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Cardiology II > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

Causes of Aortic Stenosis?

A
  • Supravalvular
  • subvalvular
  • valvular
    -Bicuspid
    -rheumatic
    -senile degeneration (Tradition risk factros for atherosclerosis (age, smoking, high LDL, HTN); Also seen in CKD
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2
Q

What are 3 classic symptoms of severe Aortic Stenosis?

A
  • syncope
  • angina
  • exertional dyspnea/ CHF/ decreased funtional capacity
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3
Q

Physical exam findings in severe aortic stenosis?

A

Systolic murmur

  • late peaking = severe
  • best heard right upper sternal border
  • radiates to the bilateral carotids
  • the intensity of the murmur does not correspond to severity

soft or absent S2
pulsus parvus et tardus

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4
Q

best testing for Aortic stenosis?

A
  • Echo- imaging modality of choice
  • Cardiac catherterization- only if echo data is not diagnostic
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5
Q

what is the pathophysiology of Aortic stenosis?

A
  • aortic stenosis generally develops gradually leading to LV hypertrophy
  • as stenosis progresses, LV filling pressures begin to increase- LV function usually remains normal until late in disease process
  • diastolic dysfunction may contribute to symptom onset
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6
Q

Treatment of severe Aortic Stenosis?

A
  • no effective medical therapy for what is a mechanical obstruction
  • aortic valve replacement is standard of care
  • operative mortality is low in young, healthy patients
  • mechanical vs bioprosthetic valves
  • TAVR (transcatheter aortic valve replacement)
  • prohibitive risk or high risk patients
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7
Q

what are some etiologies of aortic regurgitation that effect the aortic root?

A

Aortic root

  • marfan syndrome
  • ehlers-danlos
  • syphilis
  • hypertension
  • coarctation
  • dissection (only one that causes acute; everything above causes chronic)

Connective tissue disorders that can strech aortic roots

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8
Q

what are common etiologies that effect the aortic valve in aortic regurgitation?

A

Aortic valve

  • congential bicuspid
  • rheumatic
  • endocarditis (only one that causes acute; the rest above and below cause chronic)
  • prostethic valve dysfunction
  • degenerative
  • subaortic stenosis
  • radiation
  • pharmacologic agents
  • supracristal VSD
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9
Q
  • endocarditis, dissection, trauma
  • volume overload is poorly tolerated (LV is not compliant)
  • LV diastolic pressure increases rapidly
  • often surgical emergency
A

Acute aortic regurgitation

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10
Q
  • slowly progressive LV dilatation with a long asymptomatic period
  • ventricle remains compliant
  • can accommodate a large regurgitant volume
  • maintains near normal diastolic filling pressure
A

chronic

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11
Q

what would physical exam findings in acute Aortic regurgitation look like?

A
  • Few typical physical exam findings
  • murmur may be soft or nonexistant
  • manifestations of underlying process predominate
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12
Q

What would physical exam findings in chronic aortic regurgitation look like

A
  • wide pulse pressure
  • water hammer pulse- rapidly swelling and falling arterial pulse
  • deMussets- sign- head bob with each heart beat
  • quincke’s pulses- capillary pulsations in the fingertips or lips
  • laterally displaced PMI
  • high pitched diastolic murmur at the left sternal border (leaning forward, end-expiration)
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13
Q
  • Caused by group A streptococcal pharyngitis
  • characterized by an acute febrile ilness 2-4 weeks after an episode of pharyngitis
  • before antibiotics–> single largest cause of valvular heart disease
  • continues to be common in developing countries
A

Acute rheumatic fever

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14
Q

what are the major manifestations of acute rheumatic fever?

A

Major manifestations

  • carditis
  • polyarthritis
  • chorea
  • erythema marginatum
  • subcutaneous nodules
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15
Q

what are minor manifestations of acute rheumatic fever?

A
  • fever
  • arthralgias
  • previous rheumatic fever/ rheumatic heart disease
  • increased CRP or ESR
  • prolonged PR interval on ECG
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16
Q

what is a firm diagnosis of acute rheumatic fever?

A
  • 2 major manifestations or 1 major and 2 minor manifestations AND
  • Evidence of a recent streptococcal infection
17
Q
  • diffuse inflammation of the pericardium, epicardium, myocardium, and endocardium
  • valve leaflet thickening
  • small rows of vegetations (verrucae) on valves
  • symptoms: tachycardia, pleuritc chest discomfort
  • pericardial friction rub, new or changing murmurs
  • Mitral regurg is more common in young pts
  • mitral stenosis becomes more common in elderly to mid adults
  • heart block on ECG
A

Carditis

18
Q

treatment of rheumatic heart disease

A

antibiotic therapy

  • Penicillin (IM penicllin G oner or oral penicillin V for at least 10 days)

secondary prophylaxis (treatment length varies)

  • long-term administration of antibiotics to prevent recurrences
  • penicillin G administered IM every 3-4 weeks
19
Q
  • almost always caused by rheumatic heart disease
  • more than 80 % of patients are women
  • clinical presentation often occurs many years after the initial episode of rheumatic fever
A

Mitral stenosis

20
Q

clincal presentation of mital stenosis

A
  • dyspnea on exertion
  • atrial fibrillation
  • low pitched mid-diastolic murmur with opening snap
21
Q

management of mitral stenosis?

A

asymptomatic mild mitral stenosis

  • conservative therapy
  • atrial fibrillation: AV nodal blockers, anticoagulation

Symptomatic severe mitral stenosis

  • Percutaneous valvotomy (if valve anatomy is favorable)
  • mitral valve replacement
22
Q

Physical exam: midsystolic click followed by a late apical systolic murmur
complications

  • mitral regurgitation
  • endocarditis
  • arrhythmia
  • congestive heart failure

Treatment
* monitoring with Echo and phsycial exam
* severe mitral regurgitation–> timing of surgery depends on symptoms, left ventricular function, left ventricular size

A

Mitral valve prolapse

23
Q

Etiology

  • Mitral valve prolapse with chordal rupture
  • endocarditis with leaflet destruction
  • papillary muscle dysfunction or rupture following a myocardial infarction

Clinical presentation

  • Tachycardia
  • heart failure
  • hemodynamic shock
  • pulmonary edema on CXR
  • murmur may be soft or inaudible
  • S3 is often present
  • Medical emergency
  • urgent surgical intervention is usually indicated
A

acute mitral regurgitation

24
Q

Primary regurgitation

  • Mitral valve prolapse
  • endocarditis

secondary regurgitation

  • leaflet tethering or mitral valve annulus dilatation
  • consequence of ischemi myocardial dyfunction or dilated cardiomyopathy
A

Chronic mitral regurgitation

25
Q

what physical exam findings and treatment would you see for Chronic mitral regurg?

A

physical exam

  • holosystolic murmur best heard at the apex

treatment

  • primary: mitral valve repair (annuloplasty ring) or replacement- indicated if patient is symptomatic, left ventricular function decreases OR left ventricular size increases (remodeling)
  • functional mitral: preload and afterload reduction, goal directed medical therapy for cardiomyopathy, symptom management (diuretics)

Cardiology II (12 decks)

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