CVPR 312 Valve Disease Flashcards Preview

CVPR 312 Cardiac Pathophysiology > CVPR 312 Valve Disease > Flashcards

Flashcards in CVPR 312 Valve Disease Deck (62):
1

"LUB" sound. What does this mean?

- AV valve closes (beginning of systole)
- 1st heart sound

2

"DUB" sound. What does this mean?

- Semilunar Valve closure (End of systole)
- 2nd heart sound

3

2/3 of patients with valve disease are?

Acquired stenosis

4

Rheumatic Fever - develops in _____ of all Group A, ß hemolytic streptococci infections.

0.3 - 3 %

5

Autoimmune disease in nature in which the heart valves are likely to be damaged.

Rheumatic Fever

6

In the diagnosis of Rheumatic Fever, what is the Jones criteria?

2 major manifestations, or
1 major & 2 minor manifestations.

7

5 major manifestations of Rheumatic Fever?

1.) Migratory Polyarthritis
2.) Carditis
3.) Subcutaneous Nodules
4.) Erythema Marginatum
5.) Sydenham's chorea

8

Sydenham's chorea

(neurologic syndrome-dancing movements of muscles)

9

Erythema Marginatum

reddening of the skin with center areas faded.

10

Migratory Polyarthritis

Migratory arthritis occurs when pain spreads from one joint to another. In this type of arthritis, the first joint may start to feel better before pain starts in a different joint.

11

The chance of relapse is much ________after initial attack; antibodies against strep & patients own tissues are just waiting to be triggered into action

Higher

12

Rheumatic Fever mortality rate ?

1%

13

Acute Pericarditis

seepage of serum and fibrin into pericardial cavity

14

Acute Myocarditis

Ashcoff Bodies

15

Endocarditis

acute valve damage
- Edema of valve leaflet
- Fibrin/platelet deposition along edge of
valve

16

Ashcoff Bodies

nodules found in the hearts of individuals with rheumatic fever. They result from inflammation in the heart muscle and are characteristic of rheumatic heart disease.

17

(Anitschkow cells)

large macrophages

18

Rheumatic Heart Disease (RHD)

RHD is a complication of recurrent attacks of RF.

19

A single episode of RF usually leaves what behind?

little residual deformity

20

From Inflammatory Stage to
Healing Stage, the patient may be impacted by the following:

- Fusion of Commisure
- Funneling of AV valves
- Calcification

21

What percentage of infections progress to RF ?

3%

22

What percentage of patients with Rheumatic Fever suffer from mitral valve involvement as well?

70%

23

What percentage of patients with Rheumatic Fever have combined mitral and aortic valve involvement ?

25 %

24

Mitral valve involvement > in ?

women

25

Aortic valve involvement >

Men

26

Mitral Valve Stenosis Etiology?

- Rheumatic heart disease if Female
- Congenital

27

Time frame for developing severe Mitral valve stenosis after Acute Rheumatic Fever (ARF) ?

Minimum of 2 yrs

28

With MItral Valve Stenosis pressures elevate in the: LA, Pulmonary tree, and Right Heart which lead to ?

Pulmonary Edema & RV Hhypertrophy

29

Atrial Contraction represents what percentage of C.O?

30%

30

Mitral stenosis is the only valvular defect which does not affect what ?

LVEDP or LV muscle mass

31

During ventricular filling (diastole), LAP exceeds LVP gnerated by what?

Stenosis

32

Treatment for a patient with mitral valve stenosis who is Asymptomatic ?

Just follow that patient

33

Treatment for a patient with mitral valve stenosis who is Symptomatic ?

- Balloon Valvuloplasty
- Open commissurotomy
- Valve replacement
Mechanical
Bio-prosthetic

34

CBP concerns for a patient with Mitral Valve Stenosis?

- Hypervolemic
- Bicaval cannulation
- CLP required for myocardial protection
- Dearing should not be excessive,
the heart is normal size.

35

Chronic MR patient LA presentation ?

↑ LA pressures /slow LA adaptation = ↑ compliance
↑ PA pressure & PAWP

LV Dilation
- Enable ↑ SV to enable forward flow
- ↑ LVEDP (mild)

36

Acute MR patient LA presentation ?

