Valvular Dz Flashcards
(37 cards)
What are the two main types of valvular lesions?
- stenosis (scarring and blockage)
- regurgitation (insufficiency, incompetence/leaky)
Causes of Valvular dz
- rheumatic fever
- infective endocarditis
- functional (leaflets)
- Congenital malformations (pediatric/bicuspid)
- Aging valve tissues (Calcification)
- Rupture of papillary muscles
- Collagen Vascular Dz
- Aortic dissection
- Syphillis
What are the most common valvular dz?
mitral and aortic
What are some causes of Tricupside valvular dz?
- annular dilation (TR)
- rheumatic dz (TR & TS)
- Carcinoid syndrome (TR and TS)
- Endocarditis (TR)
- Ebstein Anomaly (TR)
Tricuspid Regurgitation
- pathophysiology
Patho:
-pulmonary HTN developes leading to right ventricular dilation and tricuspid annulus dilation. As dilation progresses the chordal papillary muscle complex becomes functionally shortened preventing leaflet apposition resulting in valvular incompetence.
Tricuspid Regurgitation
- clinical presentation
- Physical Exam findings
Presentation:
- fatigue & weakness related to reduction of CO
- Dyspnea on exertion and SOB
- Right heart failure leads to ascites, venous engorgement, hepatosplenomegaly, pulsatile liver, pleural effusion, peripheral edema
- cachexia, cyanosis, jaundice, a-fib.
PE:
- right sided failure
- abnormal pulse in jugular vein
- high pitched systolic murmur
Tricuspid Stenosis
- common causes
- sx & signs
- pathophys
- EKG findings
Common cause:
-rheumatic
Signs Sx:
- fatigue, anorexia, & malaise d/t reduction of CO
- edema
- hepatomegaly
- ascities
- pleural effusion
- systolic murmur.
Pathophys:
- right atrial pressure increases leading to venous congestion.
- right atrial wall thickens and chamber dilates.
EKG findings;
-tall P waves, RAE on EKG
Infective endocarditis
- most commonly affects which valve?
- common in who?
- Tricuspid valve
- Common in IV drug users
What is Ebsteins anomaly? Tx
-developmental defect in which the tricuspid valve is incompletely formed, annulus is depressed into the RV. Small RV cavity, tricuspid regurgitation. Large right atria.
Tx: fluid restriction, diuretics, and treat the complications. Difinitive surgery is to correct the tricuspid valve.
Pulmonary Regurgitation
-may be congenital or acquired, what are these?
Congenital: abnormal cusp number, abnormal cusp development, no valve (atresia)
Acquired: pulmonary htn, annular dilation, structural distortion.
Pulmonary Stenosis
-may be congenital or acquired, what are these?
Congenital is congenital..
Acquired: rheumatic heart disease, carcinoid, infective endocarditis.
Mitral Stenosis:
- etiology
- What are the mitral valve areas that are considered to be mild, moderate, and severe stenosis?
- at what Mitral valve area do sx become apparent?
etiology:
- primarily a result of rheumatic fever
- Congenital
- Carcinoid
- Lupus
- RA
- Amyloid
Mitral Valve Areas:
- Mild: 1.5-2.5
- Mod: 1.0-1.5
- Severe: less than 1.0cm2
-sx are apparent at less than 2.5cm2
Mitral stenosis
- sx
- CXR
- Auscultation
- fatigue
- palpitations
- cough
- SOB
- Left sided failure (orthopnea, PND)
- Palpitation
- Hoarseness (d/t compression of the left recurrent laryngeal by the enlarged atria)
CXR:
-congestion and large LA, if severe right heart disease can see ring of calcification (annulus)
Auscultation:
- S1 as loud as S2 in aortic area
- diastolic murmur
Mitral Stenosis:
- complications
- pathophysiology
Complications:
- atrial dysrhythmias
- systemic embolization
- CHF
- Hemoptysis (ruptured bronchial veins d/t pulm HTN.)
