Valvular Heart Disease Flashcards by Nayla Mansoor

What do stenotic lesions lead to

pressure overload on upstream

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What do regurgitant lesions lead to

Volume overload and dilation of chambers

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What is Diastolic dysfunction

The inability of ventricle to relax/decreased wall compliance limiting filling during early passive diastole. Atria has to contract harder to get blood out

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What does diastolic dysfunction lead to

Pressure in atria rises and backs up to the lungs- Pulmonary edema
Also- atrial arrhythmias

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What are causes of LV diastolic dysfunction

HTN
VH
fibrosis 
Infiltrative CM
Pericardial constriction

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What are causes of RV diastolic dysfunction

rare
constrictive pericarditis
restrictive cardiomyopathy

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What do right murmurs do

increase with inspiration

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What are left HF symptoms

dyspnea
pulmonary edema
crackles
PE
pallor/cyanosis

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What are right HF symptoms

JVD
peripheral edema
Hepatomegaly
ascites

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How can you grade a murmur

I: heard in quiet room by expert
VI: thrill with very loud murmur without steth

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What murmurs warrant an echo

Systolic > grade II

any diastolic

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What is the most common cause of aortic stenosis

calcified valve

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What is the compensatory response to aortic stenosis

LVH, more pressure needed to overcome rigid valve.
Reduced EF
LA hypertrophy

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What is the classic triad associated with aortic stenosis

Angina
Syncope
Heart failure

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What are characteristics of aortic stenosis on exam

Delayed carotid upstroke
Sustained, diffuse apical impulse
Systolic murmur at RUSB, crescendo-decrescendo, radiating to neck

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How should you treat a patient with severe AS that is not a surgical candidate

TAVR or medical therapy to control HF

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What diagnostic test is contraindicated in AS

exercise stress test

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What surgical treatments are available for AS patients

#1: Mechanical or tissue valve replacement 
-Balloon valvuloplasty for peds, or as a bridge for adults (will restenose in 6 mo.)

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What are the types of valves

Bioprosthetic: shorter lifespan (10-15 years)
Mechanical: lifelong anti-coag (warfarin) needed

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What are the biggest issues with a TAVR

CVA
Complete heart block
paravalvular leak

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What are the causes of aortic regurgitation

abnormalities of leaflets/aortic root

chronically progresses slowly over 10 years until LV dysfunction

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What is the #1 cause of acute aortic regurgitation

Aortic Dissection
(also endocarditis)

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What happens during chronic AR

Increased LV EDV
Increased wall stress causes LVH
CO initially increased but decreases as disease progresses and aorta is less compliant

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What will you see on PE for chronic AR

Water hammer pulse
Blowing Diastolic Decrescendo Murmur at LUSB
Signs of left HF

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What can you see on chronic AR CXR

Aortic knob, cardiomegaly

Who is a candidate for surgical treatment for chronic AR

Symptomatic ASx but having heart surgery LV dysfunction Aortic root dilation >5 cm (less for marfans)

What should nonsurgical candidates with chronic AR do

Take vasodilators, CCB, ACE | BB for aortic root enlargement

What is the cause of chronic aortic regurgitation

aortic root disease

What is dangerous with acute AR

no time to develop compensatory mechanisms; Hemodynamic emergency Leads to cardiovascular decompensation

What are symptoms of acute aortic regurg

weakness, AMS, dyspnea, syncope | **CP=Aortic dissection

How are PE findings for acute aortic regurgitation

Hemodynamic compromise | Soft, thready, rapid diastolic murmur

How do you treat acute arctic regurgitation

surgical emergency! Vasodilator and IV inotropes Aortic dissection: BB

What causes Chronic mitral regurgitation

MVP degeneration rheumatic fever dilated cardiomyopathy

What happens during chronic mitral regurgitation

LV dilation Decreased preload, decreased afterload CO consistent during compensation LV dilates until HF develops

What are the symptoms of chronic mitral regurgitation

Asymptomatic Then dyspnea, LHF Pulmonary HTN and RHF

What will you see on chronic mitral regurgitation PE

Displaced apical impulse S3 HF Sx

What is the Mitral Regurgitation murmur

Holosystolic, apical blowing murmur radiating to axilla

What medical treatment is available for MR

HF therapy; Diuretics, vasodilators | If with AFib, warfarin

What is the cause of acute MR

papillary infarct | chordae tendinae rupture

What happens during acute mitral regurgitation

acute volume overload into LV (high EDV) | causes acute LHF and cariogenic shock

What are symptoms of acute MR

LHF Sx (pulmonary edema, orthopnea, dyspnea, cariogenic shock)

