HRR: physiology of valve disease

Question 1

What is diastole?

Answer 1

AV valves are open and there is little resistance to flow, while SL valves are closed with no leakage.

Question 2

What is systole?

Answer 2

AV valves are closed with no leakage and SL valves are open with little resistance to flow.

Question 3

What is stenosis?

Answer 3

Obstruction to valve flow at a phase when the valve should be open; the pressure gradient serves as the hallmark.

Question 4

What is regurgitation?

Answer 4

Inadequate valve closure leads to back flow.

Question 5

Can a valve be both stenosis and regurgitant?

Answer 5

Yes.

Question 6

What are the basic anatomical elements of the mitral valve?

Answer 6

Chordae tendinae, papillary muscles, anterior and posterior leaflets.

Question 7

What is the main cause of mitral stenosis?

Answer 7

Rheumatic.

Question 8

What are some signs of mitral stenosis?

Answer 8

SOB with exertion or laying down, fatigue, swollen feet or legs, palpitations, coughing up blood, chest pain, dizziness.

Question 9

Describe some issues with mitral stenosis.

Answer 9

Increased LA pressure leads to pulmonary hypertension, and RV pressure overload can lead to RV hypertrophy, RV failure, tricuspid regurgitation, and systemic congestion.

Question 10

What are some paradoxes of mitral stenosis?

Answer 10

The LV can be unaffected and pulmonary symptoms can diminish as the RV fails.

Question 11

How does mitral stenosis impact preload?

Answer 11

It decreases it.

Question 12

How will the pressure of the LA be impacted in mitral stenosis?

Answer 12

The pressure will be higher.

Question 13

Mitral stenosis is a substrate for…

Answer 13

A fib.

Question 14

What happens to a PV loop for the LV in mitral stenosis?

Answer 14

It shifts left due to lower volumes and has a slightly lower peak pressure. The curve will also narrow due to SV being decreased. The LVEDV is also decreased.

Question 15

What are signs of mitral regurgitation?

Answer 15

Murmur, SOB with exertion or laying down, fatigue, swollen feet or ankles, excessive urination, cough.

Question 16

What is the pathophysiology of mitral regurgitation?

Answer 16

The LA pressure is increased, and it is also dilated. The LV can also experience volume overload and dilate and experience eccentric hypertrophy. The process can lead to pulmonary hypertension, A fib, and low CO.

Question 17

What happens to SV in mitral regurgitation?

Answer 17

It increases; there is a forward and a reverse SV.

Question 18

A tall V wave is seen in…

Answer 18

Mitral regurgitation.

Question 19

Mitral regurgitation is a substrate for…

Answer 19

A fib.

Question 20

What happens to the PV loop in mitral regurgitation?

Answer 20

It’s huge. The isovolumetric relaxation and contraction are gone, giving it a blob appearance. SV increases due to an increase in LVEDV from excess being pumped in as regurgitation from the previous cycle. The peak pressure decreases as well.

Question 21

What is the difference between compensated and decompensated mitral regurgitation?

Answer 21

In compensated, the body’s reflexes can account for the changes in the system. HR and systemic resistance will increase, creating bigger EDV and ESV than normal. This makes a large SV and EF. In decompensated, the body cannot overcome the issue. EDV is huge, but so is ESV and EF is low.

Question 22

Describe left ventricle events in chronic decompensated mitral regurgitation.

Answer 22

1. Increase in EDV and ESV
2. Increase in wall stress and LV dilation
3. LV dysfunction
4. Decreased LV SV
5. Lower EF.

Question 23

Describe left atria events in chronic decompensated mitral regurgitation.

Answer 23

1. Volume overload
2. L dilation
3. Increased pressure
4. Pulmonary congestion
5. Pulmonary HTN and dyspnea
6. Congestive heart failure symptoms.

Question 24

What are the cusps of the aortic valve?

Answer 24

Left, right, and posterior.

Question 25

What will a congenital bicuspid aortic valve cause?

Answer 25

Aortic stenosis.

Question 26

What are the main etiologies of aortic stenosis?

Answer 26

Degenerative calcification, congenital, and rheumatic.

Question 27

What are some signs of aortic stenosis?

Answer 27

Murmur, chest pain, fatigue, palpitation, SOB, pulsus tardus.

Question 28

Describe the pathophysiology of aortic stenosis.

Answer 28

LA pressure increases and it dilates. The LV has a volume overload, dilates, and undergoes eccentric hypertrophy. The LV can also experience concentric hypertrophy. Issues can include pulmonary hypertension, LA arrhythmia, and low CO.

Question 29

What happens to LEDP in aortic stenosis?

Answer 29

It increases.

Question 30

What happens to SV in aortic stenosis?

Answer 30

Reduced.

Question 31

What happens to pulse pressure in aortic stenosis?

Answer 31

Reduced; this is because the systolic pressure decreases from less blood being ejected into the aorta, and the diastolic pressure increases due to reduced compliance. a decrease in systolic and increase in diasotlic results in a smaller pulse pressure

Question 32

What happens to the PV loop in aortic stenosis?

Answer 32

It looks like a skyscraper. The afterload really increases, making the loop tall. EDV is slightly larger, ESV is much larger, and SV is much smaller.

Question 33

Can the body overcome aortic stenosis?

Answer 33

Yes; the body will increase HR and systemic resistance to increase output. Frank-Starling mechanisms invoke to try to make an okay SV.

Question 34

What causes angina with aortic stenosis?

Answer 34

The thickened wall means blood has farther to travel from epicardium to endocardium during diastole, which can create subendocardial ischemia and cause angina.

Question 35

How can aortic stenosis cause sudden death?

Answer 35

Subendocardial ischemia can lead to lack of oxygen in the heart tissue and cause ventricular arrhythmia and death.

Question 36

Describe the pathophysiology of aortic regurgitation.

Answer 36

LV volume overload leads to dilation and increased L pressure. The LA also dilates and there is increased optic use pressure.

Question 37

What are the compensatory mechanisms for aortic regurgitation?

Answer 37

Eccentric LV hypertrophy, increased LV compliance, peripheral vasodilation.

Question 38

What happens to aortic systolic and diastolic pressures in aortic regurgitation?

Answer 38

Systolic increases, diastolic decreases.

Question 39

What does aortic regurgitation do to afterload?

Answer 39

Increase it.

Question 40

Describe the PV loop in aortic regurgitation.

Answer 40

Another blob, but shifted right. LVEDV increases, SV increases (a lot is regurgitated) and peak pressure increases. The isovolumetric periods aren’t true ones.