Valve Disease Flashcards by Wendy Pitts

Typical sxs of valvular dx?

fatigue
dyspnea
angina
syncope
palpitations

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Aortic Stenosis definition?

narrowing of aortic outflow tract

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Levels of Aortic Stenosis?

Aortic Valve (75%)
Supravalvular
Subvalvular

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Aortic Stenosis etiology?

Congenital:

Sxs < 30yo = unicuspid valve
Sxs 30-65 = bicuspid valve
Sxs >65yo = degeneration and sclerosis of valve

Rheumatic valve disease

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Course of Aortic Stenosis?

(U) asympt until severe

Death w/i 4 yrs of sxs

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Aortic Stenosis sxs?

Early:
fatigue
dyspnea on exertion

Later:
dyspnea w/ ADL
angina
syncope
heart failure

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Aortic Stenosis physical findings? (3)

1) Systolic ejection murmur - 2nd right ICS
2) Thrill - 2nd right ICS
3) Early systolic ejection click

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Aortic Stenosis physical findings when severe?

Late peak systolic ejection murmur

Small pulse pressure

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Gradation of murmurs: 1 out of?

barley audible to very loud

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Aortic Stenosis lab findings:

ECG?

Initially normal
As LV hypertrophy (LVH) develops:
↑ QRS
Left axial deviation

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Aortic Stenosis lab findings:

CXR?

Initially normal
LVH shows:
post-stenotic dilation of aorta

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Aortic Stenosis lab findings:

Echo?

LVH:

calcified leaflets

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Aortic Stenosis management?

Mild: follow
Mod: annual ECG, Echo, CXR
Severe: cardiology

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Aortic Stenosis indications for intervention? (4)

1) Sxs: CHF sxs
2) Ejection fraction < 50%
3) CAD
4) Valve opening < 1cm

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Hypertrophic Cardiomyopathy (HCM) definition?

Form of subvalvular AS:

Disease cardiac mm w/ severe hypertrophy in ABSENCE of cause for 2º hypertophy

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Hypertrophic Cardiomyopathy etiology?

60% FH

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Hypertrophic Cardiomyopathy affects LV how?

LV is hypercontractile w/ high wall stress,

Ejects all blood during systole

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Hypertrophic Cardiomyopathy sxs?

Similar to AS
Murmur louder when standing or valsalvas (ascending aorts)
Aortic valve not calcified
No ejection sounds

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Hypertrophic Cardiomyopathy tx?

Ca2+ channel blockers

β blocker

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Aortic Regurgitation (Insufficiency) definition?

leak of blood back thru aortic valve @ diastole

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Acute Aortic Regurg etiology? (3)

1) Aortic dissection
2) Latrogenic - cath/surgical
3) Endocarditis

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Chronic Aortic Regurg etiology? (4)

1) Rheumatic val dx
2) Bicuspid aortic val
3) Dilated aortic root
4) CT dx (RA, Marfans, Ehler’s)

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Aortic Regurg indications for intervention? (3)

1) Symptomatic
2) Asymp w/ EF < 55%
3) LVESD > 55mm, EDD >70mm

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Chronic Aortic Regurg progression?

LV overload w/ gradual dilation/hypertrophy

Mild DOE

DOE and rest, orthopnea, noctural dyspnea

Post sxs survival <2yrs

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Acute Aortic Regurg progression?

Pulmonary edema Req's urgent referral

Aortic Regurg physical findings?

Austin Flint murmur Watson Waterhammer pulse Widened pulse pressure Low diastolic

Austin Flint murmur?

low-pitch diastolic @ apex | similar to diast mitral stenosis murmur

Wide pulse pressure due to?

↑ systolic P and ↓ diastolic P

Watson Waterhammer pulse?

Powerful upstroke, sudden disappearance | hallmark of AR

Aortic Regurg lab findings: | ECG?

