Cardiac Module 6

Question 1

Two types of valve dysfunction

Answer 1

Stenosis

Insufficiency (regurg)

Question 2

Valve disorders are more common in which side of the heart?

Answer 2

LEFT

Question 3

Define stenosis of a valve

Answer 3

Valve doesn’t open all the way

Not enough blood passes through

Question 4

Define regurgitation of a valve

Answer 4

Valve doesn’t close all the way

Blood leaks backwards

Question 5

Aortic valve stenosis etiologies

Answer 5

• Congenital
• Degenerative
• Inflammatory (rheumatic fever/disease)

Question 6

Rheumatic fever

Answer 6

• Post-infectious systemic inflammatory response due to strep bacteria
• Affects joints, skin, CNS, heart

Question 7

Rheumatic heart disease

Answer 7

• Inflammation a/w rheumatic fever

- Can scar/deform valves

Question 8

What are the primary effects of aortic stenosis?

Answer 8

• Reduced outflow of LV
• Increased EDLV
• Decreased output (SV/CO/BP)

Question 9

What are the secondary effects of aortic stenosis?

Answer 9

• LV hypertrophy

- Increased LA pressure, pulm pressures

Question 10

Clinical signs of aortic stenosis?

Answer 10

• DOE, angina

- Systolic murmur (R parasternal 2nd ICS)

Question 11

Mitral valve stenosis etiologies

Answer 11

• Rheumatic heart disease (MC cause)
• Degenerative not as common
• Females

Question 12

What are the primary effects of mitral stenosis?

Answer 12

• Reduced LA outflow
• Increased LA volume/pressure
• Decreased output (SV/CO)

Question 13

What are the secondary effects of mitral stenosis?

Answer 13

• LA dilation d/t incomplete emptying
• Increased LA pressure, pulm pressures
• Increased A wave due to pulm congestion
• Ischemia of atrial wall
• Atrial arrhythmias

Question 14

Clinical signs of mitral stenosis?

Answer 14

• Progressive dyspnea (from pulm HTN/congestion)
• Non-angina type chest discomfort
• Diastolic heart murmur (Left 5th ICS-MCL)

Question 15

Aortic insufficiency etiologies

Answer 15

• Congenital

- Rheumatic heart disease, bacterial endocarditis, CAD, other systemic diseases

Question 16

Primary effects of aortic regurg?

Answer 16

• Blood from aorta back flows into LV during diastole
• Increased EDV in LV
• Increased output (SV/CO)

Question 17

Secondary effects of aortic regurg?

Answer 17

• Dilation and hypertrophy of LV
• Potential for arrhythmias
• Heart failure

Question 18

Clinical signs of aortic insufficiency?

Answer 18

• Bounding peripheral pulses (increased pulse pressures)
• Progressive onset of symptoms
• Diastolic heart murmur (R parasternal 2nd ICS)

Question 19

Mitral insufficiency etiologies?

Answer 19

• Rheumatic heart disease, endocarditis, CAD

- Mitral valve prolapse progressing to regurg

Question 20

Effects of mitral insufficiency?

Answer 20

-Increased LA volumes and pressures

Question 21

Clinical signs of mitral insufficiency?

Answer 21

• DOE

- Systolic heart murmur (L 5th ICS-MCL)

Question 22

What is the MC valve disorder in the US?

Answer 22

Mitral valve prolapse syndrome

Question 23

What is mitral valve prolapse syndrome?

Answer 23

Enlarged cusps of mitral valve prolapse back into LA during systole

Question 24

Describe the pathogenesis of mitral valve prolapse

Answer 24

• Enlargement of valve caused by abnormal connective tissue accumulation/degeneration in the leaflets
• Cusps billow back into atria
• Chordae tendineae become stretched
• Eventually cusps cannot fully close and regurg develops

Question 25

Clinical signs of mitral valve prolapse?

Answer 25

- May be symptomatic or not - Midsystolic click OR systolic murmur - Most pts have good prognosis

Question 26

Tricuspid insufficiency etiologies

Answer 26

Congenital | Secondary result of pulm HTN pathologies

Question 27

Effects of tricuspid insufficiency?

Answer 27

- Increased RA pressures --> increased CVP | - Distended jugular veins, lower extremity edema

Question 28

Clinical signs of tricuspid insufficiency

Answer 28

-Systolic heart murmur (L 5th ICS-PSL)