Valvular heart disease Flashcards Preview

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Flashcards in Valvular heart disease Deck (59):
1

what grade of murmurs is loud, and associated with a thrill 

Grade 4/6

2

function of echocardiography 

  • evaluate chamber size and valve abnormalities, including pressure gradients

3

function of angiography 

  • provides detailed info preoperatively
  • evaluate for CAD

4

aortic stenosis 

narrowing of aortic outflow tract 

5

aortic stenosis can occur at what 3 levels 

  • aortic valve: 75% of cases
  • supravalvular: congenital or post-operative
  • subvalvular: congenital or hypertrophic cardiomyopathy 

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6

etiology of aortic stenosis below age 30

congential, unicuspid valve

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7

etiology of aortic stenosis age 30-65

  • congenital bicuspid valve which becomes calcified and stenotic 

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8

rheumatic valve disease account for what percentage of aortic stenosis between ages 30-70

6-27%

9

etiology of aortic stenosis over age 65

degeneration of sclerosis of valve 

10

when does mortality become significant in patients with aortic stenosis

  • after symptoms develop
  • average survival without valve replacement is 2-3 years with a high risk of sudden death

11

early symptoms of aortic stenosis

  • dyspnea on exertion
  • fatigue
  • decreased exercise tolerance

12

later symptoms of aortic stenosis

  • dyspnea with normal activity
  • angina
  • syncope
  • heart failure 

13

aortic stenosis is associated with what murmur? where would you hear the murmur 

  • systolic ejection murmur
    • high pressure to high pressure
  • 2nd RICS or apex 

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14

what type of pulse pressure indicates severe aortic stenosis disease 

small pulse pressure 

15

CXR findings of aortic stenosis 

  • LVH
  • calcification may be seen in valve 

16

management of mild asymptomatic aortic stenosis 

  • follow, educate regarding sxs 

17

management of moderate asymptomatic aortic stenosis 

  • annual ECG, echo, cxr

18

management of severe asymptomatic aortic stenosis 

  • cardiolgoy evaluation and f/u

19

patient education regarding aortic stenosis 

  • avoid strenuous physical activity
  • avoid dehydration
  • signs of worsening disease
    • exertional dizziness, dyspnea, palpitations

20

what is the definitive technique for evaluating severity and site of stenosis 

cardiac catheterization 

21

normal aortic valve area 

3-4 cm2

22

classification of severe aortic stenosis 

severe < 1.0

23

which patients with aortic stenosis are candidates for valve replacement 

  • severe, symptomatic aortic stenosis 

24

differentiate clinically between prosthetic valves and tissue valves (in aortic vavle replacement) 

  • prosthetic valves last longer but require lifelong anticoagulation
    • warfarin
  • tissue valves do not last as long but do not require  lifelong anticoagulation

25

hypertrophic cardiomyopathy 

  • a form of subvalvular aortic stenosis
  • disease of cardiac muscle characterized by severe myocardial hypertroph, in the absense of a cause for secondary hypertrophy (HBP, AS) 
  • familial, inherited in 60% of cases 

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26

hypertrophic cardiomyopathy's murmur compared to AS

  • murmur is similar except it is louder if patient stands or valsalvas (opposite of valvular AS) 

27

treatment for hypertrophic cardiomyopathy

  • calcium channel blocker
  • beta blocker 

28

aortic regurgitation (insufficiency) 

  • leakage of blood back through aortic valve during diastole 

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29

primary etiologies of aortic regurgitation (insufficiency) 

  • rheumatic valvular disease (29%)
  • bicuspid aortic valve (12%)
  • dilated aortic root (12%)
    • acutely dissecting aortic aneurysm 

30

acute causes of aortic regurgitation (insufficiency) 

  • aortic dissection
  • infective endocarditis 

31

treatment of acute aortic regurgitation (insufficiency) 

urgent cardiology consult for medication and consideration of valve replacement 

32

clinical presentation

  • LV overload and gradual dilation and hypertrophy
  • patients may be asymptomatic for 20+ years, then develop only mild DOE
  • eventually develop signs of heart failure

chronic aortic regurgitation

33

murmur associated with aortic regurgitation (insufficiency). where is it best heard

  • high-pitched diastolic decrescendo murmur 
  • aortic area and left sternal border 

