Valvular Disease Flashcards
(38 cards)
Which valves are open during diastole?
mitral and triscuspid valves
Which valves are open during systole?
Pulmonary and Aortic valves
What happens when pressure in a heart chamber decreases below the downstream pressure?
The corresponding heart valve will close
Which valves have chordae tendinae and papillary muscles?
What can happen if these structures are damaged from an MI?
Atrio-ventricular valves (Bicuspid/mitral valve on left side and tricuspid on right side)
back flow can happen (regurgitation)
True or False: The aortic and pulmonic semi-lunar valves do not have papillary muscles or chordae tendinae and lie back against the walls of the aorta and pulmonary artery
False, while they do not have either papillary muscles or chordae tendinae the valves do not rest against the walls of the aorta or pulmonary artery
What are the general symptoms for cardiac valvular disease?
- easily fatigued
- dyspnea
- palpitations
- murmurs
- chest pain
- pitting edema
- orthopnea
- dizziness
What is the result of increased LV mass with normal relative wall thickness?
Eccentric hypertrophy
What is the result of normal LV mass with increased relative wall thickness?
Concentric remodeling
What is the result of an increase in both LV mass and relative wall thickness?
Concentric hypertrophy
What are the two main types of pathophysiology for valvular disease and what are examples of each?
Congenital (genetic and maternal exposure)
Acquired (rheumatic fever, endocarditis, gradual fibrosis)
What is mitral stenosis?
What population does it primarily occur in?
What is the main cause of mitral stenosis?
Narrowing of the mitral valve which increases resistance to blood flow between A-V
Women (66%)
Rheumatic heart disease
Where would you expect to see hypertrophy in a patient’s heart that has mitral stenosis?
Left Atrium (upstream from stenosis)
What ausculatory sounds would be common for mitral stenosis?
an opening snap with diastolic rumble
What is mitral regurgitation/incompetence?
When mitral valve does not close completely during systole (incompetence) which creates backflow (regurgitation)
True or False: roughly 20% of people over the age of 55 have some degree of mitral regurgitation.
True
What are the implications of mitral regurgitation to the structure of the heart?
An increased Stroke Volume is needed to compensate for back flow which causes the L atrium to dilate out and eccentric hypertrophy to accommodate for increased volume
What medication is indicated if a patient with mitral regurgitation has symptoms w/ exercise?
Beta blockers
What is a mitral valve prolapse?
How common is it?
when the valve snaps open during systole
2-6% of the population has some degree of mitral prolapse
What accounts for the majority of aortic stenosis cases?
How common is aortic stenosis?
calcific aortic stenosis and congenital bicuspid aortic valve stenosis
~25% of the population older than 65 have some degree of aortic stenosis
What ausculatory sounds would you expect in the left ventricle of a patient with aortic stenosis?
Diastolic murmur “blowing”
What are some common causes of aortic regurgitation/incompetence?
What are some more rare conditions that can cause aortic regurgitation?
congenital, rheumatic, endocarditis, deterioration with age as well as long standing HTN
Marfan syndrome, ankylosing spondylitis and certain STDs
True or False: If a patient has aortic regurgitation/incompetence you will see pulmonary symptoms almost immediately.
False, there will be no pulmonary symptoms until very advanced stages
What exercise considerations should be made for patients with valvular stenosis?
- closely monitor with RPE
- low muscle perfusion may limit exercise
- supressed BP response to exercise, possibly exaggerated HR
- low cardiac output
- pts w/ symptomatic aortic stenosis are typically not candidates for exercise programs
- instensity should be low and progressed gradually for asymptomatic pts
- angina may be a symptom
True or False: Mechanical replacement valves usually last a lifetime but require anticoagulant medication
True
