vascular Flashcards
what are chordae tendineae
Fibrous tissue that anchor valve leaflets to papillary muscles of the ventricles
what is regurgitation
When valves do not close completely when they are supposed to close
what is stenosis
When valves do not open completely when they are supposed to open
what is the difference in the mitral valves?
The anterior leaflet is longer
what happens in mitral valve prolapse
A portion of one or both mitral valve leaflets balloons back into the atrium during systole leading to regurgitation
what heart sound can be heard in patients with mitral valve prolapse
Extra heart sound: mitral click
what are patients with mitral valve prolapse at increased risk for
Endocarditis
What antibiotic prophylaxis is recommended for high-risk patients before and after dental procedures?
amoxicillin
what can cause mitral regurgitation?
Thickness and fibrosis of the chordae tendineae → they pull on the leaflet so it can’t close
Developing countries: rheumatic heart disease
Developed countries: degenerative changes of the mitral valve
what are the symptoms of mitral regurgitation
Dyspnea, fatigue, weakness, clots, stroke
what kind of murmur does mitral regurgitation cause
High-pitched blowing sound at the apex on systole
what is the treatment for mitral regurgitation
Reduce afterload (same for HF)
what causes mitral stenosis
Obstruction of the blood flowing from the left atrium to the left ventricle due to the narrowing of the mitral valve orifice
what are the symptoms of mitral stenosis
low-key everything?
enlarged left atrium → dry cough wheezing and afib, hemoptysis, palpitations, orthopnea, paroxysmal nocturnal dyspnea, repeated infections
what kind of murmur does mitral stenosis have
low pitched rumbling diastolic
what is the surgical intervention for mitral stenosis
Percutaneous transluminal balloon valvuloplasty → child-bearing aged women
what causes aortic regurgitation
flow of blood back into the left ventricle from the aorta during diastole
what are the symptoms of aortic regurgitation
Marked arterial pulsations visible or palpable at carotid or temporal arteries
Forceful heartbeat especially in head or neck
what kind of murmur does aortic regurgitation have
High-pitched, blowing diastolic murmur at the third or fourth intercostal space at the left sternal border
what happens to the blood pressure of a patient with aortic regurgitation
widened pulse pressure
what is the medical management of aortic regurgitation
Afterload reduction, sodium restriction, and avoid fluid overload
when would surgical management be recommended for a patient with aortic regurgitation
left ventricular dilation
what kind of murmur does aortic stenosis have
Loud, harsh systolic murmur heard over the aortic area and may radiate to the carotid arteries and apex of the carotid arteries and apex of the left ventricle
Low-pitched, crescendo-decrescendo, rough, rasping, and vibrating
what is the prevention for aortic stenosis
control risk factors for proliferative and inflammatory responses
what are the types of valvuloplasty
commissurotomy, closed, open, annuloplasty, and leaflet repair
what is commissurotomy
procedure performed to separate the fused leaflets
what is closed valvuloplasty and who is it beneficial for
Balloon valvuloplasty → younger patients with mitral valve stenosis
What are the contraindications for a closed valvuloplasty?
Left atrial or ventricular thrombus, severe valvular calcifications, thoracolumbar scoliosis, rotation of the great vessels, open heart surgery
what is annuloplasty
repair of the valve annulus
what are the types of leaflets repair
Elongated: folded over onto itself and suture
Short leaflets: chordoplasty (repair of the chordae tendineae)
Holes: pericardial or synthetic patch may be used
what is the easiest valve to repair
Mitral valve, the rest should be replaced instead → aortic has a 50% restenosis 6 months later
what are the complications of a mitral balloon valvuloplasty
mitral regurgitation, bleeding from insertion site, emboli, ventricular perforation,
what are the two types of valve replacements
mechanical
More durable
Less likely to be infected
Need anticoagulants
Tissue
- Bioprosthesis: from pigs,
cows, or horses
- Homografts: human valves
- Autografts: patient’s own
pulmonic valve
- Less likely to generate
thromboemboli and long-
term anticoagulation is not
required
