Heart Valves

Question 1

Stenosis VS regurgitaion

Answer 1

If the valve does not open during systole, murmur is related to stenosis: pulmonic or aortic valve.

regurgitation valve should close during systole: mitral or tricuspid

Question 2

Systole:

Diastole:

Answer 2

Systole: pulmonic and aortic valves open, and the mitral and tricuspid close

Question 3

Valvular Flow

Answer 3

Mitral goes to aortic ( left side oxygenated)
Tricuspid goes to Pulmonary ( right unoxygenated )

Question 4

Valvular stenosis

Answer 4

Narrowing of valve HF occurs

Question 5

Valvular Regergitation

Answer 5

Incomplete closure of valve from scarring
cause blood to pump twice
dilates and hypertrophy
HF

Question 7

Casuse of Stenosis

Answer 7

Congential
Rheumatic
Senile

Question 8

causes of Regergitaion

Answer 8

Rhematic - acute or chronic
Infective- endo, dilated, cardiomyopathy
traumatic - valve rupture, papillar muscle
senile
congenital

Question 9

8 types of valve disorders

Answer 9

1. mitral stenosis .
2. mitral regergitaion
3. Aortic stenosis
4. Aortic Regurgitation
5. tricuspid stenosis
6. tricuspid regurgitation
7. Pulmonary stenosis
8. Pulmonary reurgitation

Question 10

mitral stenosis

Answer 10

usually from rheumatic HD
geriatric and HD patients
congenital
**hallmark elevated AV gradient
severe- you will see inc in PVR and PAP at rest and rising during exercise , inc RV pressure cause pulm HTN

Question 11

mitral stenosis
complications

Answer 11

1. afib
2. EF worsens
3. inc RV hypertrophy
4. emboli risk
   Symptoms:
   cough, SOB , orthopnea, pulm HTN
   RHF, edema , fatigue, AF, diastolic murmur
   CXR: straight L cardiac silloette

Question 12

Mitral stenosis management

Answer 12

1. diauretic
2. anticouagulation : DOAC not approved need coumadin
   INR: 2.5-3.5 ****
   mitral valve replacement needs lifelong anticoags
3. low NA
4. GAS prophylaxis
5. ventricular rate control : BB calcium channel blocker , dig with afib
6. pulmonary complications complicate this dx ; manage the infection

Question 13

Mitral Regergition

Answer 13

back flow of blood
Pulm congestion
L atrial dilation
dec blood into LV
dec CO
inc LA pressure
inc LA hypertrophy
inc in PA pressure
Inc in RV pressure

Question 14

mitral regurgitation
signs and symptoms

Answer 14

most predominate
fatigue and orthopnea
narrow pulse pressure
holosystolic murmur with split s2 and s3

Question 15

mitral regurg management

Answer 15

NSR avoid isometric exercise
Digoxin
vasodilators
treat underling HF
BIV pacer
anticouaglation
surg repair
beta block , ace and diuretic with severe heart condition could backfire with ICM*

Question 16

Mitral Valve Prolapse

Answer 16

Floppy valve
the primary cause is MR
more common women 15-30
benign
men > 50 more severe (surgery her)
congenital; Marfan syndrome
elhlers-donlos, osteogenesis imprefecta

mid to late systolic click
inverted T wave 2,3 and AVF

Question 17

mitral valve prolaplse
treatment

Answer 17

beta p blockers
anticoagulation
surgical: mitral clip, MV repair over replacement

Question 18

Aortic Stenosis

Answer 18

most common valvular HD
Congenital:
radiation
rheumatic fever
Risk:
LDL, DM, smoking, CKD, metabolic syndrome

Question 19

Aortic Stenosis

Answer 19

Stiffening
LV hypertrophy
compression of coronary arteries
decrease 02
chest pain
low cardiac output

Question 20

aortic stenosis signs and symptoms

Answer 20

cardinal symptoms
exertional dyspnea
angina
syncope

*mid systolic murmur
a slow rise in apical pulse
narrow pulse pressure

Pulsus parus et tardus; carotid pulse rises slowly to delay peak aculstate s2 while palpate is latent ( severe as)

*****AS murmer= mid systolic murmer after s1 increawse in intensity peak during ejection **

Question 21

aortic stenosis management

Answer 21

1. no strenuous exercise
2. avoid dehydration
3. Beta-blocker
4. nitrates
5. statin
6. eval 1-2 yr echo
7. coag and platelets
   no NOAC, only coumadin
   INR** 2.0-3.0
   2.5 target
   3.0 older generation mechanical valves (mitral)

Question 22

Anti-coaug and platelets therapy for AS

Answer 22

Afib= coumadin 2.0-3.0
target 2.5
bioprosthetic coumadin 3-6 months and Asa
no risk factor then asa
TAVAR = 6 months of Plavix and lifelong asa
Surgical= > 65 bioprestetics

Question 23

aortic regurgitation

Answer 23

failure of the valve to close causes backflow of blood into to L ventricle
1. LV hypertrophy
2. pulm edema
3. treat underlying cause
ECHO
AVR
vasoactive agents

Question 25

tricuspid stenosis

Answer 25

RARE 1. native valve 2. rheumatic HD 3. tricuspid repair most common in the USA 4. carcinoid tumors

Question 26

Tricuspid stenosis signs and symptoms

Answer 26

1. pulmonary congestion 2. fatigue 3. hepatomegaly 4. very little SOB compared to edema 5. diastolic murmur lower L sternal border

Question 27

Tricuspid findings

Answer 27

RA enlargement CXR Domes in diastole

Question 28

Tricuspid stenosis management

Answer 28

decrease edema bowel edema; bumex or toresmide liver enlargement alderstone inhibitor

Question 29

Tricuspid regergitaion

Answer 29

Primary: 1. RF 2. prolapse 3. endo fibrosis 4. radiation Secondary: 1. MI 2. trauma 3. HF 4. MV regurg 5. pacemaker wires 80% of patients have secondary reasons

Question 30

Tricuspid regurgitation findings

Answer 30

1. hepatomegaly 2. acities 3. Plural Effusion 4. increase RA pressure ***holosystolic murmur in left sternal border

Question 31

pulmonary stenosis

Answer 31

congenital carcinoid tumor endocarditis mild to moderate asymptomatic severe: syncope, chest pain, dyspnea ***mid systolic murmur ***

Question 32

pulmonary stenosis findings

Answer 32

R axis deviation ** Assess AV gradient( pressure on each side of the valve) and LV function > 60 valvotomy for asymptomatic > 50 with symptoms

Question 33

pulmonary stenosis management

Answer 33

diauretics perc ballon valuvolplasty

Question 34

pulmonary regurgitation

Answer 34

two categories high and low : high pressure cause: pulmonary HTN low-pressure cause ; dilated pulm annulus congenital plaque valve replacement

Question 35

pulmonary regurgitaion signs and symptoms

Answer 35

** hallmark finding** high pitch decrescendo diastolic murmur 1. pulm HTN 2. fatigue 3. abd fullness 4. bloating 5. LE edema

Question 36

pulm regurgitaion management

Answer 36

no specific therapy treat pulm HTN vasodilator therapy diuretics Low PVR- repairs of carcinoid tetralogy of Fallot high- PVP replace with bioproprestitic ** flow lan, viagra, nitrox oxide** for pulm htn