Valvular Heart Disease Flashcards Preview

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Flashcards in Valvular Heart Disease Deck (42):
1

What are the 2 AV valves?

-- Tricuspid Valve
-- Mitral valve

2

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

-- 3 leaflets
-- Papillary attachments on septum and moderator bands

3

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

-- 2 leaflets
-- Smoother attachments and not attached to septum

4

What are the 2 determinants of coronary perfusion?

--Supply
--Demand

5

What determines of supply?

CPP
HR
PaO2
Coronary artery diameter

6

What determines demand ?

Myocardial O2 consumption
HR
LV wall tension
Contractility
Conduction
Relaxation

7

What is the venous drainage of the heart?

Coronary sinus

8

Where is the coronary sinus located?

Just above the Tricuspid valve

9

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

Coronary perfusion pressure (CPP)

10

CPP =

Aortic diastolic - LVEDP

11

CPP is altered by what?

Decrease in aortic pressure
Increase in LVEDP
Increase in HR

12

What is the average adults coronary blood flow at rest?

250 mL

13

During what phase does isovolumetric contraction occur?

Systole

14

What must occur for ejection to take place?

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

15

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

Aortic valve

16

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

Increase the gradient

17

What murmur is heard when the mitral valve closes?

S1

18

What is happening when you hear S2?

Closing of the aortic valve

19

What are 2 types of systolic murmurs?

Crescendo
Holosystolic

20

What is considered a holosystolic murmur?

Occurs between S1 and S2
Heard with same intensity throughout (resembles a rectangle)

21

What is considered to be a crescendo systolic murmur?

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

22

What murmurs are considered to be crescendo?

Aortic stenosis

23

What murmurs are considered to be holosystolic?

Mitral regurg
VSD

24

What is known to have a "blowing" kind of sound?

Mitral regurg

25

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

Mitral stenosis
Combination of crescendo and holosystolic murmurs
Occurs after S2

26

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

Diastolic murmurs (aortic regurg)

27

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

15-25%

28

How much atrial kick is provided in unhealthy elderly patients?

Up to 50%

29

What are contributing factors to valvular heart disease ?

Disease
Generation
Connective tissue disorders
Rheumatic fever / disease
Ischemic tissue

30

In general what causes aortic stenosis ?

Pressure overload

31

In general what causes mitral regurg?

Volume overload

32

Again CPP =

Pressure in aorta - cavatory pressure

33

What is an average LVEDP?

10-20 mmHg

34

What is an average CVP?

2-8 mmHg

35

What is an average PAP?

15-25 mmHg

36

What are some classic presentations of AS?

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

37

What are signs of MR?

Heart failure- can be compensated or decompensated

38

What is the worst murmur / valve dysfunction to have?

Mitral stenosis

39

What are management techniques for MR?

Increase HR
Increase contractility
Decrease afterload
Maintain preload

40

What are management techniques for AS?

Decrease HR for myocardial perfusion
Maintain afterload
Increase preload

41

What are management techniques for AR?

Shorten diastole
Increase HR
Decrease afterload
Think inotropic agents

42

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

Increase HR
Decrease afterload