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Acute Care Seminar 1 > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

SVC & IVC

A

-Brings blood back to the heart

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2
Q

Pulmonary Artery

A

only artery that has venous blood

-goes to lungs to receive oxygen

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3
Q

Pulmonary Vein

A
  • bring back to LA

- oxygenated blood

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4
Q

LV

A
  • Pushes blood to aorta to the rest of body
  • oxygenated blood
  • work horse of the heart
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5
Q

Atrioventricular valves

A

between atria and ventricles

  • Tricuspid & mitral
  • S1 created w/ closure
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6
Q

Semiulnar

A
  • Aortic & pulmonic
  • S2 w/ closure
  • in ventricular outflow tracts
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7
Q

Aortic Valve

A
  • Calcified and degenerates
  • Most common to have issues over time
  • 3 leaflet valve
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8
Q

S1

A

softer than S2 at the base; often louder at apex

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9
Q

S2

A

normal splitting of S2 with inspiration; disappears with expiration; may be normal in younger, healthy patients & children

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10
Q

S3

A

gallop; heard just after S2; ”Kentucky” or lub- dub-ta; due to extra fluid striking a compliant left ventricle

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11
Q

S4

A

heard just before S1; “Tennessee” or ta-lub-dub; associated with a thickened ventricle (hypertension) or aortic stenosis

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12
Q

Regurgitation or Insufficiency

A

benign or pathological

-Backward flow

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13
Q

Stenosis

A
  • narrowing or impedence in flow

- Always pathological

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14
Q

Systole

A 
-occurs between S1 & S2; feel with pulse
Innocent & Physiologic murmurs
Aortic stenosis
Mitral Regurgitation
Tricuspid Regurgitation
Pulmonary Stenosis
Hypertrophic Cardiomyopathy
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15
Q

Diastole

A

(always pathological) – occurs after S2 before S1
Mitral Stenosis
Aortic Regurgitation

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16
Q

Common Systolic murmurs: Aortic Stenosis

A
  • Aortic stenosis (most common of aging)
  • Harsh murmur
  • Right, 2nd ICS
  • Crescendo-decrescendo (diamond shaped)
  • Intensity correlates with severity of obstruction
  • Carotid upstroke may be decreased and/or delayed (parvus tardus)
17
Q

Aortic Stenosis

A

Causes:
Aging- Degenerative calcification of aortic cusps
Congenital- Bicuspid Aortic Valve (BAV)
Rheumatic Heart Disease (RHD)

Risk Factors
Elevated LDL & lipoprotein a, DM, smoking, CKD, metabolic syndrome

18
Q

Aortic Stenosis Symptoms

A
  • Usually no symptoms until disease is severe
  • Onset age 60-80s in chronic degenerative AS
  • Onset age 40-50s in BAV
  • Fatigue, DOE most common
  • —Triad: Angina, Heart Failure, exertional Syncope for critical AS
19
Q

Management of AS

A
  • Treat heart failure with diuretics
  • Treat LV dysfunction
  • Cautious use of nitrates and Ace inhibitors in Severe AS
  • Avoid strenuous activity when AS is moderate or greater (esp. weight lifting)
  • Aortic Valve Replacement (SAVR)
  • Transcutaneous Aortic Valve Replacement (TAVR)
20
Q

Common systolic murmurs: Mitral Regurgitation

A
  • Mitral valve leaflets don’t meet, allowing backflow of blood into atrium during systole in LA
  • Holosystolic
  • Apex
  • High-pitched; blowing
  • Intensity is related to pressure gradient across the valve from left atrium to left ventricle
  • May radiate to axilla or into back as gradient worsens
  • Intensity increases with hand grip
  • Happening in systole not as harsh as AS
21
Q

MR

A

Acute Causes

  • Acute Myocardial Infarction (with papillary muscle rupture)
  • Ruptured chordae tendineae
  • Infective Endocarditis
  • Chest trauma

Chronic causes
-RHD; MVP; calcification; congenital; HOCM; dilated CMP

22
Q

MR Symptoms

A

Acute
-pulmonary edema
Chronic
-fatigue, DOE, orthopnea (late symptoms)

23
Q

MR management

A

Treat heart failure with diuretics
Treat LV dysfunction
If Atrial Fibrillation, anticoagulation needed
Follow serial echocardiograms based on progression of disease and symptoms
Timing of surgical repair
MitraClip percutaneous device for severe inoperable MR

24
Q

Mitral Valve Prolapse

A

Heard best at the apex
Systolic “click” murmur
May be followed by high-pitched late systolic crescendo-decrescendo murmur at apex
Most common in women ages 15-30 years old

Causes:
unknown
may be genetic; often associated with Marfan’s Syndrome or other connective tissue disorders

