Valvular Disease, infections, vasculitis Flashcards
what is the most common mitral valve disease?
mitral valve prolapse?
who gets mitral valve prolapse?
young to middle aged women mostly
who gets mitral valve prolapse?
young to middle aged women mostly
what are some signs and symptoms of mitral valve prolapse?
cardiac arrhythmias, mitral regurgitation, valve incompetence, infective endocarditis, stroke from thrombus, chordae tendinae rupture
what are pathological findings in mitral valve prolapse?
myxomatous degeneration
associated with connective tissue diseases - marfans
what are auscultatory findings in mitral valve prolapse?
midsystolic click and late systolic murmur
what are treatments of mitral valve prolapse?
acute: diuretics, vasodilators, sodium nitroprusside, cardiogenic shock –> IABP, severe? –> MV repair/replacement
chronic: diuretics
hypertensive? –> vasodilator (sodium nitroprusside), MV replacement/repair
what are causes of mitral stenosis?
congenital deformities systemic disease (SLE, RA, carcinoid syndrome) pseudo mitral stenosis mitral annular calcification rheumatic valvular disease
what are signs and symptoms of mitral stenosis?
infective endocarditis, stroke from thrombus, cardiac arrhythmia, dyspnea and cough, orthopnea, chest pain, hoarseness, peripheral edema, fatigue, passively leads to RVH
what are pathological findings of mitral stenosis?
calcification of mitral valve
JVP wave shifted up
transvalvular gradient increased (magnitude tells you about severity)
what are auscultatory findings of mitral stenosis?
diastolic rumble
possible presystolic accentuation of murmur
with increased severity: holodiastolic murmur
OS (decrease in A2 to OS with increased severity)
what are treatments for mitral stenosis?
volume management rate control treat coexisting conditions percutatneous balloon valvulopathy mitral valve commisurotomy mitral valve replacement
what are pathological findings of rheumatic valvular disease?
chronic: thickening and fibrosis of valve –> stenosis and regurgitation (Dx w/ ultrasound)
what are auscultatory findings in rheumatic valvular disease?
transient regurgitant murmurs, mid-diastolic murmurs (Carey-Coons murmur)
what are causes of mitral regurgitation?
mitral valve prolapse rhemuatic valvular disease endocarditis dilated cardiomyopathy coronary ischemia trauma systemic disease
what is the effect of mitral regurgitation on JVP
prominent v waves and rapid y descent
what are auscultatory findings in mitral regurgitation
pan or holosystolic murmur
early diastolic murmur
possible S3
(5th ICS in anteroaxillary line and radiates to axilla)
what are causes of aortic stenosis?
congenital (bicuspid)
rheumatic valve disease: ARF –> valvulitis (concomitant MVD (esp women)
calcific degeneration from atherosclerosis, rheumatic fever or endocarditis
systemic disease
what are symptoms of aortic stenosis
pulmonary edema and hypertension angina syncope dyspnea and CHF, massive LVH mitral regurgitation aortic dissection aortic valve perforation MI cardiac arrhythmia
what are pathological findings in aortic stenosis?
inferolateral displacement of PMI
duration of apical impulse prolonged
contour of carotid pulse decreases in amplitude and delay in contour of carotid upstroke = pulsus parvus et tardus
auscultatory findings in aortic stenosis?
rhomboid SEM (peaks later with severity)
early systolic ejection click
splitting of S2 narrows (with possible paradoxical splitting)
S4 possible
what are treatments for aortic stenosis?
diuretics digoxin dopamine dobutamine aortic valve replacement percutaneous balloon valvuloplasty
what is the most common congenital CV abnormality
bicuspid aortic valve
what are signs and symptoms of bicuspid aortic valve
aortic dissection –> severe tearing chest pain radiating back
endocarditis
responsible for 50% of aortic stenosis cases
EKG shows LVH
causes of aortic regurgitation
acquired: RVD, endocarditis, aortic root disease, systemic diseases
congenital: bicuspid or quadricuspid, sinus of valsalva aneurysm, subaortic membranes, subaortic VSD
signs and symptoms of aortic regurgitation?
chronic: CHF, eccentric hypertrophy, progressive LV cavity dilation, increase in wall thickness, cardiomegaly, increased myocardial mass
LV wall stress, increased afterload mismatch and LV systolic dysfunction
widening of aortic pulse pressure
acute: pulmonary edema,
what are pathological findings in aortic regurgitation
long latent period without symptoms laterally displaced PMI Quinke's sign Corrigan's water hammer pulse Deroziez's sign Hill's sign
what are auscultatory findings in aortic regurgitation
diastolic murmur (3rd or 4th ICS at LSB) descrescendo appreciated along RSB if related to aortic root dilation (Harvey's sign) severity associated with duration rather than intensity austin-flint murmur: low frequency diastolic murmur
what are treatment options for aortic regurgitation?
valve replacements
echos: 1-2 yrs if asymptomatic and mild and normal LV
6-12 months if asymptomatic, moderate/severe aortic regurgitation, preserved LV
if preserved LV systolic function and diastolic hypertension –> diuretics, sodium restriction and vasodilator therapy (nifedipine or ACE inhibitors)
aortic root replacement in those with concomitant aortic pathology
NO IABP
what are causes of carcinoid heart disease?
tumor produces 5-HT or other vasoactive compounds
thickened valvular plaques made of smooth muscle collagen and matrix
thickened tricuspid valve and fusion of the chordae tendinae associated with the carcinoid tumors
why don’t GI carcinoids cause heart lesions?
metabolized by liver
how do you get left side lesions?
exogenous vasoactive peptide use, rare otherwise
what is unique about carcinoid heart disease?
right sided valve disease
what is rheumatic endocarditis?
fibrinous necrosis of cusps and cords
vegetations overlie areas of necrosis
inflammation of the heart
damage to heart tissues
what is the cause of rheumatic valvular disease?
antigenic cross reaction between streptrococcus and heart disease
direct invasion by bacteria
immune cross reaction to heart tissues
