LA during systole → decreased forward CO/ increased LA volume and pressure → increased volume load in LV due to regurgitant volume + pulmonary venous return → enlargement of ventricle (volume overload) → decreased ability to contract (Frank-Starling curve) / lower SV → left sided heart failure
How is evidence of prior A beta-hemolytic strep infection in Jones criteria tested?
Elevated Antistreptolysin O antibodies (ASO) + Anti-DNase B titers
Sounds heard in MS and why?
In both early and late type, there is an opening snap that occurs after S2 with diastolic decrescendo murmur (“diastolic rumble”) followed by a presystolic accentuation murmur that stops at S1. Opening snap occurs bc the mitral valve becomes so calcified that it takes a little pressrue to open and when it finally does, it makes an opening snap sound. The presystolic accentuation murmur is due to an “atrial kick” that occurs when the atria contracts right before the MV closes.

What is the most common cause of Mitral stenosis?
Rheumatic fever
What are Aschoff bodies, what do they consist of, and when are they seen?
Seen in myocarditis in acute rheumatic fever. They are characterized by foci of chronic inflammation, reactive histiocytes with slender, wavy neuclei (Anitschkow cells), giant cells, and fibrinoid material.






