10 minute topic Valvular Heart Disease Flashcards Preview

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Flashcards in 10 minute topic Valvular Heart Disease Deck (33):
1

Valvular heart disease

abnormality or dysfunction of any of the heart’s four valves: the mitral and aortic valves (left side) and the tricuspid and pulmonic valves (right side)

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Valvular Stenosis

Narrowed opening that impedes blood moving forward

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Valvular Insufficiency

improper closure, some blood flows backward (regurgitation)

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Congenital Valvular heart disease

can affect all four valves (or just one) and cause either stenosis or insufficiency

5

Acquired Valvular heart disease types

Degenerative
Rheumatic
Infective endocarditis

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degenerative Acquired Valvular heart disease

Due to damage over time from mechanical stress, most common cause is hypertension

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Rheumatic Acquired Valvular heart disease

Gradual fibrotic changes, calcification of valve cusps. The mitral valve is most commonly affected – this is why it is important to treat rheumatic fever

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Infective endocarditis Acquired Valvular heart disease

Infectious organisms destroy the valve, so they become vegetative
Streptococcal infections are a common cause

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Which side is more commonly effected?

Left side because of the greater pressures on the left side of the heart

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risk factor for valvular disease: Age

fibrotic thickening occurs in the mitral and aortic valves. The aorta is stiffer because of increasing systolic BP and stress on mitral valve.

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Valvular heart disease risk factors

HTN
Marfans syndrome
murmur
age

12

Marfans syndrome

connective tissue disorder that affects the heart and other areas of the body

13

Left-sided valve damage signs

→ dyspnea, fatigue, ↑ pulmonary artery pressure, ↓cardiac output

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Signs of Mitral Stenosis

Left Side
oDiastolic murmur
oAtrial fibrillation
oPalpitations
oJVD
oPitting edema
oHemoptysis
oCough/ Dysphagia
oHoarseness
oOrthopnea

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Signs of Mitral valve insufficiency

Left Side
o paroxysmal nocturnal dyspnea – they sit up at night cause they can’t breath
o Orthopnea
o Palpitations
o S3 & /or S4 heart sounds
o Possible diminished lung sounds/ crackles
o Systolic murmur
o Atrial fibrillation

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Signs of Aortic Stenosis

Left Side
o Angina
o Syncope
o Decreased SVR (systemic vascular resistance)
o S3 & /or S4
o Systolic murmur
o Narrowed pulse pressure

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Signs of Aortic insufficiency

Left Side
o Angina
o S3 sounds
o Diastolic murmur
o Widened pulse pressure

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Signs of Right side damage

dyspnea, fatigue, ↑ right artrial pressure, peripheral edema, JVD & hepatomegaly (kind of like right sided HF, it is backing up into the periphery)

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Signs of Tricuspid stenosis

Right Side
o Atrial dysrhythmias
o Diastolic murmur
o Decreased cardiac output

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Signs of Tricuspid insufficiency

Right Side
o Conduction delays – you will see changes in the ECG
o SVT
o Systolic murmur

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Signs of Pulmonic Stenosis

Right side
from the heart to the lungs
o Cyanosis
o Systolic murmur

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Signs of Pulmonic Insufficiency

Right side
o Diastolic murmur

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Valvular heart disease dx

chest x-ray
12 lead EKG
Echocardiogram
Stress test
Radionuclide studies
Angiography

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Chest x-ray

shows chamber enlargement, pulmonary congestion, and valve calcification

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12-lead EKG

shows chamber hypertrophy

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Echocardiogram

shows chamber size, hypertrophy, specific valve dysfunction (because we can see the flow), ejection function, and amount of regurgitant flow
non-invasive

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Radionuclide studies

determine ejection fraction during activity and rest

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Angiography

is a cardiac catherization reveals chamber pressures, ejection fraction, regurgitation, and pressure gradients

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Valvular heart disease medications

diuretics, afterload-reducing agents (ACEinhibitors, beta blockers, calcium channel blockers), inotropic agents, anticoagulants

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Inotropic agents

digoxin (Lanoxin), dopamine, dobutamine hydrochloride, to increase contractility and thereby improve cardiac output

31

Valvular heart disease surgical interventions

Percuaneous balloon valvuloplasty
valve repair
commissurotomy (relieve stenosis on leaflets)
annuloplasty ring insertion – gives stability
Prosthetic valve replacement

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Percuaneous balloon valvuloplasty

procedure can open aortic or mitral valves affected by stenosis. A catheter (done in the cath lab) is inserted through the femoral artery and advanced to the heart. A balloon is inflated at the stenosis to help open and improve leaflet mobility of the valve

33

Prosthetic valve replacement

can be mechanical or tissue. Mechanical valves last longer but they do require anticoagulation. Tissue valves (human tissue from a cadaver) lasts about 10 to 15 years.