CVPR Week 3: Pathophysiology of valvular heart disease Flashcards
(108 cards)
1
Q
Objectives
A
2
Q
Normal aortic valve: # of cusps
A
3 cusps
right, left and non-coronary
3
Q
Normal aortic valve: Thickness
A
0.5 - 2mm
4
Q
Normal aortic valve: Length
A
1.5 - 2 cm
5
Q
Normal aortic valve: Area
A
3 - 5 cm2
6
Q
Normal aortic valve: Annulus
A
1.8 - 2.7 cm
7
Q
Normal aortic valve: Aortic root
A
~ 3.5 cm
8
Q
Normal aortic valve: Trivial regurgitation
A
0 - 2 %
9
Q
Normal aortic valve
A
10
Q
Aortic Stenosis: Valve area
A
when the aortic valve area is 1 cm2 or less
this is severe aortic stenosis
11
Q
Normal aortic valve: Echocardiograph
A
12
Q
Normal Mitral Valve: leaflets
A
2 leaflets
Anterior and posterior leaflets
13
Q
Normal Mitral Valve: leaflet structure
A
Each leaflet is divided into 3 scallops: AL, Mid and PM
14
Q
Normal Mitral Valve: Leaflets thickness
A
0.7 - 3 mm
15
Q
Normal Mitral Valve: D shape
A
AntPost < MedLat diameter
16
Q
Normal Mitral Valve: valve area
A
4 - 6 cm2
17
Q
Normal Mitral Valve: annulus
A
fibromuscular annulus
18
Q
Normal Mitral Valve: what structures are involved in the action of the valve?
3 listed
A
- Chordae Tendinae
- AL and PM Papillary muscles
- LV walls
19
Q
Normal Mitral Valve: etiology from dysfunction in what structures?
3 listed
A
Pathology in
- chordae tendinae
- AL and PM papillary muscles
- LV walls
can lead to mitral valve dysfunction
20
Q
Normal Mitral Valve: Trivial to mild Regurgitation
A
30 - 45 %
21
Q
Normal Mitral Valve
A
22
Q
Normal Mitral Valve: Echo
A
23
Q
Identify
A
24
Q
Identify phases
A
25
Identify
26
Types of valvular heart disease
4 listed
* Aortic stenosis
* Aortic regurgitation
* Mitral regurgitation
* Mitral stenosis
27
Aortic stenosis brief description
narrowing of the aortic valve area causing obstruction to LV ejection
28
Mitral stenosis brief description
narrowing of Mitral valve area causing obstruction to LV filling
29
Aortic regurgitation brief description
Backflow from the aorta to the LV
30
Mitral regurgitation brief description
Backflow from the LV to the LA
31
Aortic stenosis common etiology
* younger than 70 50% congenital bicuspid valve
* Older than 70 48% degenerative
* post inflammatory or rheumatic
* radiation therapy to the chest
32
Bicuspid aortic valve description
A bicuspid aortic valve (BAV) is an aortic valve that only has two leaflets, instead of three. The aortic valve regulates blood flow from the heart into the aorta. The aorta is the major blood vessel that brings oxygen-rich blood to the body.
33
Pathology of aortic stenosis
34
Aortic Stenosis: Echo
35
Aortic Stenosis: Hemodynamic consequences
6 listed
36
Identify hemodynamic changes in aortic stenosis
37
Pathophysiology of aortic stenosis
* the LV systolic pressure increases to open the aortic valve
* LV hypertrophy occurs from chronic increased LV pressure
* LV compliance decreases and so LA pressure and end diastolic pressure increases
* aortic pressure is decreased from a reduced stroke volume
* reduced coronary perfusion during diastole
* so increased oxygen demand and reduced perfusion/supply
also
*
38
Coronary blood flow in Aortic stenosis
* reduced end-diastolic volume
* ventricular is less compliant
* ventricle end-diastolic pressure is increased
* aortic diastolic pressure is decreased so the epicardial pressure gradient is decreased and therefore the coronary blood flow is decreased and eventually leads to myocardial ischemia
39
the thicker the heart muscle is...
, the less compliant it becomes
40
Pressure-volume loop of compensated aortic stenosis
6 listed
41
End-systolic pressure curve in compensated aortic stenosis
shifted to left
42
Pressure-volume loop of decompensated aortic stenosis
6 listed
now the ventricle doesnt eject normally and so the LVES volume is increased because LV contractility has decreased as a result of myocardial ischemia from chronic pressure overload and LV systolic dysfunction
43
difference between compensated and decompensated aortic stenosis
44
Symptoms of aortic stenosis
45
Characteristic symptoms of aortic stenosis
* Angina
* Syncope (exercise related too!) (exercise related syncope)
* Heart failure
46
Aortic stenosis murmur
the later the intensity murmur peaks the worse it is
47
auscultation of aortic stenosis
48
Aortic stenosis best heard
right sternal border 2nd intercostal with the diaphragm
49
Aortic stenosis severity sound
the later the murmur peaks the more severe the stenosis
50
Treatment of aortic stenosis
TAVR is evolving
51
Aortic regurgitation mechanisms
4 listed
* Primary disease of the leaflets
* Aortic root diseases
* Acute processes
* Chronic processes
52
Aortic regurgitation mechanisms: Primary disease of leaflets causes
3 listed
* Aging
* Infection
* Inflammation
53
Aortic regurgitation mechanisms: Aortic root diseases
3 listed
* Dilation
* Aneurysm
* Dissection
54
Aortic regurgitation mechanisms: Acute processes causes
3 listed
* Infective endocarditis
* Dissection of the aorta
* Traumatic injury
55
Aortic regurgitation mechanisms: Chronic processes causes
5 listed
* Bicuspid aortic valve
* aortic root dilation
* Previous endocarditis
* Rheumatic disease
* Connective tissue diseases
56
Aortic regurgitation echo: holes in the leaflets on this echo
quadricuspid valve on this
57
Endocarditis
Endocarditis is an infection of the endocardium, which is the inner lining of your heart chambers and heart valves.Endocarditis generally occurs when bacteria, fungi or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart.