Whats the acute MR murmur

Holosystolic apical murmur radiating to axilla or back

What is the treatment for acute MR

IV Nitro to reduce after load | IABP as a bridge to repair/replace

What are causes of mitral valve stenosis

mostly rheumatic fever | rarely congenital

What happens with mitral valve stenosis

stenotic valve decreases preload=decreased CO | LA has increased pressure causing pulmonary HTN=right HF

What is the biggest risk in mitral valve stenosis with associated A-Fib

High thromboembolic risk | TIA/CVA

What are the symptoms of mitral valve stenosis

asymptomatic for decades Dyspnea-->PND, orthopnea Hemoptysis (bronchial vessel rupture under pressure) Hoarseness (large LA on recurrent laryngeal) Endocarditis

What will you see on Mitral stenosis PE

high JVP Cyanosis (low CO) apical diastolic thrill

What murmur is heard with mitral valve stenosis

Low rumbling mid-diastolic murmur | Heard with bell in LLD position

What diagnostic studies would you get with Mitral stenosis

Stress echo or L/R cath if symptoms don't match echo results | TEE to look for thrombi before surgical intervention

What is the treatment for mitral valve stenosis

diuretics and Na restrict for dyspnea. BB to improve exercise capacity Anti-Coag with WARFARIN to control AFib

What is surgical intervention for Mitral stenosis

Percutaneous balloon valvuloplasty if moderate/wanna become preggers/pulm HTN Open replacement if severe

What causes tricuspid stenosis

``` RARELY isolated- usually with TR, aortic/mitral disease Due to rheumatic valve disease carcinoid disease congenital HD endocarditis ```

What happens during tricuspid stenosis

decreased preload= decreased CO= systemic venous congestion

What are symptoms of tricuspid stenosis

Fatigue (chronic low CO) | RUQ/abd pain (venous congestion)

What will you see on tricuspid stenosis PE

RHF Sx

What is the tricuspid stenosis murmur

Diastolic murmur over LSB (on inspiration)

When would a cardiac cath be needed in tricuspid stenosis

if concerned for other valve abn. or open repair planned

What is surgical intervention for tricuspid stenosis

Only repair if repairing others. Balloon valvuloplasty w/ no other lesions Open bioprosthesis replacement

What are the causes of tricuspid regurgitation

Mostly, dilated RV (dilates valve ring)

What happens during Tricuspid regurgitation

Volume overload in RV= increased systemic venous pressure= RHF

What are Tricuspid regurg symptoms

Usually asymptomatic | RHF Sx

What is the tricuspid regard murmur

Pan systolic murmur at 3-4 ICS at LSB, heard on inspiration

How would you treat Tricuspid regurgitation

Medical therapy for RHF if present. If not, nothing (asymptomatic)

When would tricuspid regard require surgery

If severe and organic cause, surgical repair | if repairing another valve and has pull HTN

What are causes of pulmonic stenosis

#1- congenital

What happens during pulmonic stenosis

RVH

What are the symptoms of pulmonic stenosis

Cyanosis in newborns | RHF/dyspnea in 40'50's

What murmur is heard with pulmonic stenosis

Harsh systolic crescendo-decrescendo at 3-4 ICS

What is the treatment for pulmonic stenosis

balloon valvuloplasty if symptomatic or severe

What causes pulmonary regurgitation

Pulmonary HTN dilates valve ring | rarely endocarditis

What is the pathophysiology of pulmonary regurgitation

RV volume overload

What are symptoms of pulmonary regurgitation

RHF Dyspnea septic pulmonary emboli and fever (if caused by IE)

What is the Pulmonary Regurg murmur

Low pitch diastolic murmur at 3-4 left ICS

What is therapy for Pulmonary Regurg

treat primary cause | valve replacement or bioprosthetic repair

What is tetralogy of fallot

Ventricular septal defect Pulmonic stenosis Overriding aorta RVH

What are symptoms of tetralogy of fallot

Cyanosis Tet spells while crying/after feeding poor growth clubbing

What relieves Tetralogy of fallot symptoms

Squatting- it increases PVR and decreases RV to LV shunt

What is the murmur associated with tetralogy of fallot

Harsh systolic murmur due to VSD

How do you diagnose Tetralogy

Echo

What is the treatment for Tetralogy

surgical repair w/in 1st year | place shunt if unable to undergo surgery

Valvular Heart Disease Flashcards

(81 cards)