Lecture 7 Valves

Question 1

what valve only has 2 leaflets?

Answer 1

mitral

Question 2

what is the largest heart valve?

Answer 2

tricuspid

Question 3

3 potential causes to tricuspid stenosis:

Answer 3

rheumatic fever, carcinoid, congenital

Question 4

Rheumatic fever typically affects the _____, followed by the _____, and ____ valves

Answer 4

mitral, aortic, tricuspid

Question 5

carcinoid syndrome is secondarty to ____ production from ___ metastasis

Answer 5

serotonin;

liver

Question 6

carcinoid syndrome can cause ____ sided valvular disease, such as fibrous plaque formation–> _____ and _____

Answer 6

right;

stenosis and regurgitation

Question 7

symptoms of tricuspid stenosis

Answer 7

excessive fatigue and dyspnea

Question 8

tricsupid stenosis forward failure: decreased ____ of the LV; thus decreased _____ _____

Answer 8

preload; stroke volume

Question 9

tricuspid stenosis backward failure: hepatic _____ and peipheral ____

Answer 9

edema, congestion

Question 10

Tricuspid stenosis:

mid ____ murmur over the ____ _____ _____ border. murmur _____ on inspiration

Answer 10

diastolic; lower left sternal;

increases

Question 11

triscupid regurgitation:
_____ murmur heard best over the ____ ____ border;
murmur ____ with inspiration

Answer 11

pansystolic; lower sternal;

increases

Question 12

tricuspid regurg:
liver is ____ and shows systolic ____;
hepatojugular reflux present

Answer 12

enlarged, pulsatations

Question 13

majority of the tricuspid regurg patients will get ____ ____

Answer 13

atrial fibrillation

Question 14

pulmonary valve lesions are typically due to ____ reasons

Answer 14

congenital (ie tetralgy of fallot, pulmonary atresia)

Question 15

mitral stenosis:

decreased flow of blood to the ____ causes decreased cardiac ____ –> symptoms of fatigue, muscle wasting, weakness

Answer 15

LV; output

Question 16

mitral stenosis:

there is ___ hypertrophy, which can cause fibrillation or mural thrombi. there is also increased ____ _____ resistence

Answer 16

LA;

pulmonary vascular

Question 17

The classic symptom of mitral stenosis is ____ on ____

Answer 17

dyspnea, exertion

Question 18

the auscultory triad of mitral stnosis is what?

Answer 18

apical diastolic rumble + increased S1 + opening snap

Question 19

with severe mitral stenosis, ____ ____ can be seen, due to engorged pulmonary lymphatics

Answer 19

kerley’s lines

Question 20

what is by far the most common cause of mitral stenosis? what is the timing of the cause?

Answer 20

rheumatic fever, late lesion

Question 21

echo of mitral stenosis will show ____ enlargment and leaflet ____ secondary to restrictive opening of the valve

Answer 21

LA;

doming

Question 22

mitral regurg is due to _____ heart disease, ____ rheumatic fever, mitral valve _______; orconnective tissue disease such as ____, _____, or osteogenesis imperfecta

Answer 22

ischemic; early;
prolapse;
ehler’s-danlos, marfan syndrome

Question 23

mitral regurg:

increased ____ pressure, ____ pressure, and pulmonary vein pressure

Answer 23

LA; pulmonary capillary wedge

Question 24

mitral regurg:

symptoms include fatigue, dyspnea, decreased ____ toleranace, palpitations, and _____ _____

Answer 24

exercise; atrial fibrillation

Question 25

if chronic, mitral regurg results in ____ hypertrophy.

Answer 25

LA

Question 26

if acute mitral regurg, such as ruptured ____ ____ post ____, then the increased in blood to the LA causes acute ____ ____

Answer 26

papillary muscle, MI; | pulmonary edema

Question 27

patients with mitral regurg have increased susceptibility to ____ ____

Answer 27

bacterial endocarditis

Question 28

in mitral regurg, the mitral ____ dilates _____

Answer 28

annulus, posteriorly

Question 29

the normal aortic valve has ___ cusps. it is a ____ valve

Answer 29

3, semilunar

Question 30

aortic stenosis is due to age-related ____, or early onset ____ if the patient has a _____ valve

Answer 30

calcification, calcification; bicuspid

Question 31

____ is another cause of aortic stenosis, but it is typically also associated with the ____ valve

Answer 31

rheumatic fever; | mitral

Question 32

aortic stenosis causes an increase in ____, with secondary impaired ___ emptying during _____