58
Marfans aortic regurgitation
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Hemodynamics of chronic aortic regurgitation
6 listed
60
Describe hemodynamic changes of chronic aortic regurgitation
6 listed
61
Aortic regurgitation murmur
decrescendo diastolic murmur & an associated flow related systolic murmur
62
Acute Aortic regurgitation
* large regurgitant volume coming to a non-adapting, non-dilating, non-accommodating ventricle so it can only dilate minimally, get a rapid increase in end-diastolic pressure translating into high atrial pressure, high pulmonary capillary pressure and pulmonary edema which is the mean pathophysiology of acute aortic regurgitation from such a sudden onset of end-diastolic volume.
* As the ventricle responds by increasing HR and contractility but diastolic filling period is decreased but there is a further decrease of CO and eventually leads to relative ischemia and myocardial dysfunction
* Both combined lead to heart failure
63
Hemodynamics of Acute Aortic regurgitation
64
Describe the hemodynamic changes of Acute Aortic regurgitation
65
Effect of Aortic regurgitation on oxygen consumption
so have increased demand and reduction in supply
66
Describe changes of PV loop in Hemodynamics of chronic compensated Aortic regurgitation
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Describe changes of PV loop in Hemodynamics of chronic decompensated Aortic regurgitation
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Murmurs of Aortic regurgitation
69
Treatment of aortic regurgitation
4 listed
* medical therapy
* Valve replacement
* Aortic root repair with spare of native valve
* Aortic root repair with valve replacement
70
Treatment of aortic regurgitation: Medical therapy
Afterload reduction with CCBs (Nifedipine), ACEI (lisinopril) or ARBs (losartan)
71
Treatment of aortic regurgitation: Valve replacement
2 listed
* Bioprosthetic valve
* Mechanical valve
72
Treatment of aortic regurgitation: Aortic root repair
2 listed
Aortic root repair with spare of the native valve or with a valve replacement
73
Mitral Regurgitation etiology
* 60% degenerative
* 20% Ischemic
* 20% other including Rheumatic fever and endocarditis
74
Pathology of mitral valve prolapse
75
Acute mitral regurgitation by Echo
76
Chronic mitral regurgitation by Echo
77
Hemodynamics of mitral regurgitation
6 listed
78
Describe the hemodynamic changes of mitral regurgitation
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Pathophysiology of mitral regurgitation
7 listed
80
PV Loop of Acute Mitral Regurgitation
81
Describe PV Loop changes of Acute Mitral Regurgitation
82
PV Loop of chronic compensated Mitral Regurgitation
9 listed
83
Describe PV Loop changes of chronic compensated Mitral Regurgitation
84
Pathophysiology of chronic decompensated Mitral Regurgitation
8 listed
85
The murmur of Mitral regurgitation
86
Auscultation of Mitral Regurgitation
87
Treatment of Mitral Regurgitation
3 listed
* Surgical repair
* Percutaneous Repair
* Valve replacement
88
Treatment of Mitral Regurgitation: Surgical Repair
2 listed
* Quadrangular resection
* Mitral annuloplasty
89
Treatment of Mitral Regurgitation: Percutaneous repair
Mitral valve clip
90
Treatment of Mitral Regurgitation: Valve Replacement
2 listed
* Bioprosthetic valve
* Mechanical valve
91
Mitral Stenosis: Etiology
2 listed
\>95% Rheumatic Fever
Congenital, infection, tumor, throbus or drugs \<5%
92
Mitral Stenosis Pathophysiology
4 listed
93
Mitral Stenosis by Echo
94
Hemodynamics of mitral stenosis
7 listed
95
Describe Hemodynamics changes of mitral stenosis
7 listed
96
Pathophysiology of Mitral stenosis
97
PV Loop of mitral stenosis
4 listed
98
Describe PV Loop changes of mitral stenosis
99
Auscultation of Mitral stenosis
100
Treatment of mitral stenosis
3 listed
* Temporary Medical Rx
* Percutaneous repair
* Valve replacement
101
Treatment of mitral stenosis: Temporary Medical Rx
2 listed
Atrial fibrillation/flutter
* Warfarin
* A-V nodal blockers
102
Treatment of mitral stenosis: Percutaneous repair
MV balloon valvuloplasty
103
Treatment of mitral stenosis: Valve replacement
2 listed
* bioprosthetic valve
* Mechanical valve
104
Summary of valvular heart disease
4 listed
105
Aortic stenosis summary
2 listed
Obstruction to LV ejection (systole)
↑ afterload = LV pressure overload
106
Aortic regurgitation summary
* Backflow from aorta to LV (diastole)
* ↑ LV preload and afterload = LV volume + pressure overload
107
Mitral regurgitation summary
2 listed
* Backflow from LV to LA (systole)
* ↓ LV afterload & ↑ LV + LA preload = LV + LA volume overload
108
Mitral stenosis summary
2 listed
* Obstruction to LV filling (diastole)
* ↓ LV preload & ↑ LA preload & afterload = LA volume + pressure overload
