Exam 1 - Valve dz Flashcards
(132 cards)
1
Q
What happens during S1? Sound?
A
Beginning of systole. CLosure of AV valves “Lub”.
2
Q
What sound when AV valves close? What’s happening?
A
S1 “lub”. Closure of AV valves=beginning of systole
3
Q
What happens during S2? Sound?
A
Closure of semilunar valves. End of systole. “Dub”.
4
Q
When does ventricular filling occur?
A
After S2
5
Q
When does ventricular ejection occur?
A
Between S1 and S2
6
Q
During which phase are the coronary arteries perfused?
A
Diastole
7
Q
What do open valves allow blood to do?
A
Blood to move forward
8
Q
What do closed valves allow blood to do?
A
Keep blood in chamber and prevent backflow
9
Q
What is definition of valvular disease?
A
Abnormal function of any one or more cardiac valves
10
Q
What sound is the hallmark of valve dz?
A
Murmur
11
Q
What is the etiolgoy of valvular heart dz in developing countries?
A
Rheumatic fever (strep)
12
Q
What is the etiolgoy of valvular heart dz in developed countries?
A
Degenerative or inflammatory processes
13
Q
What is ventricular remodeling?
A
Compensatory mechanism to increase load. Happens in LV more than RV.
14
Q
Aortic Sclerosis is long marker for what?
A
Long marker for further events
15
Q
What is the most common congenital heart dz?
A
Bicuspid aortic valve
16
Q
When to intervene with valve dz?
A
Based on symptom severity
17
Q
General tx for valve dz?
A
Repair or replace valve. Medical tx doesn’t really help.
18
Q
What is the #1 symptom of valve dz?
A
Dyspnea with exertion
19
Q
What test needed to diagnose regurg?
A
Doppler Echo
20
Q
What is “gold standard” for imaging valve morphology and motion?
A
2D Echo
21
Q
Valve stenosis is reliably diagnosed by which looking at what two things?
A
Increased valve thickness and decreased valve mobility
22
Q
Describe a stenotic valve and leaflets
A
Valve fails to completely open. Leaflets have decreased mobility, increased thickness, stiff, and fused
23
Q
What does a stenotic valve impede and cause?
A
Impeded forward flow of blood. Causes pressure overload!
24
Q
Pressure overload is found in which type of valve dz?
A
Stenotic.
25
What does pressure overload due to the left ventricle?
Causes concentric LV hypertrophy. Ventricle becomes thikc and stiff which reduces complaince and impedes filling.
26
What happens to valves during regurgitation?
Valves fail to completely close.
Incompetent, insufficient, leaking valves.
27
What happens to blood flow in regurgitation?
Back flow of blood as closing or leaking through after close.
28
What is overloaded in regurgitation?
Volume overload!
29
What causes volume overload in regurgitation? What does it result in?
Caused by flow reversal/backflow of blood. Results in eccentric hypertrophy.
30
What is the ventricular compensatory mechanism in regurgitation?
Comp mechanism maintains ventricular complaince as heart muscle wall thickens
31
What happens to ventricle area in regurgitation?
Dilation
32
Which test for regurgitation?
Doppler Echo
33
Concentric hypertrophy is consistent with which valve dz type?
Stenosis
34
Eccentric hypertrophy is consistent with which valve dz type?
Regurg
35
Rheumatic fever is associated with which two stenosic valves?
Tricuspid stenosis
| Mitral/Bicuspid stenosis
36
What is the etiology of Mitral Valve Stenosis?
Hx of rhematic fever. Thickening of leaflets, fusion of commisures, and fused chordae. Calcium deposits in valves.
37
What happens to bloof flow and chambers Mitral Valve Stenosis? Pressure?
Obstructed flow between Left Atrium and Left Ventricle. Causes LA hypertrophy. Pressure overload!
38
Describe the murmur in Mitral Valve Stenosis (Hint: rumble and snap?)
Diastolic rumble at apex in left lateral position. Opening snap following S2.
39
Which valve dz do you hear a diastolic rumble at apex in left lateral position and opening snap following S2?
Mitral valve stenosis
40
Which valve dz is pathoneumonic for an opening snap following S2?
Mitral valve stenosis
41
What is the #1 PE finding in Mitral Valve Stenosis?
Irregular pulse due to afib.
42
Sx in Mitral Valve Stenosis?
Insiduous onset of cough, orthopnea, fatigue, palpitations.
43
EKG findings in Mitral Valve Stenosis?
Afib, RVH, LA enlarged
44
Pulmonary sx in Mitral Valve Stenosis?
Pulm edema, pulm HTN, decreased exercise intolerance
45
What atrial arrythmia can Mitral Valve Stenosis induce?
