Flashcards in Hemodynamics II Deck (97)
What does aortic stenosis mimic in its pathology?
Hypertensive heart disease
What are the 3 main causes of Aortic Stenosis?
1.Congenital anomalous bicuspid valve
3.Chronic rheumatic disease
What percent reduction in size of the valve is required before increase LV pressure is needed to push a normal stroke volume during systole?
What is the result of Aortic stenosis?
Concentric Left ventricular hypertrophy with a reduction in compliance
What is the early pathology of the valve in Aortic stenosis?
Thickening with lipid deposition and inflmmation with macrophages and lymphocytes followed by fibrosis
What is the late pathology of the valve in aortic stenosis?
Nodular heaped up calcifications in the mid portion of each cusp protruding into the sinuses of the Valsalva
What are the symptoms of Aortic stenosis?
1.Angina Pectoris (fr myocardial ischemia)
When do symptoms of calcific aortic stenosis usually occur?
What are the signs of Aortic stenosis?
1.Crescendo-Decrescendo systolic mumur
2.Weak delayed pulse
3.An atrial gallop
What does the onset of symptoms indicate?
High probability of death within 5 years
What is the treatment for Aortic stenosis?
Surgical valve replacement
What is Mitral regurgitation?
The ejection of a portion of the left ventricular stroke volume backward into the left Atrium due to incompetence of the Mitral valve
What subset of the population is most prone to mitral valve regurgitation?
There is an increase in incidence with age
What is the most common cause of Mitral regurgitation?
Mitral valve prolapse
What is the second most common cause of Mitral regurgitation?
Ischemic heart disease
What are the pathophysiological consequences of Mitral regurgitation?
1.Reduced forward ejection fraction
2.Increased left Atrial volume and pressure
3.volume related stress on the left ventricle because the added left atrial volume gets returned to it
How can one determine if Mitral regurgitation is acute?
Left Atrial pressure is raised
What separates chronic from acute mitral regurgitation?
In chronic mitral regurgitation left atrial dilation allows it to hold extra volume with less elevated pressure
What causes Flash pulmonary edema?
Ruptured papillary muscle (due to MI or infective endocarditis) causes sudden mitral regurgitation the resulting increased left Atrial pressure transmitted backwards to pulmonary circulation causes rapid pulmonary congestion and edema
With the increased ejection fraction to the L atrium in acute mitral regurgitation what is the symptom?
What is the symptom with CHRONIC mitral regurgitation?
What is the sign of Mitral regurgitation?
An apical holosystolic (pansystolic) murmur which sometimes has a harsh quality
What may also be present in severe chronic Mitral regurgitation
A ventricular gallop
What happens to end diastolic volume in cases of chronic Mitral regurgitation?
The end diastolic volume increases to accommodate for what is loss to back flow into the L Atrium
What is decompensation related to Mitral regurgitation?
The drop in end distolic volume and stroke volume and left atrial pressure.(change from all being very high to very low if mitral regurge is survived long enough)
What is decompensation associated with?
The onset of symptoms.
What drug class is very helpful with chronic Mitral regurgitation?
What percent reduction of the normal forward stoke volume of 100ml is associated with the clinical symptoms of heart failure?
25% reduction to 75ml
What is Mitral valve prolapse?
A billowing / balloning of the mitral valve into the left Atrium during systole