MHD: Clinical valvular heart disease Flashcards Preview

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Flashcards in MHD: Clinical valvular heart disease Deck (27):
1

What is the predominant cause of mitral stenosis?

Rheumatic fever

2

In rheumatic fever, what determines whether MS or MR is the predominant pathology?

Location of affected tissues. Fusion of leaflets results in MS, whereas involvement of the chordae tendinae with little fusion results in MR

3

What are the primary clinical manifestations of mitral stenosis?

Dyspnea due to reduced lung compliance
Pulmonary edema
Thromboembolism
Infective endocarditis
Hoarse voice due to laryngeal nerve compression

4

What sign seen on 2D echocardiograms indicates mitral stenosis?

Hockey stick deformity showing thickened, calcified leaflets

5

How is pressure half time used to quantify mitral valve stenosis?

You can calculate the pressure half time from doppler readings
Mitral area = 220/PressureHalfTime (msec)

6

What is the definitive treatment for mitral stenosis?

Valvuloplasty

7

What are the causes of acute mitral regurgitation?

Infectious endocarditis
Trauma
Myxomatous Degeneration
Libman-Sacks lesions (SLE)
CAD
LV dysfunction, MI, myocarditis
Prosthetic valve dysfunction

8

What are the causes of chronic mitral regurgitation?

Inflammatory (rheumatic, SLE)
Degenerative (MVP, Marfans, MAC)
Infective subacute endocarditis
Structural: ruptured chordai, CAD, LV dilatation, HCM, prothetic valve dysfunction
Congenital

9

What is the difference between pressure overload and volume overload?

Pressure overload occurs with HOCM, aortic stenosis and involves hypertrophy
Volume overload occurs with mitral regurgitation and aortic regurgitation and involves acute processes (no time for remodeling)

10

Does end-systolic diameter predict the post-operative death probability for mitral regurgitation patients?

Yes. If the ESD is above 45mm, there are poor outcomes because the actin/myosin become permanently damaged due to overdilatation

11

What is the major structural difference seen between acute and chronic mitral regurgitation?

In acute, the LA is small, but at a high pressure.
In chronic, the LA is dilated

12

What is the hallmark physical exam sign for mitral regurgitation?

Holosystolic murmur

13

When do symptoms develop in patients with chronic MR?

When the left ventricle fails
Serious damage has often occurred before symptoms present

14

Which is more problematic clinically: mitral regurgitation or mitral stenosis?

Mitral regurgitation is often silent during progression, whereas stenosis is associated with early symptoms leading to better detection

15

What is the major medical treatment for mitral regurgitation?

Same as treating heart failure: afterload reduction
If it is easier to pump out, then less blood will regurgitate into the left atrium

16

What physiologic parameter of heart function predicts surgical outcome for mitral regurgitation patients?

Ejection fraction predicts surgical outcome

17

Physical exam finding of mitral valve prolapse

Mid systolic click

18

What are the two causes of aortic stenosis?

Bicuspid valve caused by either:
Genetics
Degenerative process

19

Describe the location of calcification in aortic stenosis in the elderly

In senile aortic stenosis, calcifications are at the flexion lines of the valve leaflets, with minimal consequences on valve function

20

What are the physical exam findings in aortic stenosis?

Aortic ejection sound (E) louder than S1
Systolic murmur crescendo-decrescendo

21

What symptoms decrease survival rate in aortic stenosis?

Angina, Syncope and Failure (most severe)

22

What is the main treatment for aortic stenosis?

Aortic valve replacement
*Valvuloplasty not successful due to restenosis

23

What is aortic regurgitation caused by?

Disease of valve leaflets, or wall of aortic root

24

What is the main treatment for aortic regurgitation?

Symptomatic: valve replacement
Asymptomatic: Depends on end-systolic diameter, ejection fraction

25

What is the most commonly used prosthetic valve today?

Bi-Leaflet tilting disc valve
"St. Judes valve"

26

What is the most common cause of tricuspid regurgitation?

Dilatation of the right ventricle and the tricuspid annulus

27

Which 3 conditions can a holosystolic murmur be heard in?

Tricuspid regurge: heard at suprasternal notch
Mitral regurge: heard left lateral 5th ICS, axilla
Ventricular septal defect: heart right 5th ICS