Flashcards in Valvular Heart Disease Deck (42):
What are the 2 AV valves?
-- Tricuspid Valve
-- Mitral valve
How many leaflets does tricuspid valve have and where are they attached?
-- 3 leaflets
-- Papillary attachments on septum and moderator bands
How many leaflets does mitral valve have and where are they attached?
-- 2 leaflets
-- Smoother attachments and not attached to septum
What are the 2 determinants of coronary perfusion?
What determines of supply?
Coronary artery diameter
What determines demand ?
Myocardial O2 consumption
LV wall tension
What is the venous drainage of the heart?
Where is the coronary sinus located?
Just above the Tricuspid valve
What is known as the pressure gradient that drives coronary blood pressure
Coronary perfusion pressure (CPP)
Aortic diastolic - LVEDP
CPP is altered by what?
Decrease in aortic pressure
Increase in LVEDP
Increase in HR
What is the average adults coronary blood flow at rest?
During what phase does isovolumetric contraction occur?
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
The gradient across what valve is the difference of pressure between LV and systolic BP?
Aortic stenosis will do what to the gradient across the valve during ejection?
Increase the gradient
What murmur is heard when the mitral valve closes?
What is happening when you hear S2?
Closing of the aortic valve
What are 2 types of systolic murmurs?
What is considered a holosystolic murmur?
Occurs between S1 and S2
Heard with same intensity throughout (resembles a rectangle)
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)
What murmurs are considered to be crescendo?
What murmurs are considered to be holosystolic?
What is known to have a "blowing" kind of sound?
Which systolic murmur is different than all the rest and when does it occur?
Combination of crescendo and holosystolic murmurs
Occurs after S2
What murmurs are late murmurs and usually attributed to MR because of aortic insufficiencies?
Diastolic murmurs (aortic regurg)
How much blood flow does atrial kick aid in ventricular filling in healthy young patients?
How much atrial kick is provided in unhealthy elderly patients?
Up to 50%
What are contributing factors to valvular heart disease ?
Connective tissue disorders
Rheumatic fever / disease
In general what causes aortic stenosis ?
In general what causes mitral regurg?
Again CPP =
Pressure in aorta - cavatory pressure
What is an average LVEDP?
What is an average CVP?
What is an average PAP?
What are some classic presentations of AS?
Angina even with good coronaries
Transmission of sounds to carotids
What are signs of MR?
Heart failure- can be compensated or decompensated
What is the worst murmur / valve dysfunction to have?
What are management techniques for MR?
What are management techniques for AS?
Decrease HR for myocardial perfusion
What are management techniques for AR?
Think inotropic agents