- Endocarditis
- pulmonary infections
Pathophys:
- Left atrial HTN
- pulmonary interstitial edema & pulmonary HTN.
- Left atria stretch and fibrillation
- -increased HR thus decreased LV filling
- -decreased atrial kick thus decreasing LV filling
- -atrial thrombus formation and embolus
- -limited LV filling and CO.
EKG findings for Mitral Stenosis
LAE, RVH, PVC, afib/flutter
Mitral Valve Stenosis
Tx
- Diuretics for LHF/RHF
- Digitalis/Beta Blockers/CCB: rate control in afib
- anticoagulation: afib
- endocarditis prophylaxis
- balloon valvuloplasty
- surgery: mitral commissurotomy, mitral valve replacement, mitral valve repair usually not possible.
Mitral Regurgitation
- Etiology
Etioloy:
- valvular leaflets: rheumatic, endocarditis, congenital
- chordae: fused, ruptured, degenerative, infectious endocarditis
- Annulus: calcifications, Infectious endocarditis
- Papillary Muscles: CAD (ischemia, infarction, rupture)
- LV dilatation & functional regurgitation
Mitral Regurgitation Pathophysiology
-sx
- chronic LV volume overload leads to LVH and decreased CO.
- backflow into atria leads to LAE and pulmonary HTN
Sx:
- dyspnea
- orthopnea, PND
- fatigue
- Pulm HTN, Right sided failure
- Hemoptysis
- Systemic Embolization in a-fib
Describe Mitral Valve murmur and heart sounds
murmur: pansystolic, heard loudest apex to axilla
- laterally displaced apex
- wide split S2
Mitral Valve Regurgitation
- EKG findings
- CXR findings
- echo findings
EKG:
-LAE, afib, LVH, RVH
CXR:
-enlarged LV and LA, increased pulmonary vascularity
Echo:
-can tell you the severity and etiology of MVR.
Etiology:-flail leaflets, thick (RHD), post movement of leaflets(MVP), vegetations (IE)
Severity: -regurgitant volume/fraction/orifice area, LV systolic function, increased LV/LA size, EF
Mitral Valve Prolapse
- aka
- etiology
- pathophys
- presentation
aka: floppy valve, Barlows
Etiology:
- congenital
- Marfans Syndrome
- RHD
- Sequelae of cardiomyopathy or MI
Pathophys:
- valve leaflet has redundant tissue
- extra tissue balloons into LA, click sound.
Presentation :
- asymptomatic
- symptomatic:
- -palpitations
- -arrhythmias
- -atypical chest pain (not typical of angina pectoris)
Mitral Valve Prolapse
- EKG findings
- Echo findings
- heart sounds
- Tx
EKG:
- normal or abnormal
- SVT
- Wolf parkinson white syndrome
- nonspecific ST-T changes
Echo:
-confirms dx
Heart sounds:
-mid systolic click
Tx:
- Reassurance
- Beta blockers
- Subacute Bacterial Endocarditis prophylaxis
Complications:
-rare: endocarditis, progressive MR, thromboembolism, atrial and ventricular arrhythmias
Chronic Mitral Regurgitation
- Tx
- what class of sx indicate surgical intervention?
-ACEi if hypertensive
-afib requires rate control, anticoagulation and attempt at restoration of sinus rhythm.
Preload reduction:
–low sodium diet
–diuretics
Afterload reduction:
–vasodilators(ACEi, hydralazine)
–Digoxin
–Subacute Bacterial endocarditis prophylaxis
-Surgery:
–mitral valve repair/replacement
*repair is preferred over replacement!
*surgery should be performed before onset of severe sx or development of LV contractile dysfunction.
- Class III or IV sx ALWAYS indicate need for surgery
- Class II sx indicate need for surgery in pts with repaireable valves
Acute Mitral Regurgitation
-pathophys
pathophys:
- abrupt volume overload, no time for adaptation. Sudden decrease in forward stroke volume, sudden increase in LA volume leading to increased Pulmonary volume/pressure. Decrease in forward CO…cardiogenic shock.
call the surgeon!!
