Valvular Heart Disease

Question 1

What are the 2 AV valves?

Answer 1

• • Tricuspid Valve

- - Mitral valve

Question 2

How many leaflets does tricuspid valve have and where are they attached?

Answer 2

• • 3 leaflets

- - Papillary attachments on septum and moderator bands

Question 3

How many leaflets does mitral valve have and where are they attached?

Answer 3

• • 2 leaflets

- - Smoother attachments and not attached to septum

Question 4

What are the 2 determinants of coronary perfusion?

Answer 4

• -Supply

- -Demand

Question 5

What determines of supply?

Answer 5

CPP
HR
PaO2
Coronary artery diameter

Question 6

What determines demand ?

Answer 6

Myocardial O2 consumption
HR
LV wall tension
Contractility
Conduction
Relaxation

Question 7

What is the venous drainage of the heart?

Answer 7

Coronary sinus

Question 8

Where is the coronary sinus located?

Answer 8

Just above the Tricuspid valve

Question 9

What is known as the pressure gradient that drives coronary blood pressure

Answer 9

Coronary perfusion pressure (CPP)

Question 10

CPP =

Answer 10

Aortic diastolic - LVEDP

Question 11

CPP is altered by what?

Answer 11

Decrease in aortic pressure
Increase in LVEDP
Increase in HR

Question 12

What is the average adults coronary blood flow at rest?

Answer 12

250 mL

Question 13

During what phase does isovolumetric contraction occur?

Answer 13

Systole

Question 14

What must occur for ejection to take place?

Answer 14

When pressure in LV has been achieved and overcomes SVR to open Aortic valve thus pushing blood forward

Question 15

The gradient across what valve is the difference of pressure between LV and systolic BP?

Answer 15

Aortic valve

Question 16

Aortic stenosis will do what to the gradient across the valve during ejection?

Answer 16

Increase the gradient

Question 17

What murmur is heard when the mitral valve closes?

Answer 17

S1

Question 18

What is happening when you hear S2?

Answer 18

Closing of the aortic valve

Question 19

What are 2 types of systolic murmurs?

Answer 19

Crescendo

Holosystolic

Question 20

What is considered a holosystolic murmur?

Answer 20

Occurs between S1 and S2

Heard with same intensity throughout (resembles a rectangle)

Question 21

What is considered to be a crescendo systolic murmur?

Answer 21

Very harsh murmur
Occurs between S1 and S2
Gets louder with intensity then tapers off (resembles a diamond)

Question 22

What murmurs are considered to be crescendo?

Answer 22

Aortic stenosis

Question 23

What murmurs are considered to be holosystolic?

Answer 23

Mitral regurg

VSD

Question 24

What is known to have a “blowing” kind of sound?

Answer 24

Mitral regurg

Question 25

Which systolic murmur is different than all the rest and when does it occur?

Answer 25

Mitral stenosis Combination of crescendo and holosystolic murmurs Occurs after S2

Question 26

What murmurs are late murmurs and usually attributed to MR because of aortic insufficiencies?

Answer 26

Diastolic murmurs (aortic regurg)

Question 27

How much blood flow does atrial kick aid in ventricular filling in healthy young patients?

Answer 27

15-25%

Question 28

How much atrial kick is provided in unhealthy elderly patients?

Answer 28

Up to 50%

Question 29

What are contributing factors to valvular heart disease ?

Answer 29

``` Disease Generation Connective tissue disorders Rheumatic fever / disease Ischemic tissue ```

Question 30

In general what causes aortic stenosis ?

Answer 30

Pressure overload

Question 31

In general what causes mitral regurg?

Answer 31

Volume overload

Question 32

Again CPP =

Answer 32

Pressure in aorta - cavatory pressure

Question 33

What is an average LVEDP?

Answer 33

10-20 mmHg

Question 34

What is an average CVP?

Answer 34

2-8 mmHg

Question 35

What is an average PAP?

Answer 35

15-25 mmHg

Question 36

What are some classic presentations of AS?

Answer 36

Angina even with good coronaries CHF Syncope Transmission of sounds to carotids

Question 37

What are signs of MR?

Answer 37

Heart failure- can be compensated or decompensated

Question 38

What is the worst murmur / valve dysfunction to have?

Answer 38

Mitral stenosis

Question 39

What are management techniques for MR?

Answer 39

Increase HR Increase contractility Decrease afterload Maintain preload

Question 40

What are management techniques for AS?

Answer 40

Decrease HR for myocardial perfusion Maintain afterload Increase preload

Question 41

What are management techniques for AR?

Answer 41

Shorten diastole Increase HR Decrease afterload Think inotropic agents

Question 42

If placing an epidural / spinal, what can you expect to change cardiovascular?

Answer 42

Increase HR | Decrease afterload