Valvular Heart Disease Flashcards | Cardiology Study Guide

S/S of ___ include dyspnea on exertion, SOB, dizziness, lightheadedness, syncope, decreased exercise tolerance, and fatigue.

Valvular disorders

___ is caused by insufficient opening of the leaflets?

Stenosis

___ is caused by backward flow of blood

Regurgitation

___ are caused by improper flow of blood through the heart.

Murmurs

___ murmur is louder with decreased preload

Hypertrophic cardiomyopathy

What is the most common valvular disorder?

Aortic stenosis

Incidence of aortic stenosis increases with ___ but it not the only risk factor

age

What is a significant congenital risk factor for aortic stenosis?

Congenital bicuspid aortic valve

Aortic stenosis causes the need to generate higher systolic pressures for blood to eject causing ___

LV hypertrophy

in aortic stenos increased left sided pressures are eventually going to cause ___

pulmonary hypertension

Which valvular disorder presents with a 'crescendo-decresceno'

Aortic stenosis

Where can the systolic murmur be heard in aortic stenosis?

Right upper sternal border

Which murmur has decreased intensity of S2?

Aortic stenosis

Which valvular disorder presents with pulses carves et tardus and LV hypertrophy

Aortic stenosis

What are the four diastolic murmurs?

Mitral stenosis

Pulmonic regurgitation

Aortic regurgitation

Tricuspid stenosis

Tx options for aortic stenosis?

- BAV

- TAVR

- SAVR

The only tx of aortic stenosis shown to improve survival is ___

aortic valve replacement

What are some medical interventions that can be done to improve aortic stenosis S/S?

- limitation of physical activity

- avoid hypotension

- avoid after load reducing agent (ACEi and CCBs)

- use nitrates and diuretics

Percutaneous balloon aortic valve valvuloplasty (BAV) is considered a ___

palliative procedure

What is the major risk involved with SAVR?

calcified leaflet remnants can cause stroke

___ can be done through the femoral, subclavian, aortic, transapical or transcaval approach

TAVR

In which aortic stenosis intervention are the calcified leaflets cut out and sucked up before a new valve is inserted into the annulus?

SAVR

What are the pros and cons of tissue valves over mechanical valves?

- no lifelong anticoagulation needed

- will need to be replaced in ~ 15 years

Aortic regurgitation leaks blood back into the LV during diastole which causes ___

dilation and hypertrophy of the LV

What are some of the etiologies of aortic insufficiency?

- infections (endocarditis/rheumatic)

- bicuspid valve

- inflammatory (RA/SLE)

- myxomatous

- trauma

- iatrogenic

- aortic root dilation

- aortic dissection

In aortic insufficiency how does the LV compensate for the backwards flow?

- dilates and gets thicker

- left atrial enlargement due to increased pressures

Acute AI leads to very high ___ and very poor CO

LV end diastolic pressure

Which valvular disorder causes a high pitched early diastolic decrescendo murmur?

Aortic regurgitation

Which murmur can be heard at the 3rd intercostal space on the left?

Aortic regurgitation

Which valvular disorder has a wide pulse pressure?

aortic regurgitation

Which valvular disorder can cause corrigan's pulse?

Aortic regurgitation

Tx of aortic insufficiency?

- medically: ACEi and CCB

- surgically: AVR (symptomatic HF, EF <50%, LV enlargement)

What are some primary causes of mitral regurgitation?

- prolapse

- flail leaflet

- rheumatic

- myxoma

- endocarditis

- congenital defects

What are some secondary causes of mitral regurgitation?

- dilated annulus

- dilated ventricle

- congenital defects

Acute ___ is fatal if not urgently corrected

mitral regurgitation

Chronic mitral regurgitation will cause progressive ___ and ___ hypertrophy

enlargement of the LA and LV hypertrophy

In mitral regurgitation you will frequently see ___ due to enlarged LA

atrial fibrillation

Which type of valvular disorder can present with a night time cough?

Mitral regurgitation

Which valvular murmur can be heard at the left sternal border that radiates to the axilla?

Mitral regurgitation

T/F: the loudness of a murmur does not correlate with the severity of mitral regurgitation

True

Why can patients with MR experience tachycardia?

compensate for loss of 'forward' stroke volume

Acute ___ patients can be in respiratory failure, hypotensive and in life threatening cariogenic shock

mitral regurgitation

Tx options of MR?

- acute: IABP, intubation, after load reducing Rx if normotensive, +/- inotropes/pressers

- chronic: ACEi or hydralazine to reduce after load, surgery (MVV/MVR), mitraclip, TMVR

Pros/cons of MVV vs MVR for mitral regurgitation?

MVV: pros: last longer than replacement, no anticoagulation needed. cons: might not be totally competent.

MVR: pros: will not lead, can cut down time in OR. cons: 10-15 year replacement time, need anticoagulation.

What is the most common cause of mitral stenosis?

rheumatic fever

What are the common causes of mitral stenosis?

- rheumatic fever (m/c)

- MAC

- congenital

- autoimmune (SLE)

- left atrial myxoma

MS results in decreased LV ___

preload

In ___ there is a large gradient across the mitral valve which worsens with exertion

mitral stenosis

What is the progression of mitral stenosis to HF?

- LA dilation

- increased LA pressures

- increased pulmonary pressures

- elevated pressures in right heart

- heart failure

Which valvular disorder has an opening 'snap' heard after the S2 sound?

mitral stenosis

Which murmur has a decreased S1 sound?

mitral stenosis

Which disorder can cause clots to be in the left atrium due to fib or poor flow?

Mitral stenosis

Tx of mitral stenosis?

- medical: diuretics, BB, antiarrhythmics, and anticoagulants

- surgical: mitral balloon valvuloplasty or replacement

___ occurs on the inner surface of the heart and usually involves the cardiac valves

Infective endocarditis

What is the most common cause of infective endocarditis?

bacteria (rarely fungal)

Which organisms are typically responsible for infective endocarditis?

- staph aureus

- viridian strep

- enterococci

- fungal: candida, histoplasmosis, aspergillus

Risk factors for infective endocarditis?

- IV drug abuse

- poor dental hygiene

- immunocompromised

- PPM/AICD

- damaged valves

- DM

Bacterial growth causes vegetation on valves and causes ___

regurgitation

In infective endocarditis vegetations can break off and ___ which can cause pulmonary emboli

embolize

What is often the first sign of a subacute infectious endocarditis?

complication from a septic emboli

S/S of ___ include weight loss and fever, new/different murmur, elevated CRP, Osler nodes, laneway lesions, Roth spots, organ damage, acute HF/CHF, sepsis, hypotension

infective endocarditis

How many duke criteria are necessary for a diagnosis of infective endocarditis?

- 2 major

- 1 major 2 minor

- 3-5 minor

Tx of endocarditis?

- medical: IV abx 4-6 weeks (vanco/unasyn), tx of symptoms

- surgical: replacement of valves

Where does coarctation of the aorta typically occur?

Ductus arteriosus/ligamentum arteriosum inserts

S/S of ___ include L/R heart failure, higher blood pressure in UE/head, hypo perfusion to abdominal organs, cold legs/feet

Coarctation of Aorta

Dx for coarctation of aorta?

- BP measurement all extremities

- CT/MRI

- CXR (3 sign)

Tx of coarctation of aorta?

- medical rx

- baloon angioplasty w/ or w/o stent

- surgical resection with graft

Which type of valvular pathology is usually well tolerated?

Tricuspid regurgitation

Patents with mechanical valves need to be fully ___ to prevent thrombus formation on the valve

anticoagulated