Flashcards in Valve Disease (Newman) Deck (55):
2 causes of endocarditis
bugs in blood and diseased valve
What determines the integrity of the valves?
cardiac chambers, great vessels
a narrowing of an orifice, lumen
What the size diff of healthy and stenotic valve?
3 cm vs 0.5 cm
in what valve does regurgication happen most common?
aorta (in diastole) >> mitral/left ventricle (in systole)
What is the cardiac adaptation to a stenotic valve?
Does a stenotic valve cause a pressure or volume overload?
inc thickness of wall = concentric hypertrophy
(pressure overload due to inc pressure upstream)
What is the cardiac adaptation to regurgitation?
Does a regurgitation cause an pressure or volume overload?
eccentric hypertrophy (enlarged chamber inc mass but normal thickness)
= heart dialtes without getting thicker!!
(volume overload bc volume increases upstream)
What is the thickness of the inter-ventricular septum?
loud murmur without hypertrophy (eccentric)
What causes acute regurg? (3)
ischemia, infection, dissection
heart failure (PND, edema, JVD)
** could be asymptomatic
chest pain (angina)
Where on the chest would you hear mitral regurg
right under left nipple
mitral regurg murmur is heard during _____
aortic regurg murmur is heard during _____
Where on the chest would you hear aortic regurg?
under right clavicle
aortic stenosis murmur is heard during _____
lub-ugh-dub (cough sound)
in mitral stenosis the first heart sound is
how must a pt be positioned? WHat part of hand do you use to feel for it?
left lateral dequibitis
Where will PMI be felt with eccentric hypertrophy?
What should the size of the PMI be normally? pathologic?
size of dime--> quarter
concentric hypertrophy is a risk factor for ...
left ventricle pressure < aorta
to determine the severity of the stenosis you must know...
CO (or Q)
inflammation, scarring of leaflets, chordae, and papillary muscles, frequent calcification
dyspnea, RHF, thrombi
HTN: left atrium > pulmonary bed > right heart
pulmonary artery catheter measures
left ventricular pressure?
supporting valve structures
dilation of left atria
loud first heart sound
what is the most common cause of mitral regurg?
leaflets replaced by myxomatous tissue
mitral valve prolapse --> mitral regurg
eccentric hypertrophy is the result of
Chronic mitral regurg
inc preload with dec afterload
What are the 2 most common causes of mitral regurg?
loud murmus, pulmonary edema, without enlarged ventricle or atia
acute mitral regurg
hwo is accute and chronic regurg diff?
lack of hypertrophy = acute
lub- ugh -dub heard under right clavicle
delayed arterial pressure (stays a little longer on your finger)
weakened arterial pulse
concentric hypertrophy + tardus + parvus
lub-dub-shh under right clavicle
wide pulse pressure
chronic aortic regurg
bacteremia + disease valve (or lesion)
2 requirements for endocaditis
combo of platelets + fibrin + bugs + RBCs and WBCs
valve destruction -->
complications of infective endocarditis
valve destruction --> acute regurg
What are the 3 indications for surgery in IE
1. heart failure unresponsive to medical management
2. uncontrolled infection
3. recurrent major emboli
Turbulent flow is indicative of...
Inappropriate timing is indicative of...
Severity of stenosis is determined by:
In mitral stenosis, the severity is proportional to
SIgns of aortic regurg
widened pulse pressure