Valvular Regurgitation Flashcards
pathophysiology of aortic regurgitation
increased preload and afterload
LV hypertrophy and LV dilatation which compensate for increased afterload but ultimately may lead to LV systolic dysfunction, elevated LV pressures, and pulmonary congestion
widened pulse pressure with elevated systolic BP and reduced diastolic BP
cause of aortic regurgitation
congenital
degenerative
rheumatic
endocarditis
dissecting aneurysms
Marfan’s syndrome
syphilis
ankylosing spondylitis
trauma
drugs
symptoms of AR
dyspnea
angina
physical findings of AR
dynamic, displaced LV impulse
brisk carotid upstrokes with rapid fall-off
apical third heart sound
decrescendo diastolic blowing murmur
mid-systolic outflow murmur (caused by increased forward flow across aortic valve)
apical diastolic rumble (Austin Flint murmur)
findings related to wide pulse pressure (Quincke’s, Duroziez, Dumusset’s signs)
treatment for AR
no established medical therapy
other than treating hypertensionn in patients with elevated blood pressure
ultimately patients with severe AR may require surgical aortic valve replacement
eccentric remodeling vs eccentryic hypertrophy
eccentric remodeling - increased volume, no increase in mass
eccentric hypertrophy - increased volume and mass
What is the major risk factor for aortic regurgitation?
congenital bicuspid valve
Describe the hemodynamics of aortic regurgitation.
Chamber pumping about 2/3 times the stroke volume
Huge stroke volume leads to increase in systolic pressure - higher systemic pressure
Lower diastolic blood pressure - decompressing aorta back into the ventricle
High systolic pressure and low diastolic pressures in the aorta
Murmur starts louder and gets quieter - decrescendo
pathophysiology of mitral regurgitation
volume overload of both the left ventricle and left atrium
leads to elevated LA pressure
LV dilatation which compensates for increase preload
LA dilatation that can lead to afib and embolus formation
etiology of MR
mitral valve prolapse
rheumatic
papillary muscle dysfunction
cardiomyopathies
endocarditis
degenerative
mitral annular calcification
ruptured chordae tendinae trauma
congenital
Describe the hemodynamics of mitral regurgitation.
Large regurgitant v wave, pressure in atrium
Dilated ventricle as a result
Murmur is a systolic murmur
symptoms of MR
dyspnea
angina
fatigue
palpitations
physical findings of MR
dynamic, displaced LV impulse
brisk carotic upstrokes
holosystolic apical murmur
apical third heart sound
midsystolic click (in patients with mitral valve prolapse)
apical diastolic rumble (with severe MR is, caused by increased forward flow acrosss mitral valve)
treatment of MR
treatment of patients with severe MR and evidence of LV dilatation to reduce degree of MR is uncertain
ultimately patietns may require surgical mitral valve repair or replacement
indications for mitral valve replacement surgery
