Valve Disease I

Question 1

Three pathological mechanisms in valve disease?

Answer 1

Stenosis
Regurgitation
Prolapse

Question 2

Pathological mechanisms associated with Right Sided Heart failure?

Answer 2

Increased RV/RA/Central Venous pressure
Increased JVD
Hepatomegaly
Ascites
Edema

Question 3

Pathological Mechanisms associated with L sided heart failure?

Answer 3

Increase LA/LV/Peripheral Arterial Pressure
SOB
CHF/Pulmonary Edema
Decreased Ejection Fraction
Decreased Systemic Perfusion

Question 4

Important things to look for in EKGs?

Answer 4

A Fib, Atrial Enlargement, LVH

Question 5

Important things to look for in CXR?

Answer 5

Chamber Size, Aortic Dilation, Pulm. Edema

Question 6

Purpose of cardiac cath in valvular disease treament?

Answer 6

Pre-operative coronary artery evaluation

Question 7

What might you be looking for in a CT scan or gated MRA?

Answer 7

Myxoma/Aorta size evaluation

Question 8

Three types of valve replacement

Answer 8

Bioprosthetic
Mechanical
Autograft/Homograft

Question 9

Three main causes of tricuspid stenosis?

Answer 9

Rheumatic
Carcinoid
Congenital

Question 10

Rheumatic feveralmost always hits which valve?

Answer 10

Mitral

Question 11

Tricuspid stenosis from Rheumatic fever usually does what to the valve

Answer 11

Regurgitation with variable stenosis

Rarely Pure Stenosis

Question 12

Is there calfication in Tricuspid stenosis from Rheumatic fever?

Answer 12

Nope

Question 13

The hallmark finding of Tricuspid stenosis from Rheumatic fever?

Answer 13

Commissural fusion of the valves

Question 14

Carcinoid Tricuspid Stenosis is caused by…

Answer 14

Its secondary to serotonin production from liver mets

Question 15

Carcinoid Syndrome characteristic symptoms

Answer 15

Flushing, Diarrhea, Palpitations

Question 16

How does Carcinoid disease alter the heart?

Answer 16

Fibrous plaques on leaflets
Commissure fusion, thickened/shortened leaflets and chordae
Causes combined stenosis and regurg

Question 17

Symptoms commonly seen in a tricuspid stenosis patient?

Answer 17

Excessive fatigue, Dyspnea
Forward Failure (low preload, low SV, salt/water retention)
Backward Failure (Hepatic congestion/peripheral edema)

Question 18

What is seen in the physical exam of tricuspid stenosis?

Answer 18

Mid diastolic murmur over left lower sternal border
Increase with Inspiration
Enlarged, non-pulsatile liver
Peripheral edema

Question 19

CXR findings in a tricuspid stenosis patient?

Answer 19

Increased RA, lack of PA enlargement, and clear lung fields

Pathognomonic

Question 20

EKG findings in a tricuspid stenosis patient?

Answer 20

Prominent P waves unless A fib present

Question 21

Echo findings in a tricuspid stenosis patient?

Answer 21

RA enlargement, leaflet thickening, measure gradient, look for associated lesions

Question 22

Causes of tricuspid regurgitation?

Answer 22

Rheumatic
Endocarditis
Trauma
Carcinoid
Myxoma
Diffuse Collagen disorders
Fibroelastosis
Congenital

Question 23

Infective and Non-infective causes of endocarditis

Answer 23

Infective – IV drug abused fucking up their heart

Non – LSE

Question 24

Physical findings in a tricuspid regurgitation patient?

Answer 24

Pansystolic murmur – max over lower sternal border
Increases with inspiration
Enlarged liver WITH PULSATIONS, Hepato-jugular reflex
JVD
Edema, Ascites, Anasarca

Question 25

Common EKG finding in Tricuspid Regurg patients?

Answer 25

A Fib

Question 26

How to treat a tricuspid valve regurg

Answer 26

Observe if mild. Medical -- treat functional disease, diuretics to drop afterload. Surgical -- Tricuspid valve ring valvuloplasty/repair, Commissurotomy, Replacement

Question 27

Why use a C ring...

Answer 27

to avoid the conduction system

Question 28

Common causes of tricuspid valve replacement?

Answer 28

Infective endocarditis Carcinoid Tricuspid Stenosis

Question 29

Most common cause of pulmonary valve lesions?

Answer 29

Tetralogy of Fallot, Pulmonary Atresia

Question 30

Four components of tetralogy of fallot

Answer 30

Pulmonary Stenosis, Overriding Aorta, VSD, Right Hypertrophy

Question 31

What is a Ross Procedure?

Answer 31

Remove pulmonary valve to use as an autograft to replace Aortic valve

Question 32

Why do mitral valve annuli expand?

Answer 32

Dilated with the LV

Question 33

Describe the leaflets of the mitral valve?

Answer 33

Posterior 2/3 (typically do repairs here) | Anterior 1/3 fixed between, attached to skeleton

Question 34

Consequences of Mitral stenosis?

Answer 34

Less LV blood flow, Lower CO LA hypertrophy (A fib, mural thrombi, systemic embolism) Pulmonary Hypertension/Vascular Resistance Pulmonary edema if the pressure bumps up too much

Question 35

Symptoms seen in a mitral stenosis patient

Answer 35

``` Cough/Congestion/Pulm. Edema Hemoptysis Orthopnea PND Cardiac Cahexia ```

Question 36

What is cardia cachexia?

Answer 36

unintentional severe weight loss caused by heart failure

Question 37

Ausculatory findings with Mitral stenosis?

Answer 37

apical diastolic rumble, Increased 1st heart sound, opening snap

Question 38

Xray findings with Mitral stenosis?

Answer 38

Increased LA Straigh L Heart Border MV often calcified Kerley's Lines

Question 39

How do people get mitral stenosis?

Answer 39

Rheumatic Disease | rarely, congenital lesions, myxoma, or senile calcific disease

Question 40

Mitral stenosis -- probably male or female?

Answer 40

Female in 2/3 cases

Question 41

Echo findings in Mitral Stenosis?

Answer 41

LA enlagement, leaflet thickness, vegitiations, valve area, EF, associated lesions, thrombus, calcification, leaflet doming

Question 42

Medical interventions for Mitral stenosis?

Answer 42

Follow echos, look for LA thrombus, MVA, valve gradient, PA pressures, etc. Percutaneous Balloon commissurotomy

Question 43

Who can go through Percutaneous Balloon commissurotomy?

Answer 43

``` MVA under 1.5, Minimal Ca, Favorable anatomy. NO LA thrombus Moderate/Severe MR ```

Question 44

Will Pulmonary HTN improve after mitral stenosis treatment?

Answer 44

Usually