Flashcards in Clinical Valvular Heart Disease Deck (34):
What are murmurs?
turbulent flow heard across a valve that results from structural alterations of any one or all of the components of the valve apparatus.
What are the components of the valve?
What is a murmur caused by a primary lesion?
a murmur caused by an intrinsic abnormality of the valve apparatus.
What is a murmur caused by a secondary lesion?
a murmur caused by a chamber dilation.
What are 4 ways we can diagnose valvular heart disease?
2. Chest radiography
4. Cardiac catheterization
What will an EKG show with right atrial enlargement?
tall P waves (2.5 blocks) in lead II
What will an EKG show with left atrial enlargement?
P wave in V1 will be >1 block wide and tall.
*What bacteria is associated with acute rheumatic heart disease?
Streptococcus pyogenes (aka. group A strep)
Which valve is most commonly affected in acute rheumatic fever?
What can cause Tricuspid regurgitation (insufficiency)?
- leaflet abnormalities (may be secondary to endocarditis or rheumatic heart disease)
- Ebstein's anomaly= most common congenital form
- ischemia of the papillary muscles
- RV dilatation (may be due to left heart failure or pulmonary hypertension)
What directions do the colors on the doppler correspond to?
***What is Ebstein's anomaly?
a congenital malformation in which there is apical displacement of the septal and posterior tricuspid valve leaflets leading to ATRIALIZATION of the right ventricle (there is variable degree of malformation and displacement of the anterior leaflet). AKA the tricuspid valve is deeper into the ventricle than it should be.
What can carcinoid syndrome cause?
- due to an excess secretion of SEROTONIN that can cause right heart failure, wheezing, dyspnea, palpitations, low BP, fatigue, dizziness, and diarrhea.
What does serotonin do in excess from carcinoid syndrome?
vasodilation and may increase platelet aggregation, which may result in DIC :(
When is surgery indicated in patients with tricuspid regurgitation?
only if it is SEVERE and if:
-they are undergoing left-sided valve surgery.
-symptomatic with severe isolated primary tricuspid regurg.
- they have structural deformity of the valve, or if it is destroyed by bacterial endocarditis, or when ventricular dilation is uncontrolled with medical therapy.
****What is the coronary blood supply to the posteriomedial papillary muscle of the mitral valve?
single blood supply from the POSTERIOR DESCENDING branch of the dominant RCA.
This is associate with INFERIOR wall infarctions.
****Rupture of which mitral valve papillary muscle is associated with the most cases?
posteromedial papillary muscle.
****What is the coronary blood supply to the anterolateral papillary muscle of the mitral valve?
from obtuse marginal branches of the LCX and from diagonal branches of the LAD
What are the most common causes of organic mitral regurgitation?
- MVP syndrome
- rheumatic heart disease
- infectious endocarditis
- collagen vascular disease
- ruptured papillary muscle
- ruptured chordae tendineae
What are the grades of murmurs?
1= not readily heard
2= between 1 and 3
3= readily heard
4, 5= can feel a thrill
6= don't even need a stethoscope to hear it!
What should your suspicion be if there is hyperdynamic systolic function of the left ventricle on a TTE with acute heart failure?
severe mitral regurgitation
Is TTE or TEE better for mitral valve morphology?
TEE due to color of flow jet.
What is the treatment for acute severe mitral regurgitation?
**What is the most common cause of mitral stenosis?
What other some minor causes of mitral stenosis?
- Fabry's disease
- Whipple's disease
- mucopolysaccharidoses of Hunter-Hurler phenotype
- malignant carcinoid disease
What conditions can simulate the physiology of mitral stenosis?
- severe nonrheumatic mitral annular calcification
- infectious endocarditis w/ large vegetation
- left atrial myxoma= benign tumor of connective tissue.
- ball valve thrombus
- cor triatriatum
Do more men or women tend to have a bicuspid aortic valve?
men but only 1-2% of the population has them.
What will pts with a bicuspid valve develop over time?
severe aortic stenosis
***What is the triad of symptoms for aortic stenosis?
syncope, angina, dyspnea
What other congenital abnormalities may be associated with bicuspid aortic valve?
- coarctation of the aorta
- patent ductus arteriosus
- hypoplastic left heart syndrome
What are the 3 aortic stenosis etiologies?
1. congenital (unicuspid or bicuspid)
2. calcific (due to degenerative changes)
What is the leading indication for aortic valve replacement?
calcific aortic stenosis
What will you hear with aortic stenosis?
late peeping high-pitched murmur at the right sternal border.