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CVPR Exam I COPY > 28. Aortic & Pulmonary Valve Disease > Flashcards

28. Aortic & Pulmonary Valve Disease Flashcards

1
Q

Which is more common: mitral valve disease or aortic valve disease?

A

mitral

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2
Q

Aortic valve pathology can be? (3)

A

Rheumatic, calcific, or bicuspid

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3
Q

What are the athlerosclerotic risk factors for calcific aortic stenosis?

A
  1. lipids
  2. hypertension
  3. male
  4. metabolic syndrome
  5. smoking
  6. diabetes
  7. renal failure
  8. elevated CRP
  9. hypehemocystenemia
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4
Q

What are the genetic risk factors for calcific aortic stenosis?

A
  1. vitamin D receptor
  2. apolipoprotein A1, B, and E
  3. Estrogen receptor alpha gene
  4. notch 1
  5. ACE
  6. IL10
  7. CT growth factor
  8. chemokine receptor 5 (CCR5)
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5
Q

Once thought a degenerative disease, the mechanism by which a healthy tricuspid aortic valve becomes _____ is now believed to be similar to that of atherosclerosis.

A

stenotic

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6
Q

Once thought a degenerative disease, the mechanism by which a healthy tricuspid aortic valve becomes stenotic is now believed to be similar to that of ______.

A

atherosclerosis

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7
Q

The tricuspid aortic valves become stenotic ______, mainly caused by calcium deposits in the valve cusps and not by fusion of the commissures.

A

in the sixth, seventh, and eighth decades of life

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8
Q

The tricuspid aortic valves become stenotic in the sixth, seventh, and eighth decades of life, mainly caused by ______ in the ______ and not by fusion of the commissures.

A

calcium deposits; valve cusps

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9
Q

In developed countries, ______ has become a very rare cause of aortic stenosis. When the aortic valve is affected by ______ the mitral valve is almost always affected as well.

A

rheumatic fever; rheumatic heart disease

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10
Q

In developed countries, rheumatic fever has become a very rare cause of aortic stenosis. When the ____ valve is affected by rheumatic heart disease the _____ valve is almost always affected as well.

A

aortic; mitral

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11
Q

The ______of the aortic valve serves as the mainstay of diagnosis.

A

echocardiogram with Doppler interrogation

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12
Q

Valve replacement is recommended for individuals with ______. Such patients have a dire outlook, with 75% dying within 3 years of symptom onset.

A

symptomatic severe aortic stenosis

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13
Q

______ is recommended for individuals with symptomatic severe aortic stenosis. Such patients have a dire outlook, with 75% dying within 3 years of symptom onset.

A

Valve replacement

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14
Q

The cardinal symptoms of _____ are angina, syncope and shortness of breath.

A

severe aortic stenosis

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15
Q

The cardinal symptoms of severe aortic stenosis are ____, _____, and ______.

A

angina, syncope, and shortness of breath

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16
Q

The _____ is the most common congenital cardiac malformation, occurring in 1% to 2% of the population.

A

bicuspid aortic valve (BAV)

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17
Q

The bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, occurring in ____% of the population.

A

1 to 2

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18
Q

After development, bicuspid aortic valve (BAV) is associated with _____, _____, and _____.

A

aortic dilation, aneurysms, and dissection

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19
Q

After development, _____ is associated with aortic dilation, aneurysms, and dissection .

A

bicuspid aortic valve (BAV)

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20
Q

______ are the result of abnormal aortic cusp formation during valvulogenesis.

A

Bicuspid aortic valves (BAVs)

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21
Q

Bicuspid aortic valves (BAVs) are the result of ______ during valvulogenesis.

A

abnormal aortic cusp formation

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22
Q

In bicuspid aortic valve (BAV), adjacent cusps ______, larger than its counterpart yet smaller than 2 normal cusps combined. BAVs are likely the result of a complex developmental process, not simply the fusion of 2 normal cusps.

A

fuse to form a single aberrant cusp

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23
Q

Adjacent cusps fuse to form a single aberrant cusp, larger than its counterpart yet smaller than 2 normal cusps combined. BAVs are likely the result of a complex developmental process, not simply ______.

A

the fusion of 2 normal cusps

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24
Q

In patients with bicuspid aortic valve (BAV), deficient microfibrillar elements result in ______, matrix metalloproteinases (MMPs) release, ______, cell death, and ______.

A

smooth muscle cell detachment; matrix disruption; loss of structural support and elasticity

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25
Q

In patients with _____, deficient microfibrillar elements result in smooth muscle cell detachment, matrix metalloproteinases (MMPs) release, matrix disruption, cell death, and a loss of structural support and elasticity.

A

bicuspid aortic valve (BAV)

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26
Q

In patients with bicuspid aortic valve (BAV), deficient microfibrillar elements result in smooth muscle cell detachment, ______, matrix disruption, _____, and a loss of structural support and elasticity.

A

matrix metalloproteinases (MMPs) release; cell death

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27
Q

Describe how bicuspid aortic valve (BAV) is inherited.

A

auto dominant with reduced penetrance

males 4:1

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28
Q

Name 3 valvular complications of bicuspid aortic valve (BAV).

A
  1. aortic stenosis
  2. aortic insufficiency
  3. endocarditis
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29
Q

Name 4 vascular complications of bicuspid aortic valve (BAV).

A
  1. aortic dilation
  2. aneurism formation
  3. aortic dissection
  4. associations with coarctation, PDA, and coronary anomalies
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30
Q

What is syncope?