LA is non-compliant
- Rapid change in LA pressure = rapid ↑ in pulmonary congestion
- Pulmonary Edema present

37

Chronic MR patient LV presentation ?

LV Dilation
- Enable ↑ SV to enable forward flow
- ↑ LVEDP (mild)

38

Acute MR patient LV presentation ?

The LV has not had time to distend and hypertrophy which creates a decrease in forward flow.
**** EMERGENT CASES ******

39

During ventricular contractions (systole), the left ventricle eject blood back into ?

LA & Aorta, thereby increasing the LAP
(particularly the V wave)

40

CPB considerations with patients who suffer from CHRONIC MR?

- Hypervolemic
- Bicaval cannulation
- Venous air is normal due to retraction.
- Increased needs of Myocardial protection due to LVH,
even more with co-existing CAD.
- De-airing is critical

41

CPB considerations with patients who suffer from ACUTE MR?

- Hypovolemic due to resuscitation efforts.
- Bicaval cannulation
- Venous air is normal due to retraction.
- Warm induction for myocardial protection.
- De-airing is critical

42

Mitral valve prolapse AKA

Floppy valve syndrome. It allows backflow of blood into the LA causing progressive enlargement.

43

3 - 5% of the population with 97% being asymptomatic describes what disease ?

Mitral valve prolapse

44

Mitral valve prolapse presents in pts between 20 - 40 y/o. It is most common in ?

Women

45

Etiology of Aortic Valve Disease ?

- RHD
- Congenital AV Disease
- Stenotic from birth
- Bicuspid Aortic Valve (Most Common in CHD) - Idiopathic Calcific Aortic Stenosis

46

During ventricular ejection, LVP exceeds AP in patients with ?

Aortic Valve Stenosis

47

Hemodynamic Changes of AS ?

- LV hypertrophy (LVH)
- Elevation of LVEDP
- LV dilation

48

LV dilation may occur when contractile state of myocardium becomes depressed

LVEDP continues to rise
LA pressure rises
PA pressure rises
Eventual RV failure

49

CPB concerns with patients who have Aortic Valve Stenosis ?

- Hypovolemic with ↑SVR
- Single 2-Stage cannulation
- Venting though the Right Superior Pulmonary Vein
- Higher Cardioplegia requirements

50

Degenerative valvular changes with ________ (repeated mechanical stress) and/or atherosclerosis

age

51

Calcific Aortic Stenosis Common with

congenitally unicuspid (rare) or bicuspid valves (1%)

52

Calcific Aortic Stenosis is frequently ?

Asymptomatic

53

Aortic Valve Stenosis causes increased pressures across the valve and an increase in?

proximal chamber

54

Etiology of Aortic Valve Regurgitation ?

Rheumatic Heart Disease
Infective Endocarditis
Trauma
Tear of the ascending aorta
Bicuspid valve
Aortic Root Disease

55

Aortic Root Disease can be a result of the following syndromes?

Marfan’s
Cystic Medial Necrosis
Syphilitic aortitis
HTN

56

Describe the hemodynamics during Aortic Valve Regugitation ?

During ventricular relaxation, blood flows backwards from the Ao into the LV.
Aortic systolic pressure increases,
Aortic diastolic pressure decreases,
pulse pressure increases, and
LAP increases.

57

Chronic AI patient presentation ?

- Gradual LV volume overload
- Gradual increase in LVEDP
- LV stroke volume increases by compensatory dilation
- LVH

58

Acute AI patient presentation ?

- Sudden LV volume overload
- Rapid increase in LVEDP
- May exceed LA pressures and cause MV pre-closure

59

CPB concerns with patients who have Chronic AI ?

- Hypervolemic
- Single 2-Stage Venous
- CPB initiation slowly t prevent distention
- Increased need for CLP due to LVH
(Antegrade CLP may be ineffective)
(Ostial Delivery maybe required.)
- De-airing is critical

60

Effective C.O. =

Q - LV vent Q

61

Types of Valvular Replacement ?

- Biological Prosthetic
- Artificial Prosthetic

62

4 Complications of Valvular Replacement

- Mechanical Deterioration
- Infective endocarditis
- Paravalvular leak
- Clot Formation