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Block 3 FCM > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

pressure overload and volume overload cause ___

A

hemodynamic burden

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2
Q

long term consequences of hemodynamic burden

A

muscle dysfunction
myocardial cell hypertrophy
CHF
sudden death

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3
Q

left sided valvular lesions

A

aortic stenosis
mitral stenosis
non-ischemic mitral regurgitation
aortic insufficiency

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4
Q

aortic stenosis etiology

A

acquired >65 yrs

  • idiopathic disease: degeneration and calcification of trileaflet valve
  • active inflammatory process- linked to increased LDL, HTN, Diabetes

congenital: 4th and 5th decade
- bicuspid aortic valve
- also can unicuspid or quadricuspid

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5
Q

most frequent severe valvular disease of the western countries

A

aortic stenosis

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6
Q

I aortic stenosis, pressure overload of the left ventricle causes ___ and results in muscular dysfunction, high end diastolic pressure.

A

hypertrophy

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7
Q

3 cardinal symptoms of aortic stenosis

A

Angina
Syncope
CHF

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8
Q

why is there angina in aortic stenosis?

A

reduced coronary reverse flow, increased myocardial oxygen demand

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9
Q

why do you have syncope with aortic stenosis?

A

when a patient with AS tries to exercise, they can not increase their cardiac output so their blood pressure drops and cardiac output drops to dry and maintain blood pressure. if you can not raise your cardiac output then your blood pressure drops and you have a syncope episode

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10
Q

on the physical exam for aortic stenosis, what will you find?

A
  1. systolic ejection murmur radiating to neck
  2. pulses parvus tardus
  3. S2 may be single or paradoxically split
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11
Q

what is pulses parvus trades?

A

small, delayed carotid pulse

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12
Q

what is used for Diagnosis of Aortic stenosis

A
  1. echo
  2. cardiac cath
  3. coronary angiography
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13
Q

aortic stenosis characteristics in females

A

thicker LV wall which reduces wall stress
increased ejection fraction
requires higher volume to maintain cardiac ouput= more sensitive to diuretics

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14
Q

what is aortic stenosis?

A

obstruction of left ventricular outflow of blood across the aortic valve

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15
Q

in aortic stenosis, what might you find on an echo

A

small aortic orifice during systole
LVH
Thickened/calcified aortic valve

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16
Q

in aortic stenosis what might you find on the EKG

A

LVH

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17
Q

whats the only curative treatment for AS

A

valve replacement

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18
Q

aortic regurgitation etiology

A
  1. leaflet abnormality- endocarditis, RH fever
  2. aortic root dilation- annuloaortic ectasia associated with aging, HTN, bicuspid valve, marina’s dissection, collagen vascular disease, and syphillis
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19
Q

in chronic aortic regurgitation, there is left ventricular volume overload which results in ___

A

eccentric hypertrophy, hyper dynamic LVEF

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20
Q 
left ventricular volume overload
increased stroke volume, systemic HTN
increased pulse pressure
diastolic blowing murmur
Austin flint murmur
A

chronic aortic regurgitation

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21
Q

when do symptoms in aortic regurgitation typically occur?

A

when LV dysfunction occurs

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22
Q

aortic regurgitation Peripheral Signs

A

¥ QUINCKE’S PULSES
¥ CORRIGAN’S PULSE (Bounding full carotid with rapid down stroke)
¥ MUSSET’S SIGN (head bobbing)
¥ HILL’S SIGN (Systolic pressure in leg >30mm Hg higher than in arm)

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23
Q

diagnostic studies used fir aortic regurgitation

A

ECHO, MRI

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24
Q

when should surgery be done on a patient with aortic regurgitation

A
  1. when they are symptomatic
  2. when they are asymptomatic- rule of 55
    - before LVEF is less than 55%
    - BEFORE LVESD >55mm
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25
Q

medical therapy for aortic regurgitation

A

after load reduction with vasodilators (nifedipine)

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26
Q

in aortic regurgitation, there is Incomplete aortic valve closure during diastole –> _______–> LV volume overload–> LV dilation–> CHF

A

regurgitation of blood to LV

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27
Q

most common cause of mitral stenosis

A

rheumatic heart disease

28
Q

first symptoms of mitral stenosis in pregnancy

A

a-fib

HF in second trimester= think rheumatic heart disease

29
Q

left heart failure symptoms in mitral stenosis

A

DOE
Orthopnea

hemoptysis
hoarseness
edema

30
Q

will their be neck vein distension in someone with mitral stenosis?

A

yes

31
Q

what is used to diagnose mitral stenosis

A

echo

can use EKG and chest x-ray as well

32
Q

therapy for mitral stenosis in a pt with mild symptoms

A

diuretics

33
Q

therapy for pt with mitral stenosis that has a fib

A

digoxin, BB, diltiazem

anticoagulant therapy

34
Q

therapy for pt with mitral stenosis that has moderate symptoms, pulmonary hypertension

A

mechanical relief of obstruction

balloon valvuloplasty

35
Q

treatment of choice for mitral stenosis

A

balloon valvuloplasty

36
Q

patients with mitral stenosis who ate not candidates for balloon valvuloplasty

A

heavy calcification
subvalvular distortion
more than mild MR

37
Q

some characteristics of mitral regurgitation

A

S1 soft
holosystolic murmur
S3
LF lift

38
Q

Hemodynamic of mitral regurgitation

A

¥ Volume overload of LV
¥ Hyperdynamic LV systolic function
Normal EF= >60%

39
Q

medical therapy for mitral regurgitation

A

vasodilators to stop pressure and decrease resistance

40
Q

in mitral regurgitation, is surgical repair of the valve or surgical replacement of the valve preferred?

