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Flashcards in Valvular disease Deck (23):

What is aortic stenosis? What are the main causes?

Inability of the aortic valve to open properly

Thickening/calcification, rheumatic heart disease, or congenital (bicuspid)


What is a Wigger's diagram?

Shows you pressures, volume, EKG, and heart souds


What happens to aortic pressure relative to LV pressure in aortic stenosis-- in Wigger's diagram?

Higher P in LV due to inability of valve to open AND delays upstroke of aortic pressure bc it can't open


What compensation and decompensation happens in aortic stenosis?

(1) Compensation: wall thickness increases to allow LV pressure to increase

(2) Decompensation: hypertrophic heart --> decreased LV compliance


What are the symptoms of aortic stenosis?

Angina: increased muscle mass --> increased O2 demand

Syncope: failure to augment CO during exercise

Dyspnea: hypertrophy --> decreased LV compliance --> increased LVDP --> increased PCWP


What's the physical diagnosis of aortic stenosis?

Carotid upstroke delayed & reduced in amplitude


Harsh systolic ejection murmur R 2nd intercostal space

Reduced A2

Paradoxical splitting of S2


What's the prognosis of aortic stenosis?

Long latent period (benign)

Once you get symptoms, you decline much more rapidly


What's the treatment for aortic stenosis?

Surgical aortic valve replacement

Transcatheter valve replacemtn


What is aortic regurgitation? Causes?

Leaking of aortic valve due to

(1) Primary abnormality of aortic valve leaflet

(2) Dilitation of aortic root

Many causes-- congenital (bicuspid), endocarditis, rheumatic, aortic dissection, Marfan's, hypertension


What are metrics for the size of regurgitation?

Regurgitant volume

Regurgitant fraction

Effective regurgitant orifice


What's the difference between acute and chronic aortic regurgitation?

Acute: normal LV size/compliance so increase LV diastolic V and P --> increase in PCWP & pulm congestion = shock, resp failure= emergency!

Chronic: compensation allows it to be better tolerated -- heart can accept a larger volume w/less increase in diastolic pressure
- widened pulse pressure bc increase in SV leads to increase in aortic systolic BP & large regurg volume leads to decrease in diastolic pressure
-Normal CO is maintained
- Dyspnea, fatigue, decreased exercise tolerance, angina (rare)


What are the physical findings of chronic aortic regurgitation?

Decrescendo diastolic murmur (diminishes) at LLSB

Similar metrics of severity of aortic stenosis


How do you treat aortic regurg?

Surgical aortic valve replacement


What is aortic dissection?

Blood can escape through a tear in aorta --> enters aortic wall & goes through media of the aorta

Caused by htn, connective tissue disorders (Marfan)


What is mitral stenosis? Causes?

Mostly rheumatic also calcif, congential, endocarditis

Valve can't open properly --> abnormal diastolic gradient across stenotic mitral valve (normall, P's are =)


What's the pathophysiology/symptoms of mitral stenosis?

LA P/V overlad --> backup in PA --> pulmonary alveolar edema & RV pressure overload

Can lead to atrial dilitation due to P/V overload --> predisposed to A-Fib, tachycardia, and stangnant flow (risk of LA clot formation)

Dyspnea, Pulm alveolar edema


What do you find on the physical exam of aortic stenosis?

Loud S1 due to mitral valve closure

Opening snap in diastole

Diastolic rumble

**Earlier snap/longer rumble =more severe disease


What's the progression of MS? Treatment?

Long latent period, 10 year survival after symptom onset 50% wherease asymptomatic patient >80% live 10 years

Treat with valvuloplasty, surgical mitral valve replacemetn
+ diuretics, rate/rhythm control, aticoag's for AFib 


What's mitral regurgitation? Causes?

During systole, portion of LV stroke volume ejected back into low pressure LA

Mitral valve leaks --> back flow into LA during systole --> increased LA, V+P, decreased CO, volume stress on LV due to return of regurg volume to LV in addition to normal pulmonary venous return

Rheumatic, degenerative, endocarditis, rupture chords/ pap muscles


What's the difference between acute and chronic MR?

Acute: noncompliant LA --> increase LAP/PCWP --> acute pulm edema --> RV failure
Also CO decreases

Chronic: LA enlargement  --> accomodation of regurg volume
**shift of LV diastolic P-V relationship, normal CO maintained, eccentric hypertroph due to volume overload
- fatigue, weakness on exertion, dyspnea, Afib


What do you see on physical exam of MR?

Holosystolic murmur at apex radiating to axilla; worsens with fist clench bc increased afterload

Apex can be displaced/diffuse

S3 audible/palpable

Treat: diuretics, afterload reduction, if functional MR, treat underlying dysfunction, mitral repair/replacement 


AS, AR, MS, MR: PV loops