A

fainting

31
Q

What is coarctation?

A

narrowing

32
Q

What is PDA?

A

persistent ductus arteriosus

33
Q

_______ is one of the more common forms of congenital heart disease. Most of the patients are children however patients may come to medical attention during adolescence or adulthood.

A

Stenosis of the pulmonic valve

34
Q

In recent years, ______ has largely replaced surgical valvotomy except in patients with dysplastic valves.

A

percutaneous balloon valvuloplasty

35
Q

In recent years, percutaneous balloon valvuloplasty has largely replaced surgical valvotomy except in patients with _____.

A

dysplastic valves

36
Q

What is aortic stenosis?

A

a tight aortic valve- blood can’t flow through well

37
Q

What are some of the major causes of aortic stenosis?

A
  1. a bicuspid aortic valve
  2. age related calcification
  3. Rheumatic fever
38
Q

What is a bicuspid aortic valve?

A

a congenital defect where the aortic valve only has 2 cups

39
Q

Why is a bicuspid aortic valve bad?

A

the valves can get damaged more quickly

40
Q

What are the risk factors for a calcified aortic valve?

A
  1. smoking
  2. HTN
  3. hyperlipidemia
  4. diabetes
41
Q

What valve is more commonly affected by Rheumatic fever?

A

the aortic valve

42
Q

What does the acronym SAD, for the s/s of aortic valve stenosis, stand for?

A

syncope
angina
dyspnea

43
Q

What is Pulsus Parvus et tardis?

A

a small or weak pulse that is slow to rise

44
Q

Where do you palpate the PMI (point of maximal impulse)?

A

in the 5th intercostal space, similar to where the mitral valve is auscultated

45
Q

How can the PMI give information about the LV in aortic valve stenosis?

A

if the PMI is more medial towards the sternum, it is indicative of LVH bc there is growth of the myocardium

46
Q

What does MAHA stand for?

A

microangiopathic hemolytic anemia

47
Q

Why does MAHA occur in aortic valve stenosis?

A

RBCs are lysed as they are pumped through the stiffened valve

48
Q

What auscultative finding is present in aortic valve stenosis?

A

a systolic ejection murmur at the R upper sternal border

49
Q

Why do aortic stenosis pts get angina?

A
  1. they also have CAD (blockage = chest pain)

2. they also have LVH (increased O2 demand that it’s not getting = chest pain)

50
Q

What is aortic regurgitation?

A

an insufficient, floppy aortic valve that causes blood to flow back into the L ventricle

51
Q

What causes aortic regurgitation?

A
  1. a widening or anerismal change of the aortic annulus (3a syphilis, Marfans, Ehlers-Danlos Syndrome)
  2. endocarditis
  3. Rheumatic fever
52
Q

What are the s/s of aortic regurgitation?

A
  1. fatigue
  2. syncope
  3. SOB
  4. palpitations
53
Q

What is wide pulse pressure? When does it present?

A

a large difference in systolic - diastolic pressure

54
Q

How can the PMI give information about the LV in aortic valve regurgitation?

A

the LV is dilated, and this is shown by a displaced PMI laterally and inferiorly

55
Q

What extra heart sound can be heard in aortic valve regurg?

A

S3 (early diastolic murmur along the L sternal border)

56
Q

What is S1?

A

the closing of the mitral and tricuspid valves

57
Q

What is S2?

A

the closing of the aortic and pulmonic valves

58
Q

What happens btw S1 and S2?

A

systole

59
Q

What happens btw S2 and S1?

A

diastole

60
Q

What is a murmur btw S1 and S2 called?

A

systolic murmurs (aortic stenosis or pulmonic stenosis; tricuspid regurgitation or mitral regurgitation)

61
Q

What is a murmur btw S2 and S1 called?

A

diastolic murmur (aortic regurg or pulmonic regurg; tricuspid stenosis or mitral stenosis)

62
Q

The ____ sided valve problems are much more common than ____ sided valve problems.

A

left > right

63
Q

What is a murmur?

A

the sounds of turbulent blood flow

64
Q

What is an ejection sound/click?

A

valve leaflets moving quickly and then shooting open quickly

65
Q

What is the shape/description of an aortic stenosis murmur?

A

it occurs just after S1 and is a crescendo-decrescendo or diamond shape with an ejection click

66
Q

Aortic stenosis is a _____ _____ murmur that commonly radiates to _____.

A

systolic ejection; the carotids

67
Q

What is the shape/description of a pulmonic stenosis murmur?

A

it occurs just after S1 and is a crescendo-decrescendo or diamond shape without an ejection click

68
Q

What is the difference btw an aortic and pulmonic stenosis murmur?

A

the location; pulmonic doesn’t have an ejection click nor does it radiate to the carotids

69
Q

Mitral regurgitation is a ______ murmur.

A

holocystolic/pancystolic

70
Q

What does holocystolic/pancystolic mean?

A

it lasts through all of systole to S2

71
Q

Describe the mitral regurgitation murmur and its shape.

A

starts right at S1, goes all the way to S2, and intensity stays the same throughout (flat); radiates to the axilla

72
Q

What happens to the L atrium in mitral regurg?

A

it becomes more compliant in order to accommodate the increased blood volume

73
Q

Describe a tricuspid regurgitation murmur.

A

a holocystolic, flat murmur in the tricuspid area that does not radiate to the axilla

CVPR Exam I COPY (29 decks)

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