Answer 32

afterload; LV, systole

Question 33

aortic stenosis causes a ____ _____ hypertrophy

Answer 33

concentric LV

Question 34

Aortic stenosis: LV Hypertrophy with increased ____ ____ --> increased ___ demand and decreased ____ ____ during diastole. This, ____ can occur during exercise

Answer 34

muscle mass; O2, subendocardial flow; angina

Question 35

classic symptoms of aortic stenosis: acronym? and what each letter stands for

Answer 35

SAD | syncope, angina, dyspnea

Question 36

Aortic stenosis can result in sudden death due to _____ ____ or if untreated, can cause gradual ____ _____ _____

Answer 36

ventricular arrhythmia, congestive heart failure

Question 37

aortic stenosis: | ____ ____ murmur heard best in the ____ ____ ____ that radiates to the ____

Answer 37

systolic ejection; right 2nd intercostal space; carotids

Question 38

An aortic valve area (AVA) less than ____ or an ejection fraction less than ____is considered severe as seen on Echo. What is indicated?

Answer 38

.8 cm squared; 50% | surgery

Question 39

causes of aortic regurg: | mixed aortic stenosis, aortic root dilatation (______ _____), congenital (____ valve), rheumatic fever, endocarditis

Answer 39

annuloaortic ectasia; | bicuspid

Question 40

aortic regurgitation is the most common valvular lesion in ____ ___ ____

Answer 40

blunt chest trauma

Question 41

what 2 rheumatic disease are associated with aortic regurg?

Answer 41

rheumatoid arthritis; | ankylosing spondylitis

Question 42

Aortic regurg results in volume ____ of the ____. This results in increased _____ and wall stress.

Answer 42

overload, LV; | LV end diastolic pressure

Question 43

Aortic regurg: increased LVEDP causes progressive LV ____, eventually leading to ____ ____ of the LV (increased ____ size and increased ____ thickness)

Answer 43

dilatation; | eccentric hypertrophy; CHAMBER*; wall

Question 44

___ ____ is massive dilatation of the LV

Answer 44

Cor Bovinum

Question 45

Aortic regurg: | LV failure --> fall in ____ and _____ until CO can not be maintained.

Answer 45

contractility, ejection fraction

Question 46

Aortic regurg: ______ ischemia from decreased _____ coronary blood flow, increased ventricular pressure, LVH, and increased workload --> ____ despite normal coronaries

Answer 46

subendocardial; diastolic; | angina

Question 47

Aortic regurg: ____ ____ murmur; ____ pulse pressure due to ____ systolic and _____ diastolic pressure

Answer 47

diastolic blowing; | widened, increased, decreased

Question 48

Aortic regurg: ____ ____ pulse = bounding and forceful peripheral pulse; _____ = forceful carotid pulse; ______ = forceful limb pulse

Answer 48

water hammer; corrigan's; watson's

Question 49

Aortic regurg: what is de musset's sign? what is quincke's pulse?

Answer 49

bobbing of head with cardiac cycle; pulsating nail beds

Question 50

aortic regurg: austin flint murmur - when regurgitant jet hits the anterior leaflet of the ____ ____, causes closure --> murmur at the ____

Answer 50

mitral valve; | apex

Question 51

aortic regurg: _____ sign = systolic and diastolic murmur over the femoral arteries; ____ sign - pistol shot sounds over the large arteries

Answer 51

duroziez's; traube's

Question 52

____ ____ is unexplained LVH associated with a non-dilated ventricle in the absence of another cardiac or systemic condition

Answer 52

hypertrophic cardiomyopathy (HCM)

Question 53

HCM: | ____ ____ dysfunction, with dynamic ____ outflow obstruction, often at rest

Answer 53

LV diastolic, LV

Question 54

HCM: often see ____ anterior motion of the ____ valve and ____ regurg

Answer 54

systolic; mitral; mitral

Question 55

what heart sound is often seen with HCM? | there is also a ____ ____ murmur and a holosystolic murmur of ____ ____

Answer 55

S4 | systolic ejection; mitral regurg

Question 56

HCM: | ____ carotid ____ aka '______'

Answer 56

bisferiens upstroke; spike and dome

Question 57

maneuvers to decrease the LV size and make an HCM murmur louder: _____ and ____ maneuvers to increase the LV size and make a murmur softer: ______ and ____

Answer 57

standing, valsalva maneuver; squatting, handgrip exercise

Question 58

HCM causes ____ during exercise. It can also cause sudden death in young athletes due to ____ _____. Can also cause CHF symptoms

Answer 58

syncope ; | ventricular arrhythmia

Question 59

Patients with HCM should restrict ____. If at a high arrythmic risk, they should receive an ____

Answer 59

exercise; | ICD