Afib
46
How can preggers increase Mitral Valve Stenosis risk?
Increased CO
47
Tx of Afib in Mitral Valve Stenosis?
Convert to NSR, rate control, long-term anticoagulation
48
What do you need to control in order to reduce pulm edema?
Control HR
49
When to do surgery in Mitral Valve Stenosis?
When symptoms are bad
50
TOC in Mitral Valve Stenosis?
PMBV
51
When to replace mitral valve instead of PMBV in Mitral Valve Stenosis?
If combo stenosis and regurgitation present
53
Two types of Mitral Valve Regurg?
Organic=primary abnormality in 1+ valve apparatus from degeneration. #1 in developed countries.
Functional=2nd causes CAD #1->Ischemia or Infarct->LV dilation
54
What are etiologies of Mitral Valve Regurg?
Mitral valve propalse is #1. S/P MI, ruptured chordae.
55
Backflow in Mitral Valve Regurg affects which cambers and output?
Backflow from LV to LA. Causes LV volume overload and LV hypertrophy. Reduces CO.
56
What is overloaded in Mitral Valve Regurg?
Volume overload!
57
Pulm HTN means what in Mitral Valve Regurg?
Severe Mitral Valve Regurg
58
Murmur in Mitral Valve Regurg?
Systolic murmur. Holosystolic/pansystolic at apex and radiation to axilla. S3 heard on ascultation
59
Which valve dz is a Holosystolic/pansystolic murmur heard at apex and radiation to axilla?
Mitral Valve Regurg
60
What happens to LV in Mitral Valve Regurg? (Hint: not just LVH)
LV hypertrophies and dilates
61
Chronic signs/sx in Mitral Valve Regurg?
Dyspnea, SOB, pulm edema, orthopnea, progressive LVD within 6-10 years
62
Acute signs/sx in Mitral Valve Regurg?
Heart failure, cardiogenic shock, severe pulm edema
63
PE for Mitral Valve Regurg?
S3 heart sound, JVD, ronchi, rales wheezes
64
EKG in Mitral Valve Regurg?
Double hump P-wave in II, V4, V5, V6. Left atrial abnormality (enlarged).
65
Double-hump P-wave in II, V4-V6 from which valve dz?
Mitral Valve Regurg, d/t left atrial abnormality
66
CXR in Mitral Valve Regurg shows?
Increased LA, LV, and Pulm Edema
67
Mitral Valve Regurg LV enlargement reflects what?
Severity and chronicity of regurg
68
Severe LV volume overload leads to what?
LV failure and reduced CO
69
Tx Mitral Valve Regurg based on what?
Based on symptoms, Pulm HTN, LV dilation w/reduced contractility, or LV dysfunction (EJ less than 60%)
70
What is most common congenital valve lesion?
Mitral Valve Prolapse
71
Mitral Valve Prolapse is #1 cause of what?
Mitral Valve Regurg
72
Mitral Valve Prolapse often in what population?
Young women
73
Murder heard with Mitral Valve Prolapse?
One or many mid-systolic click.
Worse w/valsalva. Better w/leg elevation.
74
One or more mid-systolic clicks better with leg elevation and worse with valsalva is which dz?
Mitral Valve Prolapse
75
Test to dx of Mitral Valve Prolapse?
Echo. TTE is fine.
76
Sx of Mitral Valve Prolapse?
Usually asymptomatic. Sometimes CP, palpitations, fatigue, and panic.
77
Tx of Mitral Valve Prolapse?
Beta-blockers for CP, palpitations, or panic
Mitral valve repair/replacement if progress into severe mitral regurg.
78
Who gets Aortic Stenosis most often?
When parent has had it. Congenital defect.
79
Aortic Stenosis does what with blood?
Obstructs blood flow from LV to aorta
80
What type of overload in Aortic Stenosis?
Pressure overload!
81
Congenital Aortic Stenosis leaflets look like?
1 or 2 leaflets. Normal is 3.
82
Pathological Aortic Stenosis leaflets look like?
Valves degenerated or calcified
83
Which other dz often happens with Aortic Stenosis?
Coartation of aorta
84
Describe Murmur in Aortic Stenosis?
Systolic ejection murmur. Paradoxical S2 split. LV heave or thrill if severe.
85
Systolic ejection murmur and paradoxical S2 split heard in which dz?
Aortic stenosis
86
LV heave or thrill in which dz?
Severe aortic stenosis
87
Sx in Aortic Stenosis?
CHF-like sx. Dyspnea, fatigue, orthopnea. Worse with exertion.
88
Is Aotric Stenosis symptomatic in younger years?
No. Can be asymptomatic until mid or old age.
89
How to dx Aortic Stenosis?
