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Flashcards in Valvular Regurgitation Deck (15):
1

pathophysiology of aortic regurgitation

increased preload and afterload

LV hypertrophy and LV dilatation which compensate for increased afterload but ultimately may lead to LV systolic dysfunction, elevated LV pressures, and pulmonary congestion

widened pulse pressure with elevated systolic BP and reduced diastolic BP

2

cause of aortic regurgitation

congenital

degenerative

rheumatic

endocarditis

dissecting aneurysms

Marfan's syndrome

syphilis

ankylosing spondylitis

trauma

drugs

3

symptoms of AR

dyspnea

angina

4

physical findings of AR

dynamic, displaced LV impulse

brisk carotid upstrokes with rapid fall-off

apical third heart sound

decrescendo diastolic blowing murmur

mid-systolic outflow murmur (caused by increased forward flow across aortic valve)

apical diastolic rumble (Austin Flint murmur)

findings related to wide pulse pressure (Quincke's, Duroziez, Dumusset's signs)

5

treatment for AR

no established medical therapy

other than treating hypertensionn in patients with elevated blood pressure

ultimately patients with severe AR may require surgical aortic valve replacement

6

eccentric remodeling vs eccentryic hypertrophy

eccentric remodeling - increased volume, no increase in mass

eccentric hypertrophy - increased volume and mass

7

What is the major risk factor for aortic regurgitation?

congenital bicuspid valve

8

Describe the hemodynamics of aortic regurgitation.

Chamber pumping about 2/3 times the stroke volume

Huge stroke volume leads to increase in systolic pressure - higher systemic pressure

Lower diastolic blood pressure - decompressing aorta back into the ventricle

High systolic pressure and low diastolic pressures in the aorta

Murmur starts louder and gets quieter - decrescendo

9

pathophysiology of mitral regurgitation

volume overload of both the left ventricle and left atrium

leads to elevated LA pressure

LV dilatation which compensates for increase preload

LA dilatation that can lead to afib and embolus formation

10

etiology of MR

mitral valve prolapse

rheumatic

papillary muscle dysfunction

cardiomyopathies

endocarditis

degenerative

mitral annular calcification

ruptured chordae tendinae trauma

congenital

11

Describe the hemodynamics of mitral regurgitation.

Large regurgitant v wave, pressure in atrium

Dilated ventricle as a result

Murmur is a systolic murmur

12

symptoms of MR

dyspnea

angina

fatigue

palpitations

13

physical findings of MR

dynamic, displaced LV impulse

brisk carotic upstrokes

holosystolic apical murmur

apical third heart sound

midsystolic click (in patients with mitral valve prolapse)

apical diastolic rumble (with severe MR is, caused by increased forward flow acrosss mitral valve)

14

treatment of MR

treatment of patients with severe MR and evidence of LV dilatation to reduce degree of MR is uncertain

ultimately patietns may require surgical mitral valve repair or replacement

15

indications for mitral valve replacement surgery