Valvular heart disesase Flashcards
What is the Venturi effect
In HOCM it is when there is turbulent flow in the ventricle
What is laminar blood flow
calm (quiet) blood flow
During diastole what valves are open
AV valves
During systole what valves are open
Semilunar
What sound is S1
Lub (systole)
What heart sound is S2
Dub (Diastole)
Where is Erbs point and what is it used for
Third, left intercostal space
Good for listening to pathology like aortic regurge
What does it mean if there is a splitting of a heart sound
Valves are closing asynchronously
When is S4 heard in the cycle
just prior to S1(atrial gallop)
When is S4 heard in the heart cycle
Early diastole (ventricular gallop)
What can cause valvular stenosis
fibrosis
sclerosis
calcification
What happens when there is valvular regurge
Valve doesn’t shut completely and allows blood to back flow
What causes rheumatic fever
complication of GAS infection (s.pyogenese)
What gets attacked in the heart with rheumatic disease
aortic and mitral valves
When does acute rheumatic fever occur
weeks after initial illness
What are the symptoms of severe aortic stenosis
Heart failure
Angina
Syncope
What occurs with the valve in aortic stenosis
Thickening of the aortic valve with calcification
*ends up causing increase velocity
What is the most common cause of outflow obstruction in both kids and adults
Aortic stenosis
What does aortic stenosis cause
increased pressure within the LV which causes and increase pressure that the ventricle has to push against (AKA end diastolic pressure)
What are increased risk factors for aortic stenosis
HTN
Hyperlipidemia
Smoking
DM
What occurs in the valve with rheumatic heart disease
Fusion of the tissue of the valve
What does BNP test for
CHF
What is BNP
Brain naturetic peptide
If you have a high BNP what does it mean
the more severe the CHF
What is aortic regurge
During diastole, blood that should be within the aorta/systemic circulation, is able to reenter the LV
What kind of murmur does aortic regurge cause
diastolic
what is the aortic valve attached to
aortic root
What does back flow into the LV cause
eccentric hypertrophy (leads to dilated cardiomyopathy)
What happens if there is a problem with the aortic root
causes adhered valvular cusps to separate (aneurysm / dissection)
Where in the vessel does a dissection happen
Separation of the intimacy and media
What type of CT pathology is also associated with aortic regurge
Marfans
Ehlers-danlos
What are the risk factors for mitral stenosis
Older patients
End stage renal disease
Calcification deposits
What is the normal opening size for the mitral valve
4-6cm
When do patients become symptomatic with mitral stenosis
<2cm opening
what is orthopnea
difficulty laying down from fluid
How will a patient present with mitral stenosis
dyspnea
orthopnea
hemoptysis
What are the causes of primary regurgitation
Infective endocarditis
Rheumatic heart disease
Mitral prolapse
CT disease
MI (papillary muscle rupture)
What are the causes of secondary regurge
Valve is normal, the problem is in the ventricle causing change in the annular shape (HOLCOM)
What is a mitral valve prolapse
Valve becomes loose / floppy
-> bends inappropriately
What is the job of the moderator band
Carries large amount of the RBB to the myocardium of the RV
Where are moderator bands found
near the papillary muscles
What are some cause of tricuspid stenosis
Rheumatic heart disease
Carcinoid syndrome
Tumors
What symptoms will occur with tricuspid stenosis
Venous issues (Incr. JVP)
Arrhythmias
When do symptoms of tricuspid regurge get worse
with increased preload
What are the common causes of tricuspid regurge
pulmonary HTN
Enodcarditis (IVDU)
papillary muscle rupture
What is pulmonic stenosis
Thickening of the pulmonic valve with calcification = increased velocity
What are the outcomes of pulmonary stenosis
-RV hypertrophy
-systolic murmur (lub)
- Diastolic dysfunction
- RV failure
What are the causes of pulmonary stenosis
Congenital
Part of tetralogy of fallot
What is tetralogy of fallot
Combination of 4 congenital heart defects
-VSD
-pulmonary stenosis
-misplaced aorta
-Thickened RV wall
What kind of murmur is heard with pulmonic regurge
diastolic
What are some causes of pulmonary regurge
Endocarditis
Carcinoid syndrome
post Valvuloplasty
What increases the risk of endothelial disruption
Turbulent or high flow states
*bacteria will increase platelet aggregation = increased sequestration of microorganisms
What is the Duke criteria for
To diagnosis Endocarditis
Where do septic emboli come from
vegetations in the right side of the heart
What is empyema
abscess in the lungs
What is endocarditis associated with in children
Congenital valvular disease
nosocomial infection
rheumatic heart disease
What are the acute causes of endocarditis
S.Aureus
B-hemolytic strep
Aerobic gram neg bacili
