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Flashcards in Valvular Disorders Deck (105)
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1

What is the problem in cardiac valve disease?

What is the result of this?

Describe the pathophysiology behind the problem?

The problem: Structural and/or functional abnormality of the cardiac valve

The result: altered blood flow across the valve

The pathophys: Pressure and volume changes of atria and ventricles (hypertrophy, dilatation and failure)

2

What are the two types of valvular lesions?

1. Stenosis (scarring and blockage)
2. Regurgitation (insufficiency, incompetence…they leak)

3

Etiology of valvular disease?
9

1. Rheumatic fever
2. Infective endocarditis
3. Functional
4. Congenital malformations (pediatric/bicuspid)
5. Aging valve tissue (calcification)
6. Rupture/dysfunction of the papillary muscles (MI)
7. Collagen vascular disease
8. Aortic dissection
9. Syphilis

4

Pathology of the Tricuspid Valve
6

1. Regurgitation
2. Stenosis
3. Endocarditis
4. Carcinoid Syndrome
5. Traumatic Rupture
6. Ebstein’s Anamoly

5

Which disease processes cause tricuspid regurgitation?
5

1. Annular dilation (most common right-sided valve disease in the adult)
2. Rheumatic disease (calcification and fusion)
3. Carcinoid syndrome
4. Endocarditis
5. Ebstein anomaly

6

Which disease processes cause tricuspid stenosis?
2

1. Rheumatic disease (calcification and fusion)
2. Carcinoid syndrome

7

Describe the following symptoms involved with each organ system in carcinoid syndrome:

1. Heart? 2
2. Liver?
3. GI? 4
4. Skin? 2
5. Respiratory? 3
6. Retroperitoneal? 2

1.
-pulmonic and tricupid valve thickening and stenosis
-endocardial fibrosis

2. heptomegalgy

3.
-diarrhea
-cramps
-nausea
-vomiting

4.
-cutaneous flushes
-apparent cyanosis

5.
-cough
-wheezing
-dyspnea

6. retroperitoneal and pelvic fibrosis

8

What is the pathophysiology behind tricuspid regurgitation?
4 steps to result

1. Pulmonary hypertension develops leading to right ventricular dilation… tricuspid annulus dilates
2. As the annular & ventricular dilation progresses, the chordal papillary muscle complex becomes functionally shortened
3. This combination prevents leaflet apposition, resulting in valvular incompetence
4. The pre-load, afterload and RV function also contribute

9

What is the most common presentation of tricuspid regurgitation due to?

The most common presentation of tricuspid regurgitation is functional rather than organic (MS, MR, AS, AI or left-sided failure)
*******Process of annular dilatation

10

Clinical presentation of tricuspid regurgitation
4

1. Clinical presentation (usually need pulmonary hypertension)
2. Fatigue & weakness related to reduction of cardiac output
3. DOE and SOB
4. Right heart failure lead to

ascites, venous engorgement, hepatospenomegaly, pulsatile liver, pleural effusions & peripheral edema (sounds familiar)

11

In late stages of tricuspid regurgitation what will manifest?
4

1. cachexia
2. cyanosis
3. jaundice
4. A-fib is common

12

What does right sided heart failure cause?

1. ascites
2. venous engorgement
3. hepatospenomegaly
4. pulsatile liver
5. pleural effusions &
6. peripheral edema (sounds familiar)

13

What will you find on physical exam in tricuspid regurgitation? 3

ECG?

1. Right sided failure
2. Abnormal pulse in jugular vein
3. High pitched systolic murmur

RAE (starting to make sense)

14

What is tricuspid stenosis usually caused by?

Most commonly rheumatic, rare isolated stenosis

15

In tricuspid stenosis pts present with Fatigue, anorexia & malaise related to what?

reduction of CO

16

As the right atrial pressure increases, venous congestion leads to what? 6

Anatomic features are similar to mitral stenosis. How so? 2

The right atrial wall thickens and chamber ______?

Systolic murmur at _____, ___ P waves, ____ on EKG.

1. distention of jugular veins,
2. edema,
3. hepatomegaly,
4. ascites,
5. pleural effusion, &
6. peripheral edema

1. with fusion and shortening of chordae
2. leaflet thickening

1. dilates

1. LLSB
2. tall
3. RAE

17

1. Infective endocarditis causes what to happen to the tricuspid valve?

2. Increasing due to rising incidence

3. What are the four pathological disease processes that endocarditis causes?

4. How should we treat? 2
5. Prognosis?

6. What organism?

1. Tricuspid valve lesion of
2. IV drug abuse
3.
-Regurgitation,
-Conduction Abnormalities,
-Embolic Events and
-SEPSIS

4. Intensive medical Tx (Abx) and maybe valve replacement

5. Horrible mortality


6. Staph

18

What is ebsteins anomaly? 3

1. Atrialization of RV,
2. sail-like TV,
3. TR

19

What does the disease severity depend on for ebsteins anomaly?
4

1. Age at presentation varies from childhood→adulthood and depends on factors such as
2. severity of TR,
3. Pulm Vascular resistance in newborn, and
4. associated abnormalities such as ASD

20

50% of ebsteins have what? 2
50% will show what on the EKG?

50% ASD/PFO
50% EKG evidence of WPW

21

What will a chest xray show on a pt with ebstens anomaly?

Massive cardiomegaly,
mainly due to RAE

22

Medical Management
of ebsteins anomaly?
3

1. Fluid Restriction
2. Diuretics
3. Treat the complications (for example: rhythm disturbances)

23

Pulmonary Regurgitation has two kinds. What are they?

Congenital and Acquired (rare)

24

Describe the pathphysiology behind congenital pulmonary regurgitation? 3

1. Abnormal cusp number
2. Abnormal cusp development
3. NO VALVE (Pulmonary Atresia)

25

Describe the pathphysiology behind acquired pulmonary regurgitation? 3

1. Pulmonary hypertension (this is what you treat and this is a big deal)
2. Annular dilation
3. Structural distortion

26

What diseases cause acquired pulmonary stenosis?
3

1. Rheumatic heart disease
2. Carcinoid
3. Infective endocarditis

27

If you have a diastolic murmur how is the mitral valve affected?

stenosis

28

Mitral stenosis is primarily a result of what?

Primarily a result of rheumatic fever
(~ 99% of MV’s @ surgery show rheumatic damage )

29

What are the etiologies of mitral valve stenosis? 6

what are the two most common?

1. Rheumatic heart disease
--Female
2. Congenital
Rare
3. Carcinoid
4. SLE
5. Rheumatoid Arthritis
6. Amyloid

30

Mitral Stenosis:
Pathophysiology

Normal valve area?
Mild mitral stenosis?
Moderate?
Severe?

Normal valve area: 4-6 cm2

Mild mitral stenosis:
MVA 1.5-2.5 cm2
Minimal symptoms

Mod mitral stenosis
MVA 1.0-1.5 cm2 usually does not produce symptoms at rest

Severe mitral stenosis
MVA less than 1.0 cm2

Pressure Difference