What are the role of the semilunar valves?
aortic and pulmonary; maintain unidirectional flow
What are the AV valves?
mitral and tricuspid
Where do the AV valves attach to the wall?
free margins attached to ventricular wall via chordae tendinae and papillary muscls
What is valvular stenosis?
failure of a valve to open completely; usually a chronic process affecting a valve cusp
What is insufficiency of valvular heart disease?
failure to close completely;
functional regurgitation: valvular incompetence due to disruption of supporting structures; -aorta root dilation-left ventricle dilation
intrinsical disease of valve cusps
What are the major causes of valvular disease?
congenital causes (bicuspid aortic valve-most common)
(stenosis of aortic valve, insufficiency of aortic valve: dilation of ascending aorta related to HTN and aging)
MItral valve (stenosis: rheumatic heart disease
Insufficiency: myxomatous degeneration)
Stenoses are more frequent than insufficiencies
What is calcific valvular disease?
dystrophic calcification, damage caused by wear and tear complicated by desposits of calcium phosphate
distinct from atherosclerosis
What are the clinical effects of calcific valvular disease?
LV: increased pressure causes hypertrophy
- angina, ischemia and CHF
- CHF often leading to death within two years
HOw do you treat clacific aortic stenosis?
What are the symptoms, relation of mitral annular calcification?
in women greater than 60 years old, usually doesn’t affect function but site for thrombi /infection
What are the role of myxomatous degeneration of mitral valve prolapse?
very common; 3% adults, young women, usually no complications and fx of marfan and other hereditary disorders
What ar ethe clinical fx of myxomatous mitral valve?
asymptomatic with mid systolic click
complication suncommon but infective endocarditis, mitral insufficiency, thrombi on atrail surface, arrythmias and sudden death
Wha tis the most important complication of rheumatic fever?
progression to chronic valvular dysfunction, mitral stenosis
What is the morphology of acute rheumatic fever?
pancarditis (affect all 3 layers) pericaritis myocarditis with aschoff bodies endocarium and left sided valves with fibrinoid necrosis sunbendocardial plaques
What is an aschoff body?
foci of swollen eosinophilic collagen, surrounded by T lymphocytes, plasma cells and plump macrophages
What is the pathogenesis of rheumatic heart disease?
hypersensitivity rxn inducd by group a strep
antibodies against M protein cross react with glycoprotein antigens in heart
What is the infective endocarditis morphology?
acute and subacute endocarditis, friable large bluky vegetations
fibrin and inflammatory cells
mitral valve and aortic valve common site
may cause ring abscess
What is the duke criteria?
bacterial endocarditis; major: positive blood culture echocardiographic findings new valve regurgitation minr: predisposing heart lesion fever uncommon finding resulting from septic emboli
What are the complications of baacterial endocarditis?
valvular insufficiency or stenosis
myocardial abscess and possible perforation
vegetations break off
What is nonbacterial thrombotic endocarditis?
depositions of small masses of fibrin platelets and other blood products on leaflet
What is libman-sacks endocarditis?
SLE; primary antiphospholipid syndrome
may have intense inflammation
What is carcinoid heart disease?
cardiac manifestation of carcinoid tumor
505 OF PATIENTS WITH CARRINOID SYNDROME PLAQUE LIKE FIBROSIS OF RIGHT HEART ENDOCARDIUM AND VALVES
What are the complicationss of artifical valves?
What do you see on physical exam of aortic stenosis?
sustained LV impulse, no LV displacement
pulsus parvus et tardus of the carotid impulse
absent A2 or paraoxically split A2
murmur is systolic cresendo
What are the mean survival rates of aortic stenosis pts from different symptoms?
What ar ethe causes of aortic regurgitation?
dilation of aortic root including anuerysm, inflammation, dissction, symphilis
What is the presentation of aortic regurgitation?
dyspnea on exertion fatiue decrease excercie tolerance chest pain hyperdynamic pulse widened pulse pressure
What is the treatment of aortic regurgiation?
acute–> surgical emergency
asymptomatic with normal LVEF - periodic echos and reduce afterload
asymptomatic and low LVEF or symptomatic and normal LVEF —> surgery and valve replacemet
What are the causes o mitral valve regurgitation?
myxomatous disease (MVP) rhemuatic vlave endocarditis ceft leaflet(Congenital)
What is the physical cause associated with all of the causes of mitral valve regurgitationa functionally?
volume overload state
which is well tolerated until severe; when seere regurgitation develops slowsly
What are the symptoms of acute mitral regurgitation?
normal LA size and compliance high left atrial pressure pulmonary venous pressure up pulmonary congestion prominent V waves medical emergency
What are the signs of chronic mitral regurgitation?
increased left atrial size and compliance
increased left ventricular size
eventual systolic dysfunction
What is the treatment for mitral regurgitaiton?
acute: diuretic and vasodilators and consider emergent surgery
chronic: asymptomatic monitor
if symptomatic repair or replacement valve
if there is severe left ventricular dyfunction often little can be done
What are the causes of mitral steonsis?
rheumatic fever is most common other rare causes endocarditis calcification congenital stenosis
What are the symptoms of mitral valve stenosis?
dyspnea and reduced excercise capacity
right sided heart failure
What are the treatment of mtiral valve stenossis?
diuretics for sxs, with afib tx beta blockers, digoxin or calcium channel blockers
vlavle replacement or balloon valvuloplasty