25
Q

Mitral Valve Prolapse: Symptoms

A 
Symptoms:
Often asymptomatic
Palpitations, presyncope/syncope
     (with associated arrhythmias)
Chest pain

Classification/Pathophysiology:
May progress to Severe Mitral Regurgitation (MR)
Most common cause of isolated severe MR requiring surgical intervention in North America

26
Q

MV prolapse management

A

Treat arrhythmias
In Atrial Fibrillation, anticoagulation needed
With history TIA/stroke, use Aspirin or Warfarin
Follow serial echocardiograms on patients MR or progressive symptoms

27
Q

TR

A

-Systolic Murmur heard when severe
–Primary Tricuspid Regurgitation:
RHD
Congenital – Ebstein’s Anomaly, TV Prolapse
Endocarditis
Carcinoid tumors
Device lead impingement
Iatrogenic (RV biopsy)

-Secondary Tricuspid Valve Regurgitation:
Functional (Sev LV failure, Pulm HTN)
90% cases

28
Q

TR Symptoms

A

PE findings / Symptoms:
-Prominent V waves, DOE, dyspnea at rest with severe HF, liver congestion, early satiety, LE edema, anasarca

Classification/Pathophysiology:

  • Severe TR leads to right heart failure, venous system congestion & decreased CO.
  • Poor outcomes and high mortality
29
Q

TR Management

A

Manage Right HF with diuretics
Treat LV dysfunction
Anticoagulate patients with Atrial Fibrillation
Often requires frequent hospitalizations
May be surgically repaired in some cases
Device lead impingements
FORMA percutaneous device

30
Q

Common Systolic murmurs: Hypertrophic Cardiomyopathy

A
  • Harsh, systolic murmur
  • Through precordium
  • Worsens with Valsalva
  • Lessens with standing or squatting
  • Due to thickened ventricular septum restricting ventricular outflow track
  • Genetic disease < 200,000 cases/year
31
Q

Common Diastolic murmurs: Aortic Regurgitation

A
  • High pitched
  • Decrescendo
  • Left 4th ICS
  • Intensity related to amount of blood that reflexes back into left ventricle during diastole
  • Instruct patient to lean forward & hold breath
  • Intensifies with hand grip
32
Q

AR Symptoms

A

Symptoms:
Fatigue, dyspnea, syncope

PE Findings:
Increased arterial pulse pressure; “Water hammer” pulse; head bobbing
Thrill and heave may be palpable
Thrill may radiate into carotids

33
Q

AR Management

A

Follow with echocardiogram every 3-12 months
Treat heart failure
Treat LV dysfunction

Surgery
Consider symptoms, LV function, assessment of end-diastolic and systolic dimensions, response to exercise
Patients are not usually symptomatic until LV function deteriorates
Operate in asymptomatic patients when severe AR with LV dysfunction < 50% and LV end SD > 55 mm & end DD > 75 mm.
Delayed surgical treatment often does not restore LV function

34
Q

Common Diastolic Murmurs: Mitral Stenosis

A 
-Low-pitched
Rumble
-Use Bell of stethoscope applied lightly at apex
-Turn patient on left side
-May be accompanied by opening snap
-Intensifies with light exercise
35
Q

Guidelines for anticoagulation

A

WARFARIN ONLY – NO DOACS

Bioprosthetic Valves:
Typically for 4-6 weeks post-operatively

Mechanical Valves:
Dependent upon position
Mitral position is most thrombogenic
Consider other comorbid conditions

36
Q

Mitral Stenosis classifcation

A

-Normal valve area 4 - 6 cm2

  • Mild - Valve area < 2 cm2
  • –causes an increased atrioventricular pressure gradient to maintain CO
  • –PVP and PAP increase (dyspnea)
  • Moderate - Valve area 1 - 1.5 cm2
  • —LVEF normal at rest & rises suboptimally with exertion
  • Severe - Valve area < 1 cm2
  • —-LVEF may be suboptimal at rest and fail to rise with exertion
37
Q

Mitral Stenosis Management

A

Treat heart failure with diuretics

Anticoagulate patients with Atrial Fibrillation

Balloon Valvotomy or Repair before LVEF can increase with exertion

38
Q

Valve Replacements

A

Bioprosthetic:
Traditionally for patients > 65 yo
Technology is improving

Mechanical:
Traditionally for patients < 65 years old
Require life-long anticoagulation with Warfarin (Coumadin)

-ABX treatment before dental procedures (SBE prophylaxis)

39
Q

Spontaneous Bacterial Endocarditis (SBE) Prophylaxis: Oral

A

Amoxicillin
Ampicillin
or Cefazolin or Ceftriaxone

Allergic to penicillin’s or ampicillins: Cephalexin or Clindamycin or Azithromycin or clarithromycin

Acute Care Seminar 1 (31 decks)

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