Week 3 Valvular Disease

Question 1

what are the AV valves

Answer 1

the tricuspid and the mitral valve

Question 2

what is the tricuspid valve

Answer 2

between the right atrium and ventricle

Question 3

what is the mitral valve

Answer 3

aka bicuspid. between the left atrium and ventricle

Question 4

during diastole, which valves are closed

Answer 4

the pulmonary and aortic valves

Question 5

during systole what valves are closed

Answer 5

the mitral and tricuspid

Question 6

when do valves open

Answer 6

when contraction increases pressure within a give chamber greater than the downstream pressure.

Question 7

when do valves close

Answer 7

when the pressure decreases below the downstream pressure.

Question 8

what do the chordea tendinae and papillary muscles do

Answer 8

prevents the inversion of the valves, during ventricular systole

Question 9

what happens with the chordea tendinae and papillary muscles are damaged from an MI

Answer 9

they can regurgitate and there can be back flow

Question 10

what are the semilunar valves

Answer 10

aortic and pulmonary valves.

Question 11

do the semilunar valves have chordea tendinae and papillary muscles

Answer 11

no!

Question 12

what are some general symptoms of valvular disease

Answer 12

fatigue, dyspnea, palpitations, murmuring, chest pain, pitting edema, orthopnea and dizziness.

Question 13

what is the most common type of valvular disease

Answer 13

aortic stenosis

Question 14

how can bacteria on teeth affect the valves

Answer 14

the bacteria can affect the mitral valve.

Question 15

what is the main cause of mitral stenosis

Answer 15

rheumatic heart disease, and autoimmune things.

Question 16

what does stenosis to the mitral valve do

Answer 16

is increases the resistance to flow, and it doesn’t open as easily.

Question 17

what happens int eh chamber upstream from the stenosis

Answer 17

there is hypertrophy

Question 18

how can stenosis cause an arrhythmia

Answer 18

the atrium is stretched, and then there are multiple foci, which cause the arrhythmia.

Question 19

why are people more at risk for a thrombus with a mitral stenosis

Answer 19

there is pooling and turbulent flow in the left atrium.

Question 20

why might you have dyspnea with a mitral valve stenosis

Answer 20

the blood may pool and back up into the lungs.

Question 21

what happens if you have mitral valve regurgitation or incompetence

Answer 21

you will get a valve that doesn’t close all the way during systole. This will create a back flow into the atria, and then the SV will have to increase to compensate for this diminished output. the atria will also get eccentric hypertrophy, which can lead to a dilated chamber.

Question 22

what are signs and symptoms of mitral regurgitation and incompetence

Answer 22

anxiety and palpations with exercise.

Question 23

what is a mitral valve prolapse

Answer 23

this is when the valve snaps open during systole, and you get a lot of regurgitation.

Question 24

how might an MI lead to valve prolapse

Answer 24

if you have ischemia to the papillary muscles, you cannot maintain the cord tendinae, and you can get a prolapse.

Question 25

what is aortic stenosis

Answer 25

thickening, calcification or both of the aortic valve without restricted motion. may even have a 2 leaflet valve (born that way)

Question 26

what is aortic regurgitation and incompetence? causes?

Answer 26

the aortic valves can’t maintain their closure during diastole. may have congenital, rheumatic, endocarditis, Marfans, ankylosing spondy.

Question 27

does aortic regurgitation or incompetence hurt pressure?

Answer 27

no became it is not changing the radius of the vessel. this is a condition in which the valve is spitting back.

Question 28

can we rely on BP to determine how hard an exercise is for patients with valvular stenosis

Answer 28

no, must use RPE

Question 29

what does impaired output mean for muscles

Answer 29

may have low perfusion

Question 30

TF: patients with aortic stenosis are good candidates for exercise

Answer 30

false, the are not

Question 31

how do we start exercise with someone with asymptomatic aortic stenosis

Answer 31

start at a low intensity and gradually build.

Question 32

what is the difference between a mechanical and a biologic valve

Answer 32

mechanical lasts a lifetime, but need to be on anti clotting drugs all their lives. Biological last about 10 years.

Question 33

who is a better candidate for a mechanical valve, age wise

Answer 33

a young kid.

Question 34

mechanical valves are at higher risk for

Answer 34

infection, thrombus or emboli.

Question 35

what is a minimally invasive option for a valve replacement

Answer 35

Da Vinci Robot. its a few small ports, and there is less risk of death, and you have a shorter LOS and less scar. But, you are on bypass longer, so the more of a risk for other things to go wrong.

Question 36

what is a transcutaneous aortic valve repair/implantation (TAVI/R)

Answer 36

patients who are at higher risk for open heart surgery get this. you get a catheter in the femoral nerve and then to the aorta, which implants the new valve.

Question 37

what are the layers of the pericardium

Answer 37

• fibrous outer layer that connects to the diaphragm and the mediastinum.
• a serous layer that lines the inner surface, (epicardium) and the fibrous layer (parietal)

between is the pericardial space, filed with fluid and lubricates the heart and decrease friction.

Question 38

what can happen to the layers of the heart

Answer 38

you can get swelling, inflammation, infection. things like that

Question 39

what is pericarditis

Answer 39

swelling and irritation of the pericardium

Question 40

what can causes pericarditis

Answer 40

infections, bacterial, viral and fungal, and MI open heart surgery and radiation

Question 41

what are the S/S of pericarditis

Answer 41

start pain with radiation to the back
fever
pain worse with deep breathing, coughing or laying flat
pain improved with sitting and leaning forward.
friction rub is heart on an auscultation.

Question 42

what is pericardial effusion

Answer 42

accumulation of fluid in the pericardial space.

Question 43

symptoms and signs of pericardial effusion

Answer 43

pressure in the chest, dysphagia, dyspnea, muffled heart sounds and JVD.

Question 44

what can pericardial effusion progress to… and what is it

Answer 44

cardiac tamponade. the heart becomes compressed by that fluid, and the heart can’t pump, and fluid will go back into the lungs, so you die.