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Cardiovascular > SM 141 Valvular Heart Disease > Flashcards

SM 141 Valvular Heart Disease Flashcards

1
Q

What is the main cause of Mitral Stenosis?

A

Rheumatic Fever -> Rheumatic Heart Disease

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2
Q

Describe the global burden of Rheumatic Heart Disease?

A

Rare in developed countries with antibiotics to treat Strep infections, common in developing countries

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3
Q

How does Mitral Stenosis affect the Left Atrium?

A

Mitral Stenosis increases the contraction pressure of the Left Atrium

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4
Q

What is Mitral Stenosis?

A

Thickening of the Mitral Valve that leads to LV Hypertrophy, decreased LVEDV and decreased SV

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5
Q

How does the increase in Left Atrial pressure affect the lungs?

A

Increased Left Atrial pressures leads to fluid backup into the lungs, causing fluid to accumulate in the alveoli

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6
Q

How does Mitral Stenosis affect the right side of circulation?

A

Increased Left Atrial pressure -> pulmonary congestion -> increase pulmonary pressure -> increase RV/RA Pressure = systemic venous congestion

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7
Q

Does Mitral Stenosis cause systemic congestion or pulmonary congestion?

A

Both; increasing pulmonary pressure causes congestion that ultimately induces systemic congestion because the 2 circuits of the heart are in series

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8
Q

How does Mitral Stenosis affect cardiac output?

A

Decreased LVEDV = Decreased CO

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9
Q

How does Mitral Stenosis affect the Left Atrium and what does it predispose?

A

Increased LA Pressure causes dilation of the LA, which leads to Fibrosis -> Atrial Fibrillation -> Embolism formation

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10
Q

What heart sound indicates LV Hypertrophy?

A

S4 - always pathologic

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11
Q

What heart sound indicates LV Dilation?

A

S3 - may be pathologic, can be normal in pregnancy

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12
Q

What does an S4 sound indicate and when does it occur?

A

S4 indicates loss of compliance of the LV leading to LV Hypertrophy

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13
Q

What does an S3 sound indicate and when does it occur?

A

S3 indicates the LV is overfilled with blood and leads to LV Dilation

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14
Q

How does Mitral Stenosis affect the Venous return curve?

A

Increased pressures in the Left Atrium shift the entire curve upward, so that S1 occurs later and Ventricular filling occurs earlier

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15
Q

What murmur presents with an opening snap?

A

Mitral Stenosis, seen as the presystolic potentiation on the upward shifted venous return curve

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16
Q

What are the physical findings of Mitral Stenosis?

A

Loud S1, opening snap, diastolic rumble

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17
Q

How does Mitral Stenosis progress with time?

A

Calcification and thickening of the Mitral Valve continues, leading to increased LA dilation and pressure

18
Q

What can be used to quantify the extent of Mitral Stenosis?

A

Ultrasound w/ Doppler, which measures fluid velocity; increased velocity = greater stenosis

19
Q

How does Atrial Fibrillation affect Mitral Stenosis?

A

Increased risk of embolism formation

20
Q

What is a “paroxysmal” rhythm?

A

One that is entered and exited randomly

21
Q

How does Mitral Stenosis progress?

A

Mitral Stenosis progresses over time, varying from mild increases in LA Pressure + RA Pressure + CO only during exercise to increases in LA Pressure + RA Pressure + Decreased CO at rest

22
Q

When should Mitral Stenosis be treated and why?

A

Immediately after detected, especially if the patient is symptomatic, because it worsens with time

23
Q

What is the treatment for Mitral Stenosis?

A

Mitral Commisurity, which cleaves the calcified commisures to restore valve function, as well as balloon inflation

24
Q

What causes a bicuspid Aorta?

A

Normally tricuspid, due to Congenital Aortic stenosis

25
Q

How can Aortic Stenosis arise?

A

Congenital AS, Rheumatic AS, and Calcification AS

26
Q

Why do valve problems occur on the Left side of the heart?

A

Left side is a high pressure system, Right side is not

27
Q

Why is a bileaflet Aortic Valve inherently stenotic?

A

Doesn’t open as much as Trileaflet Aortic Valve

28
Q

How does Aortic Stenosis affect the Left Ventricle?

A

Increased LVEDP and decreased SV

29
Q

Why does Aortic Stenosis cause LV Hypertrophy?

A

LV needs to hypertrophy to reach higher pressures and overcome increased afterload from Aortic Valve

30
Q

How does Aortic Stenosis affect LV and Aortic pressures?

A

LV has to reach higher pressure to eject blood and therefore the Aortic pressure decreases

31
Q

Why does Aortic Stenosis produce a crescendo-decrescendo murmur?

A

High increase in pressure to overcome stenotic Aortic valve causes crescendo while drop in pressure causes decrescendo

32
Q

What are the physical exam findings for Aortic Stenosis?

A

Delayed Carotid impulse due to higher pressure needed for ejection, systolic thrill, paradoxical S2

33
Q

What is a thrill?

A

Feel the murmur from the heart

34
Q

Explain the mechanism behind paradoxical splitting of S2?

A

Normal S2 splitting results in Pulmonary Valve closing after Aortic Valve due to increased blood flow and decreased thoracic pressure through the Right Ventricle; Paradoxical splitting in Aortic Stenosis causes the Aortic Valve to close after the Pulmonary valve because it reaches a higher peak pressure to overcome increased afterload

35
Q

What valvular defect causes paradoxical splitting of S2?

A

Aortic Stenosis

36
Q

When is the optimal time to operate in Aortic Stenosis patients and why?

A

Only operate after symptoms develop, because they decline rapidly and there is no evidence to support early intervention

37
Q

What are symptoms of Aortic Stenosis?

A

Dyspnea, Angina, Syncope

38
Q

What is the treatment for Aortic Stenosis?

A

Operate and replace Aortic Valve with either a prosthetic valve or a mechanical valve?

39
Q

How do prosthetic vavles compare to mechanical valves?

A

Prosthetic valves are made of non-thrombogenic material so clots don’t form and blood thinners aren’t need, but they’re less durable; Mechanical valves are made of metal and form clots, so blood thinners are needed, but they’re more durable

40
Q

What is the newest treatment for Aortic Stenosis?

A

TAVR = Transaortic Valve Replacement

Cardiovascular (25 decks)

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