A

surgical repair

41
Q

what might you see on an echo on a pt with mitral regurgitation

A

hyperdynamic LV

42
Q

____ is the obstruction of outflow of blood from the right ventricle to the pulmonary artery

A

Pulmonic stenosis

43
Q

More than 90% of pulmonic stenoses are ______- can be associated with Carcinoid Syndrome or Tetralogy of Fallot. Valvular pulmonic stenosis is a benign disease, which only rarely progresses

A

congenital

44
Q

symptoms in pt with Mild pulmonic stenosis:

A

Asymptomatic

45
Q

symptoms in pt with Moderate to severe pulmonic stenosis:

A

Fatigability, Dyspnea on exertion, Chest pain

46
Q

symptoms in pt with Severe pulmonic stenosis in the neonate:

A

Poor feeding, Tachypnea, Cyanosis

47
Q

Principal finding on examination of pulmonary stenosis

A

SEM- ejection systolic murmur, loudest at the left upper sternum and radiating towards the left shoulder

48
Q

Severe _____ is characterised by a loud harsh murmur, an inaudible pulmonary closure sound (P 2 ), an increased right ventricular heave, prominent a waves in the jugular pulse,

A

pulmonary stenosis

49
Q

EKG findings on pt with pumonary stenosis

A

ECG evidence of right ventricular hypertrophy

50
Q

chest x ray findings on pt with pumonary stenosis

A

post-stenotic dilatation in the pulmonary artery on the chest X-ray.

51
Q

in pulmonary stenosis, _______is the definitive investigation.

A

Doppler echocardiography

52
Q

Severe pulmonary stenosis (resting gradient > 50 mmHg with a normal cardiac output) is treated by ______ or, if this is not available, by surgical valvotomy

A

percutaneous pulmonary balloon valvuloplasty

53
Q

This is rare in isolation and is usually associated with pulmonary artery dilatation due to pulmonary hypertension.

A

Pulmonary Regurgitation

54
Q

Pulmonary Regurgitation
may complicate mitral stenosis, producing an early diastolic decrescendo murmur at the left sternal edge that is difficult to distinguish from _____ (Graham Steell murmur).

A

aortic regurgitation

55
Q

Tricuspid stenosis is usually ____ in origin and is rare in developed countries.

A

rheumatic

56
Q

_____ disease occurs in fewer than 5% of patients with rheumatic heart disease and then nearly always in association with mitral and aortic valve disease.

A

Tricuspid

57
Q

Tricuspid stenosis and regurgitation are features of the ____syndrome.

A

carcinoid

58
Q

tricuspid stenosis symptoms

A

Although the symptoms of mitral and aortic valve disease predominate, tricuspid stenosis may cause symptoms of right heart failure, including hepatic discomfort and peripheral edema.

59
Q

tricuspid stenosis main clinical features

A

The main clinical feature is a raised JVP. There is also a mid-diastolic murmur, best heard at the lower left or right sternal edge.

60
Q

tricuspid stenosis treatment

A

: In patients who require surgery to other valves, either the tricuspid valve is replaced or valvotomy is performed at surgery. Balloon valvuloplasty can be used to treat rare cases of isolated tricuspid stenosis.

61
Q

Tricuspid regurgitation is common, and is most frequently ‘functional’ as a result of right _____. Refers to an abnormal retrograde flow of blood from the right ventricle to the right atrium

A

ventricular dilatation

62
Q

Tricuspid Regurgitation

causes

A

Primary: Rheumatic heart disease, Endocarditis (particularly in injection drug-users), Ebstein’s congenital anomaly

Secondary : Right ventricular dilatation due to chronic left heart failure (‘functional tricuspid regurgitation’), Right ventricular infarction, Pulmonary hypertension (e.g. cor pulmonale)

63
Q

Tricuspid Regurgitation symptoms

A

usually non-specific, with tiredness related to reduced forward flow, and edema and hepatic enlargement due to venous congestion caused by accompanying right-sided heart failure (e.g., jugular venous distention, peripheral edema, parasternal lift, ascites, right-sided S 3 ).

64
Q

Tricuspid Regurgitation signs

A

The most prominent sign is a jugular venous pulse. Other features include a pansystolic murmur at the left sternal edge and a pulsatile liver.

65
Q

echo findings in tricuspid regurgitation

A

Echocardiography may reveal dilatation of the RV. If the valve has been affected by rheumatic disease, the leaflets will appear thickened and, in endocarditis, vegetations may be seen.

66
Q

_____ is a congenital abnormality in which the tricuspid valve is displaced towards the right ventricular apex, with consequent enlargement of the RA. It is commonly associated with tricuspid regurgitation.

A

Ebstein’s anomaly

67
Q

tricuspid regurgitation treatment

A

Tricuspid regurgitation due to right ventricular dilatation often improves when the cause of right ventricular overload is corrected, with diuretic and vasodilator treatment of congestive cardiac failure.

Block 3 FCM (7 decks)

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