LVH

Aortic Regurg lab findings: | CXR?

normal if acute LVH if chronic (P) CHF/pulm edema

Aortic Regurg lab findings: | Echo?

LVH

Aortic Regurg management?

Aysmp/mild: follow 6-12mo, (P) Vasodilators (ACE inhib) Symp: valve replacement

Mirtal Regurge definition?

leak of blood from LV into L atrium

Acute Mirtal Regurge etiology?

Papillary mm necrosis/rupture from eschemia | Endocarditis

Acute Mirtal Regurge tx?

(U) emergent surgery

Chronic Mirtal Regurge etiology?

``` Barlow's Synd Inherited MV prolapse Sub-acute endocartitis Rheumatic HD Acquired CT dx (SLE) ```

Barlow's Syndrome is?

Common cause of Mirtal Regurge Degeration of value tissue -> stretched leaflets (C) w/ Grave's, Marfan's, MD

Mirtal Regurge progression?

``` LV enlarges to accommodate ↑ volume -> SV ↑ -> LA enlarges to accom ↑ vol -> Atrial fibr Pulm HTN RV hypertrophy ```

Mirtal Regurge sxs?

Dyspnea, fatigue Arrhythmias Pulm HTN

Mirtal Regurge physical findings?

High-pitch pansystolic murmur (apex to axilla) Late: S3, S4 gallops JVD hepatomegaly

Mirtal Regurge lab findings: | EKG?

LAEnlargement LVH (P) RVH

Mirtal Regurge lab findings: | CXR?

LAE | LVH

Mirtal Regurge lab findings: | Echo?

LAE LVH Hyperdynamic LV wall motion

Mirtal Regurge tx?

Afterload reduction w/ ACE inhib, vasodial ↓ sodium Valve repair/replace

Mitral Valve Prolapse etiology?

Ballooning of mitral leaflets into LA during systole

Mitral Valve Prolapse physical findings?

mid-late systolic clicks

Mitral Valve Prolapse tx?

(U) benign | (P) β blockers

Mitral Stenosis definition?

Narrowing of mitral valve | Obstructs flow from LA to LV

Mitral Stenosis etiology?

(U) Rheumatic HD

Mitral Stenosis results in?

↑ LA P | ↑ pulmonary HTN

Mitral Stenosis progression?

Asymp 20+ yrs post Rheum fever | 7yrs between sxs and total disability

Mitral Stenosis sxs?

Plumonary congestion sxs | (U) atrial fibr

Mitral Stenosis physical findings?

Loud S1 w/ opening snap Mid-dias rumbling murmur followed by pre-syst kick Late: loud P2 and RV heave

Mitral Stenosis lab findings: | EKG?

LAE Late: RVH a fib

Mitral Stenosis lab findings: | CXR?

LAE calcified mitral annulus Late: Kerley B lines RVH pulm cong

Mitral Stenosis lab findings: | Echo?

DIAGNOSTIC Thick valves ↓ vale excursion

Mitral Stenosis lab findings: | Angio/Cath?

``` Giant LA Small LV LA HTN pulm HTN gradient LA to LVEDP ```

Mitral Stenosis management?

Mild: diauretics Warfarin for a fib or significant LA enlarg Valve surgery

Endocarditis sxs?

Viral-like SOB, persistent cough New murmur Skin ∆s

Endocarditis indications for surgery: Class 1

Valve stenosis or regurg HF Regurge w/ ↑ LVEDP or mod pulm HTN Resistant organisms Heart block, abscess, lesion

Endocarditis indications for surgery: Class 2

Recurrent emboli | Persistent veg > 1cm

Anticoag and Thromboembolism (TE) risks?

``` Older Female DM Malig HTN Alcohol ```

Tricuspid Valve Regurge etiology?

(U) 2º to RV dysfxn (vol overload, pulm HTN) Result of LV failure a/w pulmonary regurge, mechanical interference

Valve Disease Flashcards

(64 cards)