Valvular Heart Disease Flashcards

1
Q

Majority of defects

A

involve aortic valve (63%) & mitral valve (14%)»_space; left <3

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2
Q

valvular dz & pregnancy

A
blood vol increases 40-50%
CO increases 30-40%
Stroke Vol increases 25-30%
Heart rate increases 15%
increasing demand poses greater risk when diseased
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3
Q

Rheumatic Heart Dz

A

worlds most common valvular dz

declined considerably in developed countries

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4
Q

Valvular stenosis

A

narrowing, stiffening, thickening, fusion of leaflets
or blockage of one or more valves
obstruction nml blood flow

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5
Q

valvular regurgitation

A

aka insufficiency

blood leaks back into the wrong direction b/c the valve is not closing properly

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6
Q

Valvular atresia

A

valve failed to develop properly in utero

completely closed at birth

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7
Q

valvular prolapse

A
leaflets of valve do not close properly
excessive length or width
bulge into chamber it's protecting
may result in regurgitation
mitral valve prolapse common & rarely serious
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8
Q

abnormal ongoing valvular processes

A

often leads to both stenosis & regurgitation

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9
Q

congenital valvular dz

A

abnormal development in utero

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10
Q

acquired valvular dz

A

some process is changing or has altered the once normal valve

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11
Q

heritable valvular dz

A

congenital
marfan syndrome (+ other CT disorders)
Bicuspid aortic valve
hypertrophic cardiomyopathy HTC (aka: Idiopathic Hypertrophic Subaortic Stenosis)

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12
Q

Inflammatory-Immunologic valvular dz

A

rheumatic fever
AIDS & Non Bacterial Thrombotic Endocarditis (NBTE)
Kawasaki’s dz
Spondylarthropthies > ankylosing spondylitis, Reiter dz Becketts dz SLE ect
Cardiovascular syphilis

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13
Q

Endocardial disorders

A

infective endocarditis»_space; bacterial, fungal

non bacterial chromatic endocarditis»_space; systemic wasting type of states like AIDS and cancer

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14
Q

Myocardial valvular disfxn

A

Ischemic heart disease»_space;ex papillary muscle ischemic d/f
Dilated Cardiomyopathy»_space; stretches valve annulus
hypertrophic cardiomyopathy (HTC/IHSS)

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15
Q

Diseases and disorders of other organs

A

chronic renal failure»_space; abnormal calcification of valves

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16
Q

Aging

A

Calcific aortic stenosis»_space; mitral annular calcification

17
Q

Post Interventional valvular dz

A

balloon vavlulotomy
valve reconstructive surgery (commissurotomy)
valve replacement

18
Q

Drug & physical agents

A

chronic Ergotamin Rx (migraine tx)
appetite suppressant drugs (Fen-fen)
Radiation»_space; affects all tissue in path of the XR’s
Trauma induced valve dz»_space; aortic regurg most common

19
Q

Grading of mumurs (6)

A

Grade 1: very faint, special effort (cardiologist) needed
Grade 2: quiet but clearly audible
Grade 3: moderately loud
Grade 4: loud, often w/ thrill
Grade 5: very loud w/ thrill palpable
Grade 6: very loud, audible w/out stethoscope, thrill palpable & visible

20
Q

Continuous murmurs

A

heard throughout cardiac cycle

21
Q

Mill wheel murmur

A

heard throughout cardiac cycle

associated w/ Venous Air Embolism

22
Q

murmur shape

A

crescendo: pressure increases progressively
decrescendo: pressure decreases progressively
crescendo-decrescendo : pressure increases then
decreases
Plateau: pressure is constant through murmur

23
Q

pitch of murmur

A

high, medium, low

24
Q

quality of murmur

A

rumbling, blowing, harsh

25
Q

antibiotic prophylaxis

A

for procedures & dental cleanings for anyone w/ acquired valvular dz

26
Q

valve replacement

A

before cardiac decompensation!

best prior to development of cardiac compensatory mechanism

27
Q

periodic reassessment of valvular dz

A

for potentially progressive valvular dz

28
Q

Acute medical therapy for valvular dz

A

ex: after load reduction in aortic regurg for pre-op

29
Q

Chronic therapy for valvular dz

A

Ex: diuretics for moderate mitral stenosis > decreases L atrial P.
Ventricular rate control in A. Fib
After load reduction> aortic regurgitation

30
Q

Interventional procedures for valvular dz

A

Balloon valvulotomy
valve repair»_space; prosthetic rings, valve commissurotomy
valve replacement»_space; mechanical, porcine, human cadaver

31
Q

Valsalva maneuver & murmurs

A

decreases preload
decrease in length & intensity of murmur
after maneuver murmur returns to regular intensity/length
**Exceptions:
*Hypertrophic Cardiomyopathy»_space;becomes louder
*Mitral valve prolapse» becomes longer & louder

32
Q

Exercise & murmurs

A

Become louder

Handgrip exercises also increase audibility

33
Q

Diastole murmurs (ARMS PaRTS )

A

aortic regurgitation
mitral stenosis
pulmonic regurgitation
tricuspid stenosis

34
Q

Aortic Regurgitation valve replacement postponer

A

after load reduction may fend off procedure by 5 yrs

35
Q

squatting exercise

A

increases preload, increases after load