Valvular Heart Dz Flashcards
What is the majority of defects in valvular heart disease?
1) aortic valve
2) mitral valve
What is rheumatic heart disease?
- repeated inflammation on the heart that causes the weakening of the chordeae tendinea that can results to valve damage (stenosis/regurgitation)
- d/t strep
- most common but now is decreased in developed countries
Who are at high risk of complication w/ valvular dz?
pregnant women b/c the changes in the body can harm the heart:
- BV incr 40-50%
- CO incr 30-40%
- SV incr 25-30%
- HR incr 15%
- they should see a cardiologist and fix the valve issue before getting pregnant
What are the the types of valvular dz?
- valvular stenosis
- valvular regurgitation/insufficiency
- valvular atresia (congenital pulm trunk dz)
- valvular prolapse
What is valvular stenosis?
the valve is narrow cxing the heart to overwork (b/c the body is not getting perfused)
valve is having a hard time opening but able to SNAP shut
What is valvular regurgitation/insufficiency?
when the blood leaves the valve but comes back in b/c the valve isn’t CLOSING properly
What is valvular atresia?
when the valves don’t develop properly and is closed at birth
What is valvular prolapse?
when the chordeae tendinae is ‘broken’ cxing the valve leaflet to not close correctly (bulge) and leak into the ventricle
What are the two etiology of valvular heart dz?
- congentinal
- acquired
What is heritable?
- congenital
- marfan syndrome
- biscupsid aortic valve
- hypertrophic cardiomyopathy
What is marfan syndrome?
CT disorder
What is inflammatory?
- rheumatic arthritis
- NBTE (aids)
- kawasaki’s dz
What is endocardial disorders?
- infective endocarditis
- NBTE (aids)
What is myocardial dysfunction?
- ischemic heart disease (papillary m. ischemic dysfunction)
- dilated cardiomyopathy (stretched valve annulus)
- hypertrophic cardiomyopathy
What are disease and disorders of other organs?
-chronic renal failure
What is aging valvular dz?
-calcific aortic stenosis
Drug and physical agents of valvular dz?
- ergotamine products
- fen fen
- radiation
What are causes of aortic stenosis?
- bicuspid aortic valve (usually 3)
- calcific senile
What are sx of aortic stenosis?
CLASSIC: ANGINA, DYSPNEA, EXERTIONAL SYNCOPE
-pts may be asymptomatic for years but once symptomatic, mortality is high
PE of aortic stenosis?
- systolic ejection murmur w/ radiation to neck
- murmur peaks at mid systole
- carotid upstroke is diminished and delayed
- LVH
Management of aortic stenosis?
- follow progression: CXR, ECG, echocardiogram
- valve replacement BEFORE LV dysfunction
- endocarditis prophylaxis
What is the cause of aortic regurgitation?
- bicuspid aortic valve
- infective endocarditis
- floppy aortic valve
- rheumatic fever
- aortic dissection
What are the sx of aortic regurgitation?
aysmptomatic until SEVERE LV dysfunction
What are LV heart failure sx?
- pulmonary edema
- dyspnea
- fatigue
PE of aortic regurgitation?
- diastolic murmur along sternal border
- diastolic rumble at apex
- wide pulse pressure
- water hammer pulse
- quinke’s pulse
- musset’s sign
- LVH
What are the different grades of murmurs?
Grade I, II, III, IV, V, VI
What is Grade I?
VERY faint
What is Grade II?
quite but hearable
What is Grade III?
kinda of loud
What is Grade IV?
same as grade III w/ thrill
What is Grade V?
VERY loud w/ thirll
What is Grade VI?
VERY loud (w/o stethoscope) w/ thrill (visible)
What is management of Aortic Stenosis?
- valve replacement BEFORE LV dysfunction
- endocarditis prophylaxis
What is Mitral Stenosis?
- valve is having a hard time opening
- affects women
- slow and progressive
What are sx mitral stenosis?
- dyspnea
- orthopnea
- paroxysmal nocturnal dyspnea
- a fib
PE of mitral stenosis?
- apical rumbling diastolic murmur
- loud S1
What are cx of mitral stenosis?
rheumatic heart dz
What are the cx of mitral regurgitation?
- ischemic heart dz
- dilated cardiomyopathy
- floppy mitral valve/mitral prolapse
- mitral annular calcification (mitral valve is dying)
Management aortic regurgitation?
- blood cultures
- valve replacement
- after load reduction
- endocarditis prophylaxis
PE of mitral stenosis?
- apical rumbling diastolic murmur w/ opening snap
- loud S1
Cx of Tricuspid regurgitation?
- dilated cardiomyopathy w/ RIGHT ventricle enlargement/dysfunciton
- ischemic cadiomypoathy
- floppy tricuspid valve/tricuspid valve prolapse
- infective endocarditis
What is tricuspid regurgitation?
valve is not closing so there is backflow into the atria
Tricuspid regurgitation is seen in?
- LV failure cxing overworking RV –> dilation of the venticle
- inferior MI (heart dies slowly)
- infective endocarditis (IV drug users)
Sx of tricuspid regurgitation?
RV failure
PE of tricuspid regurgitation?
JVD, hepatomegaly, pretibial edema (d/t Right HF)
Management of tricuspid regurgitation
tx underlying cx
What are the cx of COMBINED mitral regurgitation and tricuspid regurgitation?
- dilated cardiomyopathy
- ischemic cardiomyopathy
- heritable CT disorder (marfan syndrome)
What are the cx of COMBINED mitral stenosis and aortic regurgitation?
rheumatic heart dz
What are tx of valvular heart dz?
- abx prophyalxis (including dental)
- valve replacement BEFORE cardiac starts to die off
- Periodic reassessment
- acute tx or chronic tx
- balloon valvulotomy
- valve repair
- valve replacement
PE of valvular dz?
- Respiration
- Valsalva maneuver
- Exercise
What is respiration PE?
- Inspiration: right sided murmurs are LOUDER
- Expiration: left sided murmurs are LOUDER
What is valsalva maneuver PE?
- decrease preload
- bearing down
- MURMURS get LOUDER in Hypertrophic cadiomyopathy
What is hand grip PE and squatting PE?
-increases preload and afterload
What is hand grip PE good for?
distinguishing between systolic murmur: aortic stenosis murmur decrease and mitral regurgitation murmur increase
Diastolic rumble, Loud S1, Normal S2?
Mitral stenosis
- having trouble opening –> diastolic fill is abnormal –> able to close real well = loud S1
- aortic and pulmonary valves are closing well –> normal S2
Blowing diastolic, Soft S1, normal S2, wide pulse pressure, systolic HTN?
Aortic regurgitation
- less blood in the ventricle so SOFT S1
- S2 is normal b/c the aortic and pulm is still able to close, they just can’t STAY closed
Holosystolic, soft S1, normal/split S2, +/- S3?
Mitral regurgitation
- less blood in ventricle so SOFT S1
- S2 is normal b/c aortic and pulm is FINE
- S3 maybe b/c blood splashes back d/t mitral
20 yo, female?
mitral valve prolpase
Sx for mitral valve prolapse?
-vague: chest pain, dypsnea, anxiety, palpitaiton
PE for mitral valve prolapse?
-CLICK by LATE systolic murmur
Management for mitral valve prolapse?
- reassurance
- beta blockers
- cessation of ETOH, smoking, caffeine
- NO abx
