Cardiovascular Module #6

Question 1

What are the 2 types of valvular dysfnction?

Answer 1

Stenotic

Insufficiency

Question 2

Which side of the of heart is it more common to have valve disorders?

Answer 2

Left Side

Question 3

What happens in stenotic conditions?

Answer 3

Narrowing of the orifice of the valve which restricts blood flow throught

Question 4

What are the causes of aortic valve (left semilunar) sentosis?

Answer 4

Congenital = abnromal formation of the valve (have bicuspid valve instead of normal tricuspid valve)

Degenerative Changes

Inflammatory secondary to rheumatic heart disease

Question 5

What are the primary mechanical effects on the cardiac pump?

Answer 5

Reduced outflow of left ventricle = incomplete empyting of L ventricle/increased end-systolic LV pressure

Question 6

What are the secondary mechanical effects on the cardiac pump?

Answer 6

Hypertrophy of L ventricle as compensation to increased workload

Question 7

What are the output changes seen in aortic valve stenosis?

Answer 7

↓SV/↓CO

↓systolic BP

↓pulse pressure

Question 8

What are the cardiac pressure/congestion changes seen in aortic valve stenosis?

Answer 8

↑ left atrial pressure (↑ PCWP)

pulmonary HTN

↑ pulmonary pressures –> edema

Question 9

What are the symptoms of aortic valve stenosis?

Answer 9

Dyspnea on exertion (DOE)

Syncope

Angina Symptoms

Can progress to heart failure

Question 10

When would you hear the heart murmur w/ aortic valve stenosis?

Answer 10

Systolic

Question 11

What is the cause of mitral (L AV valve) stenosis?

Answer 11

Rheumatic Heart Disease

Question 12

What are the primary mechanic effects on the cardiac pump seen in mitral stenosis?

Answer 12

Reduced outflow of L atria = incomplete emptying of L atria/increased LA pressures

Question 13

What are the secondary mechanical effects on the cadiac pump seen in mitral stenosis?

Answer 13

L atria dilation d/t incomplete emptying of L atria

Hypertrophy as compensation to increased workload

Question 14

What are the output changes seen w/ mitral stenosis?

Answer 14

Potential exertional insufficiency of ↓SV/↓CO

**heart is able to compensate during rest, but you see defect during exercise when you would need to pump faster

Question 15

What are the cardiac pressure/congestion changes you see w/ mitral stenosis?

Answer 15

↑ left atrial pressure (↑ PCWP)

pulmonary HTN

↑ pulmonary pressures –> edema, right ventricular congestion/failure

Question 16

What kind of symptoms do you see w/ mitral stenosis?

Answer 16

Prominent pulmonary symptoms/complications d/t pulmonary HTN/edema:

   Dyspnea on Exertion

   Orthopnea (difficult breathing laying 
   down/easier sitting up)

   Nocturnal Dyspnea

Non-angina type chest discomfort (atypical chest pain)

Question 17

When do you hear the heart murmur w/ mitral stenosis?

Answer 17

Diastolic

**narrowed AV valve during ventricular filling

Question 18

Generally what is the problem in regurgitation conditions?

Answer 18

Insufficiency or incompetence

Inability of valve to completely close allows back-flow of blood

Question 19

What are the primary mechanical effects on the cardiac pump in aortic valve insufficiency/incompetence?

Answer 19

During ventricular relaxation (diastole) blood from aorta “back-flows” into L ventricle –> increased end-diastolic filling volumes of L ventricle

Question 20

What are the primary output changes seen in aortic valve insufficiency/incompetence?

Answer 20

↑ SV/CO to accommodate for “back-flow loss”

Question 21

What are the primary pressure changes seen in aortic valve insufficiency/incompetence?

Answer 21

“spread out”↑ systolic BP

↓ diastolic BP

↑ pulse pressure

Question 22

What are the secondary mechanic effects seen in aortic valve insufficiency/incompetence?

Answer 22

L Ventricle Dilation (to compensate/maintain SV/CO volumes)

L Ventricle Hypertrophy (to compensate for increased workload w/ larger SV/CO)

Question 23

What are the secondary cardiac pressure/congestion changes?

Answer 23

↑ pulmonary pressure and edema

Question 24

Clinically what are the symptoms seen with aortic valve insufficiency/incompetence?

Answer 24

Angina type discomfort

Dyspnea on Exertion

Bounding peripheral pulses (d/t pulse pressure changes)

Question 25

When do you hear the murmur associated w/ aortic valve insufficiency/incompetence?

Answer 25

Diastolic

Question 26

What are the primary mechanical effects on the cardiac pump in mitral insufficiency/incompetence?

Answer 26

Back flow of blood into L atria during ventricular contraction (systole)...leads to: increased L atrial volumes/pressures left atrial dilation/hypertrophy viscous cycle as atrial dilation may enlarge mitral valve even more Eventually compensation fails to maintain CO and heart failure occurs

Question 27

When do you hear the murmur in mitral valve insufficiency/incompetence?

Answer 27

Systolic

Question 28

What is the most common valve disorder in the US?

Answer 28

Mitral Valve Prolapse Syndrome

Question 29

What happens in mitral valve prolapse syndrome?

Answer 29

Enlarged cusps of mitral valve prolapse back (billow back) into L atrium during systole May develop mitral valve regurgitation

Question 30

What are the symptoms of mitral valve prolapse syndrome?

Answer 30

Have large continuum of presentation/prognosis --> no symptoms - symptoms (most have good prognosis w/o symptoms/complications) Might hear mid-systolic click or systolic murmur

Question 31

What causes tricuspid (R AV valve) insufficiency/incompetence?

Answer 31

Congenital Secondary to pulmonary HTN pathologies

Question 32

What are the mechanical effects on the cardiac pump in tricuspid insufficiency/incompetence?

Answer 32

Pulmonary HTN/congenital regurgitation causes back flow into R atria, leads to: increased R atrial pressures --> increased venous pressures (increased CVP) increased atrial volumes/pressures --> R ventricular volumes/pressures R ventricular hypertrophy/dilation to compensate/maintain CO

Question 33

What are some of the symptoms seen w/ tricuspid (R AV) insufficiency/incompetence?

Answer 33

Distended Jugular Veins Lower extremity/generalized edema

Question 34

When do you hear the heart murmur w/ tricuspid (R AV) insufficiency/incompetence?

Answer 34

Systolic