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24 Cards in this Set
- Front
- Back
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What is valve stenosis?
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Obstruction to valve flow during phase of cardiac cycle when valve is normally open
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What is valve regurgitation?
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Inadequate valve closure-->Back leakage
AKA Valve insufficiency, Incompetence |
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Causes of mitral stenosis
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Rheumatic: 99.9%
Congenital, prosthetic valve stenosis Calcification |
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Causes of acute mitral regurgitation
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Infective endocarditits
Ischemic heart dz Mitral valve prolapse |
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Causes of chronic mitral regurgitation
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Ischemic heart dz
Mitral valve prolapse Infective endocarditis |
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What is mitral valve prolapse?
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When one leaflet of mitral valve is much larger than the other (it is redundant) and upon closure of the valve, part of leaflet enters left atrium
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Mitral Regurgitation:
Effects Compensatory Mechanisms Resulting Symptoms |
Leakage of blood into LA during systole
Loss of forward stroke volume into left atrium Compensatory Mechanisms: Increase stroke volume (and ejection fraction) Forward stroke volume (from RV) + regurgitant volume (from LA) Consequences: Left ventricular volume overload (LVVO AND HYPERTROPHY!!!) which leads to inc'd LA pressure, DYSPNEA, pulmonary HTN, arrythmias, and low output state |
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Acute vs Chronic Mitral Regurgitation
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Acute:
Normal (noncompliant) LA, increased LA pressure, acute pulmonary edema Chronic: Dilated, compliant LA LA pressure normal or slightly increased Fatigue, low output state; atrial arrhythmias |
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Physical findings of mitral regurgitation.
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Brisk carotid upstrokes (hyperdynamic LV)
P2 increased (pulmonic valve closes at higher pressure) Holosytolic blowing murmur at apex |
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Mitral Stenosis:
Effects Compensatory Mechanisms |
Restriction of blood flow from LA to LV during diastole
As HR increases, diastole shortens disproportionately and MV gradient increases Results in increase in LA pressure Pulmonary HTN RV Pressure overload (RV needs to overcome this gradient) which leads to RV hypertrophy, RV failure, tricuspid regurgitation (leads to peripheral edema bc right heart is failing) LV is unaffected (protected) |
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Mitral Stenosis:
Symptoms Physical Findings |
A fib (unrelated to severity of decrease in MVA)
Systemic thromboembolism (also unrelated to severity of decrease in MV area) Symptoms due to pulmonary HTN and RV failure: Fatigue, low output state Peripheral edema and hepatosplenomegaly Hoarseness (laryngeal nerve palsy) Physical findings: Body habitus: thin, female Low BP Low-pitched diastolic rumble at apex upon auscultation |
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Mitral Stenosis:
Treatment: Medication and Surgeries |
1) Keep HR Low (beta-blockers to blunt increase in heart rate that they have when they engage in physical activity
2) Anticoagulants to prevent thromboembolic events (Coumadin) Interventional: 1) Balloon Mitral Valvuloplasty (balloon mitral commissurotomy): balloon inflation reduces gradient; not for patients with tons of thrombi, calcifications, or severe mitral regurgitation 2) Mitral Valve Replacement |
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Chronic Mitral Regurgitation:
Treatment: Medication and Surgery |
1) Vasodilators to favor forward flow of blood
2) Diuretics, Anticoagulants Surgical: Before LV systolic fn declines: MV replacement CABG |
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Aortic Stenosis:
Causes |
Degenerative calcific stenosis (very common in the elderly)
Congenital |
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Aortic Insufficiency:
Acute vs Chronic (Subtypes and Causes) |
Acute: Infective endocarditis, Acute aortic dissdection (Marfan's)
Chronic: 1) Aortic leaflet dz (infective endocarditis, Rheumatic, bicuspid aortic valve) 2) Aortic root dz (aortic aneurysm/dissection, Marfan's) |
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Aortic Stenosis:
Hemodynamic Hallmark Compare with Mitral Stenosis Cardiac Changes |
SYSTOLIC Pressure Gradient!
(Mitral Stenosis has DIASTOLIC pressure gradient) Gradient is larger and resting flows are higher (smaller AV area) Cardiac Changes: Chronic LV pressure overload-->concentric LVH (stiff, noncompliant, increased LVEDP) Well tolerated for decades (don't get CHF until LV fails) but a. fib is poorly tolerated; loss of atrial kick, rapid HR |
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Aortic Stenosis:
Symptoms Physical Findings Compensatory Mechanisms |
Asyx for many years
Syx develop when valve is critically narrowed and LV fn deteriorates Syx: Angina, CHF, syncope PE findings: Slow rising carotid pulse (parvus tardus pulse) Heaving and sustained LV apical impulse (will lift your fingers off chest) Murmur peaks at early systole Inc'd HR is well tolerated (such as during physical activity) Compensatory: LV dilation, eccentric LVH Increased LV compliance Peripheral vasodilation |
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Left Ventricular Pressure Overload is symptomatic of ____________.
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Aortic Stenosis
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Left Ventricular Volume Overload is symptomatic of ___________.
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Mitral Regurgitation
Aortic Insufficiency |
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Aortic Stenosis vs Mitral Regurgitation:
LV Volume Wall Thickeness LV Compliance LV Diastolic Pressure LV Systole Pressure LV Ejection Fraction |
AS, MR:
LV Volume: n/l, dilated Wall thickness: Concentric LVH, n/l to slightly inc'd LV compliance: stiff noncompliant, inc'd compliance LV diastolic Pr: Inc'd, n/l to slightly inc'd LV systolic Pr: Inc'd, n/l to slightly inc'd LVEF: n/l, inc'd |
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Chronic Aortic Regurgitation:
Physical Findings |
Widened Pulse Pressure >70mmHg
Low Diastolic Pressure: <60mmHg ex: 170/60 DeMusset's Signs: head bobbing |
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Aortic Stenosis:
Treatment: Medications vs Surgery |
1) A. fib rate control; CHF - diuretics
2) Balloon Aortic Valvuloplasty (usually for younger pts with congenital aortic stenosis) |
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What is the Ross Procedure?
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Used for aortic stenosis
It's autotransplant of pulmonic valve to the aortic position Artificial porcine valve placed in pulmonic position Good for younger patients that don't want to be on coumadin for the rest of their lives |
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Aortic Insufficiency:
Treatment: Medication vs Surgery |
1) Vasodilator
Surgical only for acute AI or CHF |
