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Cardiovascular > SM 142 Valvular Heart Disease: Regurgitant > Flashcards

SM 142 Valvular Heart Disease: Regurgitant Flashcards

1
Q

Is Mitral Stenosis a Systolic or Diastolic murmur?

A

Diastolic

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2
Q

Is Mitral Regurgitation a Systolic or Diastolic murmur?

A

Systolic

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3
Q

Is Aortic Stenosis a Systolic or Diastolic murmur?

A

Systolic

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4
Q

Is Aortic Regurgitation a Systolic or Diastolic murmur?

A

Primarily Diastolic but also Systolic

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5
Q

Why is Aortic Regurgitation both a Diastolic and Systolic murmur?

A

Diastolic murmur due to the inflow of blood through an incompetent Aortic Valve + Systolic murmur due to increased volume in the LV pushing more blood over the AV

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6
Q

Under Aortic Regurgitation, how does SV change and what is significant about this?

A

Total SV = SV from LA + Regurgitant SV from Aorta, leads to increased preload

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7
Q

How does increased EDV alter the LV during Aortic Regurgitation?

A

Increased Volume = Increased Preload = Dilation of the LV

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8
Q

What can be used to measure the extent of Aortic Regurgitation?

A

LVEDV + Preload, which increase due to backflow over incompetent Aortic Valve

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9
Q

How does Aortic Stenosis affect Afterload and Preload?

A

Aortic Stenosis = Increased Afterload + Normal Preload

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10
Q

How does Mitral Regurgitation affect Afterload and Preload?

A

Mitral Regurgitation = Increased Preload (due to extra volume from regurg being pumped back in) + Normal Afterload

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11
Q

How does Aortic Regurgitation affect Afterload and Preload?

A

Aortic Regurgitation = Increased Preload (due to extra volume from regurg being pumped back in) + Increased Afterload (due to extra volume)

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12
Q

Why does afterload increase in Aortic Regurgitation?

A

Increased stretch of the LV leads to increased forced resisting contraction = increased afterload

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13
Q

Why does Mitral Regurgitation not increase Afterload?

A

The increased volume is pumped back into the low pressure LA leading to Dilation + Fibrosis w/ no change in afterload, as opposed to Aortic Regurg where volume cannot be pumped into the high pressure Aorta

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14
Q

What can cause LV Dilation?

A

Increased Preload/EDV

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15
Q

What can cause LV Hypertrophy?

A

Increased Afterload

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16
Q

How does Mitral Regurgitation affect the Left side of the heart?

A

Since blood is pumped back into the LA, the LA dilates

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17
Q

How does Aortic Regurgitation affect the Left side of the heart?

A

Increased Preload + Increased Afterload = LV Dilation and LV Hypertrophy + Aortic Dilation

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18
Q

Which valve defect affects the Aorta and how?

A

Aortic Regurgitation leads to a dilated Aorta due to increased blood flow across the Aortic Valve

19
Q

What does Aortic Valve damage lead to?

A

Aortic Regurgitation since it is no longer structurally viable

20
Q

What murmur presents with altered pulse pressure, and how?

A

Aortic Regurgitation leads to widened Pulse Pressure due to more blood pumped out as well as more blood sucked back in and a Decrescendo murmur

21
Q

Why does Aortic Regurgitation lead to a decrescendo murmur?

A

LV experiences increased LVEDV after regurgitant blood fills the Ventricle, so pressure on ejection is high, while regurgitation sucks blood back in leading to a decrescendo in pressure and sound

22
Q

When is the optimal time to operate on Aortic Regurgitation?

A

When patients have worse symptoms, LV dysfunction, and LV/Aorta dilation

23
Q

How is Aortic Regurgitation operated on?

A

If no Aorta enlargement, just replace the Aortic Valve; if the Aorta is enlarged, replace the Aortic Valve + enlarged portion of the Aorta

24
Q

What are the two main causes of Mitral Regurgitation?

A

Primary Valve disease = Primary cause; Primary Muscle disease = Secondary cause

25
Q

What can cause Mitral Regurgitation via Primary Valve disease?

A

Rheumatic + Bacterial Infection + Mitral Valve Prolapse

26
Q

What does Mitral Regurgitation do to the right side of the heart?

A

Mitral Regurgitation causes congestion spanning pulmonary to systemic venous areas

27
Q

How does Mitral Regurg effect Cardiac Output?

A

Low Cardiac Output

28
Q

How does LV Dysfunction manifest from Mitral Regurg?

A

Volume Overload = Dilation

29
Q

How does Arial Fibrillation + Systemic Embolism form from Mitral Regurg?

A

Mitral Regurg promotes stretching of the Left Atrium, causing fibrosis which alters conductivity, causes Atrial Fibrillation -> Embolism formation

30
Q

What causes Mitral Valve prolapse?

A

Leaflet thickening and enlargement

31
Q

How does Mitral Regurg alter the LA filling curve?

A

Leads to a more prominent V wave due to incompetent valve allowing blood to return into the Left Atrium

32
Q

How does Mitral Regurg present on physical exam?

A

Holosystolic Apical murmur

33
Q

How is Mitral Regurg operated on?

A

Unlike other valvular defects, the valve can be repaired with optimum outcome before the onset of symptoms

34
Q

How is Mitral Regurg repaired?

A

Slice out parts of the leaflet and make the valve tighter with an Annuloplastic ring

35
Q

How are secondary causes of Mitral regurg treated?

A

Secondary Cause = Muscle disease such as ischemia + cardiomyopathy, so treat the disease

36
Q

Which form of Mitral Regurg precipitates from damage to the Left Ventricle?

A

Secondary Mitral Regurgitation, because the muscles are affected and not the valves themselves

37
Q

What is the target for Primary Mitral Regurg?

A

The Mitral Valve

38
Q

What is the target for Secodary Mitral Regurg?

A

The Ventricle

39
Q

How are Primary MR and LV dysfunction related?

A

Primary MR can result in LV Dysfunction due to increased EDV + LV Dysfunction can impair the ability to open valves (not the valves themselves) causing Secondary MR

40
Q

Is valve surgery curative?

A

No, just prolongs lifespan

41
Q

How dos Aortic Valve disease affect the LV?

A

In both Aortic Stenosis + Aortic Regurg, afterload increases leading to LV Hypertrophy

42
Q

How does valvular heart disease vary with age?

A

Valvular Heart Disease increases with age

43
Q

Generally, when should valvular stenosis be operated on?

A

Once symptoms develop

44
Q

Generally, when should valvular regurgitation be operated on?

A

Symptoms develop + LV dysfunction/dilation

Cardiovascular (25 decks)

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