exam 3- Valvular Disease

Mitral Stenosis- LV Underfilled (blocked valve)

The opening of the mitral valve is narrowed (small and tight), making it harder for blood to flow from the left atrium to the left ventricle

• Tiny hole

Etiology- the cause of a disease or condition

what caused the mitral valve to become narrowed?

• Rheumatic fever- inflammatory disease that develop after untreated strep throat and damage heart valves (most common)

• Infective endocarditis- infection of inner lining of the heart (endocardium)

Pathophysiology- study of how or why disease or co duration happen in body and it change normal body function

• Pressure builds up in LA and it becomes dilates (stretch/enlarge)- like balloon

• Fuild buildup in lungs

• A-Fib due to dilated LA- upper chambers best fast, chaotic, irregular way instead of contracting normally (can’t squeeze)

• Stroke due to A-Fib- blood clot to fo in heart which travels into brain

• Right heart failure due to the fluid built up in the lungs (leg swelling, enlarged liver, fluid belly)- Left heart fails 1st (fluid in lungs) → pulmonary hypertension→ RV working hard (pump higher)→ right heart strain (stress)

Symptoms

Early MS

• SOB when exercising- Dyspnea

• Fatigue- decrease exercise tolerance

Mild MS

• SOB even at rest

• Waking up breathless at night- orthopnea(SOB when lying flat)

• Swelling

Severe MS

• Signs of right heart failure (neck vein bluging, liver swelling, leg swelling, ascites)- LA high pressure → pulmonary hypertension→ Right Heart strain (stress)

Mitral Regurgitation- LV overload (leaky valve)

The backward flow of blood into the LA during ventricular systole

• Acute: Sudden

  • LA has no time to adapt

  • Sudden huge volume→ rapid Pressue rise

• Chronic: Slow

  • LA slowly adapt over time

  • LA dilates (stretches) to handle extra blood

Etiology

The valve doesn’t close properly causing blood to lack backward into the LA

Two types of MR:

• Primary: valve it’s self is damage (valve problems)

  • Acute: Sudden- no time to adapt

    • Papillary muscle rupture after a heart attack- muscle supporting the valve tears

    • Torn chordae from infection, chest injury or Marfan syndrome- the valve loses support and becomes floppy

  • Chronic: Slowly- develops over years

    • Mitral Valve prolapse- leaflets bulge backward like umbrella

    • Rheumatic heart disease- valve become a scar and deformed(no longer normal shape)

    • Calcium buildup around the valve- can’t close properly

• Secondary: the valve is normal, but the LV is enlarged/weak, stretching the valve and pulling the valve apart (ventricle problems)- the MV ring (annulus) stretches too, can’t close tightly→ leaks backward

Pathophysiology

• Pressue builds up in the LA and it becomes dilates (stretch/enlarge)

• Lower Cardiac output- less blood flow into LV then to the the body

• LV gets volume overload- blood leaks back LA and return to LV again

Symptoms

Acute: SHOCK

• Sudden SOB

• Pulmonary Edema- fluid in lungs

“Flash flooding into the lungs”

Chronic: HF over time

• Fatigue

• SOB with exertion- when doing exercises

• Swelling (edema) if right heart failure develops

• A-Fib- due to LA enlargement

Treatment

Acute: Emergency surgery

• Surgery is usually required right away!!

• Medicines only stabilize temporarily

Can’t rely on meds alone- fix valve quickly

Chronic: Monitor→ Surgery when worsening

• Surgery if symptoms or if LV start weakening- decrease LV dilation

• Valve repair preferred if possible; Valve replacement if repair isn’t possible

• Medicines are less effective long term- does not fix valve problems

Meds: support only, not sure

Mitral Valve Prolapse (MVP)

Characterized by abnormally billowing (bulging) of a portion of one or both mitral leaflets into the LA during ventricular systole, and is frequently accompanied by MR- It happens bc valve is too floppy or weak, so it bends backward when the LV contracts

Also known as Barlow Syndrome- valve doesn’t close tightly

• MVP = valve leaflets “prolapse” (bulge) into LA during systole (contraction)

• Can lead to leaky valve → MR

Aortic Stenosis

When the opening of the aortic valve becomes narrowed (small/tight), making it harder for blood to leave the left ventricle and enter the aorta during contraction

Etiology

• Degenerative calcification- calcium buildup on a normal valve as people age

-making to stiff n narrow (common in older adults)

• Congenital bicuspid valve- instead of 3 leaflets, people are born with 2. These wear out faster and calcify earlier (Common in younger age)

• Rheumatic disease- scar from last rheumatic fever (untreated strep throat) (less common)

-the scarred valve becomes thick and narrowed over time

Pathophysiology

• LA and LV thicken (hypertrophy)

• Valve narrows

Symptoms

• Chest pain- thick heart muscle needs more oxygen

• Fainting (syncope), especially with exercise- body needs more blood flow but marrow valve prevents it

• Heart Failure- SOB, pulmonary congestion, swelling (edema)- eventually fluid overload

Treatments

• No medicine can stop progression- maybe help with SOB n fluid but doesn’t stop narrowing

• Surgical aortic valve replacement (AVR)

• Balloon valvuloplasty

• TAVR (Transcatheter Aortic Valve Replacement)

Tricuspid Stenosis

The narrowing (Small/Tight) of tricuspid valve orifice impeding the diastolic flow of blood from the RA into the RV