Echo
90
When and how to tx Aortic Stenosis?
Surgery, if sx severe
91
Etiology of Aortic Regurg?
Aortic root dz from Marfan or EDS, Congenital bicuspid valves, IE, HTN, CAD
92
What are happening to valves and blood in Aortic Regurg?
Floppy valves. Blood backflow to LV.
93
What is overloaded in Aortic Regurg?
LV volume overload!
94
What happens to LV in Aortic Regurg?
LVH, LV dysfunction
95
Describe murmur in Aortic Regurg?
Diastolic Decrescents at right sternal border. Rumble at apex +/- Austin Flint maneuver.
96
Which dz do you hear a Diastolic-Decrescendo at right sternal border and rumbe at apex?
Aortic Regurg
97
Most common PE in Aortic Regurg?
SOB + Dyspnea
98
What does chronically high LV preload cause in Aortic Regurg?
Increased LVEDP causes LVH and LV dysfunction resulting in CHF
99
Aortic Regurg causes heart failure on which side?
Left sided heart failure
100
Pulse pressure and Aortic Regurg?
Widened pulse pressure on BP
101
Widended pulse pressure on BP in which dz?
Aortic Regurg
102
Chronic Aortic Regurg sx?
Dyspnea, CHF-like SOB, palpitations
103
Acute Aortic Regurg signs/sx?
Sudden pulm edema, hypotension, cardiogenic shock
104
Initial dx method for Aortic Regurg?
Doppler Echo
105
When to replace valve in Aortic Regurg?
Before irreversible myocardial dysfunction.
If LV less than 50% or LVESD more than 55.
106
Etiologies of Tricuspid Stenosis?
Rheumatic fever, carcinoid syndrome, IE, trauma
107
What is obstructed in Tricuspid Stenosis?
Obstructed blood flow from RA to RV
108
What is overloaded in Tricuspid Stenosis?
Pressure overload
109
What happens to RA in Tricuspid Stenosis?
Right atrial dilation
110
Systemic manifestations of Tricuspid Stenosis?
Hepatosplenomegaly, ascites, lower extremity pitting edema, peripheral edema
111
Which side heart failure in Tricuspid Stenosis?
Right sided. Pulm HTN
112
Murmur in Tricuspid Stenosis?
Mid-diastolic rumble at left lower sternal border (4th ICS). Open snap.
113
Which valve dz has mid-diastolic rumble at left lower sternal border (4th ICS) and Open snap.
Tricuspid Stenosis
114
Tricuspid Stenosis signs/sx?
Chronic pulm edema, severe COPD, right-sided HF/pulm HTN
115
Tricuspid Stenosis and neck sensation?
Neck pulsation d/t JVD
116
Tricuspid Stenosis and EKG findings?
Tall pointed P-waves (look like T-waves)
117
Tall pointed P-waves in which valve dz?
Tricuspid stenosis
118
Medical tx for Tricuspid Stenosis?
Diuretics
119
Surgical tx for Tricuspid Stenosis?
Bioprosthetic TVR is definitive care. Don't use mechanical valve d/t thrombosis, can't pass cath through it, and can't place pacemaker.
120
2 causes of Pulmonic Valve Regurg?
High-pressure=Pulm HTN #1 cause
Low-pressure=d/t dilated pulm annulus, bicuspid/dysplasic pulm valve, or plaque on pulm valve
121
What is overloaded and where in Pulmonic Valve Regurg?
Right sided volume overload!
122
Pulmonic Valve Regurg backlow from where to where?
From Pulm Art to RV
123
Pulmonic Valve Regurg murmur?
Loud P2 followed by rapidly attenuating early diastolic murmur
124
Which valve dz has a loud P2 followed by rapidly attenuating early diastolic murmur?
Pulmonic Valve Regurg
125
Sx of Pulmonic Valve Regurg?
Right sided HF sx. Peripheral edema, JVD, liver dz, etc
126
Tx for Pulmonic Valve Regurg?
Tx underlying cause
127
Bioprosthetic valves made of what? Last how long?
Porcine or bovine. Reoperation in 10-20 years.
128
Anticoagulation in bioprosthetic valve?
No lifelong anticoagulation. 3 months ASA after implantation.
129
Who best to use bioprosthetic valve?
Elderly. No anticoagulation and they might not outlive the valve.
130
Risk and prophylaxis with bioprosthetic valve?
Risk of IE increased.
Prophylax w/ABX if dental procedure on gingival or periapical areas.
131
Do mechanical valves degenerate?
No degeneration of mechical valves
132
Anticoagulation and mechanical valves?
Lifelong anticoagulation with Warfarin. Goal INR 2-3.
133
Mechanical valve better for who?
Better for younger PTs
