Valvular Heart Disease

Question 1

Majority of defects

Answer 1

involve aortic valve (63%) & mitral valve (14%)&raquo_space; left <3

Question 2

valvular dz & pregnancy

Answer 2

blood vol increases 40-50%
CO increases 30-40%
Stroke Vol increases 25-30%
Heart rate increases 15%
increasing demand poses greater risk when diseased

Question 3

Rheumatic Heart Dz

Answer 3

worlds most common valvular dz

declined considerably in developed countries

Question 4

Valvular stenosis

Answer 4

narrowing, stiffening, thickening, fusion of leaflets
or blockage of one or more valves
obstruction nml blood flow

Question 5

valvular regurgitation

Answer 5

aka insufficiency

blood leaks back into the wrong direction b/c the valve is not closing properly

Question 6

Valvular atresia

Answer 6

valve failed to develop properly in utero

completely closed at birth

Question 7

valvular prolapse

Answer 7

leaflets of valve do not close properly
excessive length or width
bulge into chamber it's protecting
may result in regurgitation
mitral valve prolapse common & rarely serious

Question 8

abnormal ongoing valvular processes

Answer 8

often leads to both stenosis & regurgitation

Question 9

congenital valvular dz

Answer 9

abnormal development in utero

Question 10

acquired valvular dz

Answer 10

some process is changing or has altered the once normal valve

Question 11

heritable valvular dz

Answer 11

congenital
marfan syndrome (+ other CT disorders)
Bicuspid aortic valve
hypertrophic cardiomyopathy HTC (aka: Idiopathic Hypertrophic Subaortic Stenosis)

Question 12

Inflammatory-Immunologic valvular dz

Answer 12

rheumatic fever
AIDS & Non Bacterial Thrombotic Endocarditis (NBTE)
Kawasaki’s dz
Spondylarthropthies > ankylosing spondylitis, Reiter dz Becketts dz SLE ect
Cardiovascular syphilis

Question 13

Endocardial disorders

Answer 13

infective endocarditis&raquo_space; bacterial, fungal

non bacterial chromatic endocarditis&raquo_space; systemic wasting type of states like AIDS and cancer

Question 14

Myocardial valvular disfxn

Answer 14

Ischemic heart disease&raquo_space;ex papillary muscle ischemic d/f
Dilated Cardiomyopathy&raquo_space; stretches valve annulus
hypertrophic cardiomyopathy (HTC/IHSS)

Question 15

Diseases and disorders of other organs

Answer 15

chronic renal failure&raquo_space; abnormal calcification of valves

Question 16

Aging

Answer 16

Calcific aortic stenosis&raquo_space; mitral annular calcification

Question 17

Post Interventional valvular dz

Answer 17

balloon vavlulotomy
valve reconstructive surgery (commissurotomy)
valve replacement

Question 18

Drug & physical agents

Answer 18

chronic Ergotamin Rx (migraine tx)
appetite suppressant drugs (Fen-fen)
Radiation&raquo_space; affects all tissue in path of the XR’s
Trauma induced valve dz&raquo_space; aortic regurg most common

Question 19

Grading of mumurs (6)

Answer 19

Grade 1: very faint, special effort (cardiologist) needed
Grade 2: quiet but clearly audible
Grade 3: moderately loud
Grade 4: loud, often w/ thrill
Grade 5: very loud w/ thrill palpable
Grade 6: very loud, audible w/out stethoscope, thrill palpable & visible

Question 20

Continuous murmurs

Answer 20

heard throughout cardiac cycle

Question 21

Mill wheel murmur

Answer 21

heard throughout cardiac cycle

associated w/ Venous Air Embolism

Question 22

murmur shape

Answer 22

crescendo: pressure increases progressively
decrescendo: pressure decreases progressively
crescendo-decrescendo : pressure increases then
decreases
Plateau: pressure is constant through murmur

Question 23

pitch of murmur

Answer 23

high, medium, low

Question 24

quality of murmur

Answer 24

rumbling, blowing, harsh

Question 25

antibiotic prophylaxis

Answer 25

for procedures & dental cleanings for anyone w/ acquired valvular dz

Question 26

valve replacement

Answer 26

before cardiac decompensation! | best prior to development of cardiac compensatory mechanism

Question 27

periodic reassessment of valvular dz

Answer 27

for potentially progressive valvular dz

Question 28

Acute medical therapy for valvular dz

Answer 28

ex: after load reduction in aortic regurg for pre-op

Question 29

Chronic therapy for valvular dz

Answer 29

Ex: diuretics for moderate mitral stenosis > decreases L atrial P. Ventricular rate control in A. Fib After load reduction> aortic regurgitation

Question 30

Interventional procedures for valvular dz

Answer 30

Balloon valvulotomy valve repair >> prosthetic rings, valve commissurotomy valve replacement >> mechanical, porcine, human cadaver

Question 31

Valsalva maneuver & murmurs

Answer 31

decreases preload decrease in length & intensity of murmur after maneuver murmur returns to regular intensity/length **Exceptions: *Hypertrophic Cardiomyopathy >>becomes louder *Mitral valve prolapse>> becomes longer & louder

Question 32

Exercise & murmurs

Answer 32

Become louder | Handgrip exercises also increase audibility

Question 33

Diastole murmurs (ARMS PaRTS )

Answer 33

aortic regurgitation mitral stenosis pulmonic regurgitation tricuspid stenosis

Question 34

Aortic Regurgitation valve replacement postponer

Answer 34

after load reduction may fend off procedure by 5 yrs

Question 35

squatting exercise

Answer 35

increases preload, increases after load