34

austin flint murmur 

  • soft, low-pitched diastolic murmur at the apex which sounds like a diastolic mitral stenosis murmur
  • may be associated with aortic regurgitation (insufficiency) 

35

wide pulse pressure is seen in which condition 

aortic regurgitation (insufficiency) due to increased systolic and decreased diastolic pressures -> "water hammer" or "corrigan pulse"

36

CXR findings of aortic regurgitation (insufficiency) 

  • normal if acute
  • LVH if chronic, possible CHF/pulmonary edema 

37

treatment of chronic aortic regurgitation (insufficiency) 

  • if asymptomatic, f/u q 6-12 months (ECG, echo, CXR)
  • vasodilators reduce regurgitant volume and increase EF
    • ACE inhibitors are most helpful
  • valve replacement is available if symptomatic 

38

mitral regurgitation 

  • leakage of blood from LV into left atrium
  • may develop due to abnormality of 
    • valve leaflets
    • chordae tendinae
    • papillary muscles
    • valve annulus

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39

etiologies of mitral regurgitation 

  • papillary muscle necrosis secondary to ischemic heart disease
  • inherited
    • mitral valve prolapse
    • marfans
  • rheumatic heart disease (5-15% cases) 
  • congenital 

40

causes of acute mitral regurgitation 

  • papillary muscle necrosis from ischemia
  • endocarditis 
  • ***poorly tolerated and often required emergent surgery 

41

explain what happens in chronic mitral regurgitation 

  • LV adapts to larger blood volume by enlarging and increasing SV
  • heart may compensate for years with normal CO but eventually it is unable to keep up with demands and CHF develops
  • A-Fib frequently develops due to left atrial enlargement 
  • pulmonary HTN and RVH may also develop 

42

what often develops with chronic mitral regurgitation 

A-Fib due to left atrial enlargement 

43

murmur associated with mitral regurgitation. where is heard best 

  • high pitched, pansystolic murmur 
  • loudest at apex
  • later stages, S3 develops (early passive rapid filling of the ventricles with blood from atria)

44

CXR findings common in mitral regurgitation 

  • left atrial enlargement
  • LVH

45

treatment of chronic mitral regurgitation 

  • afterload reduction: ACE inhibitors and vasodilators 
  • sodium restriction and diuretics (Reduce preload)
  • anticoagulation for A-Fib
  • surgery:
    • repair valve vs valve replacement 

46

mitral valve prolapse 

due to ballooning of mitral leaflets into the left atrium during systole 

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47

heart sounds associated with mitral valve prolapse 

  • mid-late systolic clicks
  • mitral regurgitation may also occur with late systolic murmur 

48

prevelance of mitral valve prolapse 

  • 5% of general population
  • usually benign 

49

diagnostic study for mitral valve prolapse 

echocardiogram 

50

management of mitral valve prolapse  associated with palpitations or arrhythmias 

  • B-blockers may be helpful
  • if symptomatic or worsening, follow as with other patients with MR

51

pathophysiology of mitral stenosis

  • narrowing of mitral valve
  • obstructs flow from LA to LV
  • increases LA pressure
  • increase pulmonary vascular pressure 

52

most common cause of mitral stenosis

rheumatic heart disease 

53

rheumatic heart disease 

  • spectrum including acute rheumatic fever, pericarditis, myocarditis, and valvular lesions
  • delayed sequela following group A steptococcus pharyngitis 

54

signs and symptoms expected in mitral stenosis 

  • usually due to pulmonary congestion
    • dyspnea, orthopnea, PND, fatigue
    • pulmonary edema with hemoptysis
    • pulmonary HTN -> RHF
  • A-Fib in 40-50% 
  • 20% have systemic emboli, usually to brain

55

40-50% of patients with mitral stenosis have what conditions 

AFIB

56

murmur associated with mitral stenosis. where is it best heard 

  • Loud S1 with opening snap
  • mid diastolic rumbling murmur 
  • apex with patient in left lateral decubitus position, with bell 

57

CXR findings with  mitral stenosis

  • Left atrial enlargement
  • later, pulmonary congestion and RVH
  • kerley B lines 

58

management of mitral stenosis

  • mild symptoms: diuretics and sodium restriction
  • anticoags for A-Fib
  • valve sx for progressive symptoms

59

who needs antibiotic prophylaxis 

  • prosthetic cardiac valve or prosthetic material used for cardiac valve repair
  • previous infectious endocarditis