Module 8

Question 1

Causes of mitral stenosis

Answer 1

99% chance- Rheumatic heart disease
congenital heart disease
severe mitral annular calcification (MAC)
left atrial tumour
iatrogenicity (prosthetic mitral valve) 
thrombus
endocarditis

Question 2

Mitral valve stenosis effect and symptoms

Answer 2

dilation of left atrium due to volume overload (seen on ECG(P-mitrale))
many patients have atrial fibrillation
symptom: left sided heart failure and eventually right sided HF

Question 3

Mitral Stenosis physical findings

Answer 3

Loud S1
opening snap
diastolic rumble

Question 4

Mitral regurgitation (MR)

Answer 4

when the valve is compromised in some way causing retrograde back flow fro LV to LA in V systole.
Classified as acute, chronic or intermittent

Question 5

MR etiology

Answer 5

abnormalities of mitral annulus (calcification, dilation)
abnormalities of leaflets of chordae tendineae (flail, prolapsed)
abnormalities of papillary muscles (elongation, rupture)
or abnormalities in ventricular myocardium (ischemia, infarct, cardiomyopathy)

Question 6

MR ECG and physical findings

Answer 6

ECG- left atrial enlargement followed by ventricular hypertrophy (diastolic volume overload), atrial fibrillation very common.
acute- ischemia changes or infarct
Physical- holosystolic murmur at apex accentuated my clenching fists
-widely split S2.
acute- pulmonary edema Chronic- left HF, fatigue, low CO

Question 7

Tricuspid Stenosis (TS)

Answer 7

restriction of the tricuspid valve that impedes diastolic flow from RA to RV.

Question 8

TS causes and ECG findings

Answer 8

99%- rheumetic heard disease
carcinoid heart disease, congenital heart disease
ECG- right atrial or biatrial enlargement due to pressure overload. and RV hypertrophy, may eventually lead to heart failure.

Question 9

TS signs and symptoms

Answer 9

Dyspnea upon exertion
hemoptysis (coughing up of blood)
chest pain
peripheral cyanosis

Question 10

Tricuspid Regurgitation (TR)

Answer 10

tricuspid valve is compromised in some way causing retrograde back-flow from RV to RA during V systole.
acute, chronic, or intermittent.
primary cause abnormal tricuspid annulus. secondary cause- functional cause with normal valve.

Question 11

TR ECG findings

Answer 11

chronic- RA enlargement due to volume overload
acute- RV infarct or ischemia
may eventually lead to right heart failure with associated symptoms

Question 12

TR etiology

Answer 12

Functional: pulmonary hypertension, cor pulmonale, RV infarct, RV pathological conditions (pulmonary stenosis), constrictive pericarditis
Anatomical: rheumetic heart disease, infective endocarditis, congenital heart disease, trauma, tricuspid valve prolapse, carcinoid heart disease, latrogenic, connective tissue disorders.

Question 13

Aortic stenosis (AS)

Answer 13

narrowing or restriction of the aortic valve that impedes systolic blood flow from LV into aorta.
most often degenerative but in some cases forms from congenital heart disease or rheumetic heart disease.
classified- subvalvular, valvular, supravalvular
many ppl develop a thickening of aortic leaflets with age-> heavy calcification and restriction = high pressure gradient= valvular stenosis

Question 14

AS signs & symptoms & physical findings

Answer 14

dyspnea upon exertion, angina pectoris, syncope.

physical: suprasternal thrill by palpitation, soft A2, systolic ejection murmur

Question 15

Aortic Regurgitation (AR)

Answer 15

Valve is compromised in some way causing retrograde back-flow from Aorta into LV during V diastole. - Acute, chronic or intermittent.
may be genetic, inflammatory, structural or stress in origin.
asymptomatic ———> left heart failure followed by right HF

Question 16

Signs, symptoms and physical findings of AR

Answer 16

dyspnea upon exertion, possible chest pain.
ECG- LV hypertrophy, LA enlargement (later cases)
acute- sinus tachycardia chronic-atrial fibrillation
physical: bounding pulses, early diastolic decrescendo murmur

Question 17

Pulmonary Stenosis (PS)

Answer 17

narrowing or obstruction of the pulmonary valve impeding blood flow from RV during V systole.
subvalvular, supravalvular, valvular

Question 18

PS etiology and ECG findings

Answer 18

congenital heart defect, rheumetic heart disease (usually found in other valves as well)
causes right ventricular hypertrophy, right atrial enlargement

Question 19

Pulmonary Regurgitation (PR)

Answer 19

valve is compromised in some way causing retrograde back-flow in RV during V diastole.
most ppl have minor PR, but may indicate pulmonary hypertension

Question 20

PR etiology and ECG

Answer 20

infective carditis, rheumatic heart disease, congenital abnormalities, chest trauma, carcinoid heart disease, etc.
asymptomatic —–> long period of time may show signs of right HF
ECG - RV hypertrophy, RBBB

Question 21

Mitral Stenosis (MS)

Answer 21

restriction of mitral valve opening that impeded diastolic flow from left atria to left ventricle.