Flashcards in Valvular Disorders Deck (105)
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)
What are the two types of valvular lesions?
1. Stenosis (scarring and blockage)
2. Regurgitation (insufficiency, incompetence…they leak)
Etiology of valvular disease?
1. Rheumatic fever
2. Infective endocarditis
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
Pathology of the Tricuspid Valve
4. Carcinoid Syndrome
5. Traumatic Rupture
6. Ebstein’s Anamoly
Which disease processes cause tricuspid regurgitation?
1. Annular dilation (most common right-sided valve disease in the adult)
2. Rheumatic disease (calcification and fusion)
3. Carcinoid syndrome
5. Ebstein anomaly
Which disease processes cause tricuspid stenosis?
1. Rheumatic disease (calcification and fusion)
2. Carcinoid syndrome
Describe the following symptoms involved with each organ system in carcinoid syndrome:
1. Heart? 2
3. GI? 4
4. Skin? 2
5. Respiratory? 3
6. Retroperitoneal? 2
-pulmonic and tricupid valve thickening and stenosis
6. retroperitoneal and pelvic fibrosis
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
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
Clinical presentation of tricuspid regurgitation
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)
In late stages of tricuspid regurgitation what will manifest?
4. A-fib is common
What does right sided heart failure cause?
2. venous engorgement
4. pulsatile liver
5. pleural effusions &
6. peripheral edema (sounds familiar)
What will you find on physical exam in tricuspid regurgitation? 3
1. Right sided failure
2. Abnormal pulse in jugular vein
3. High pitched systolic murmur
RAE (starting to make sense)
What is tricuspid stenosis usually caused by?
Most commonly rheumatic, rare isolated stenosis
In tricuspid stenosis pts present with Fatigue, anorexia & malaise related to what?
reduction of CO
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,
5. pleural effusion, &
6. peripheral edema
1. with fusion and shortening of chordae
2. leaflet thickening
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
6. What organism?
1. Tricuspid valve lesion of
2. IV drug abuse
-Embolic Events and
4. Intensive medical Tx (Abx) and maybe valve replacement
5. Horrible mortality
What is ebsteins anomaly? 3
1. Atrialization of RV,
2. sail-like TV,
What does the disease severity depend on for ebsteins anomaly?
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
50% of ebsteins have what? 2
50% will show what on the EKG?
50% EKG evidence of WPW
What will a chest xray show on a pt with ebstens anomaly?
mainly due to RAE
of ebsteins anomaly?
1. Fluid Restriction
3. Treat the complications (for example: rhythm disturbances)
Pulmonary Regurgitation has two kinds. What are they?
Congenital and Acquired (rare)
Describe the pathphysiology behind congenital pulmonary regurgitation? 3
1. Abnormal cusp number
2. Abnormal cusp development
3. NO VALVE (Pulmonary Atresia)
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
What diseases cause acquired pulmonary stenosis?
1. Rheumatic heart disease
3. Infective endocarditis
If you have a diastolic murmur how is the mitral valve affected?
Mitral stenosis is primarily a result of what?
Primarily a result of rheumatic fever
(~ 99% of MV’s @ surgery show rheumatic damage )
What are the etiologies of mitral valve stenosis? 6
what are the two most common?
1. Rheumatic heart disease
5. Rheumatoid Arthritis