Cardio Valvular Pathophysiology I & Ii

Front 1

Heart Sounds: S3 and S4

Back 1

S3: rapid filling phase in early/mid diastole
S4: associated with very stiff ventricle; coincides with atrial contraction

Front 2

Aortic Reguritation

Back 2

during systole, blood flows out of ventricle into aorta. During disastole, instead of valve staying closed, blood flows back into left ventricle (must pump more blood out to maintatin SV because some comes back in

Front 3

Mitral Regurge

Back 3

during systole blood flows into aorta and LA. some blood ejects backwards. That blood refills LV during systole. Franks starling mech. increase LVEDV

Front 4

Causes of Acute AR

Back 4

infective endocarditits, Aortic dissection, Trauma
SURGICAL EMERGENCY
problem with valve leaflets

Front 5

comp vs. demcomp Chronic AR

Back 5

Compensated: asymptomatic phase with marked LVdilatation, but presssures remain constatnt
Decompsenates: myocardial dysfunction tirggers sympstoms and mortality becomes significan

Front 6

Stenosis Murmur

Back 6

occurs when valves are supposed to be open

Front 7

regurge murmur

Back 7

occurs when valves are supposed to be closed

Front 8

Factors affectiving severity of AR

Back 8

1. size of hole
2. pressure gradient (high BP)
3. duration of diastole (tachy may help)

Front 9

Treatment of chronic AR

Back 9

symptoms indicate dysfunction=Surgery
Vasodilators only useful in asymptomatic patients w HTN

Front 10

Characteristics of Acute AR
Pressure?
Murmur?

Back 10

volume increase results in an increase ESV and EDP (to time to compensate)
short murmur

Front 11

Acute MR
organic vs. functional

Back 11

organic: leaflet, chordae, or pap muscle problem
functional: LV problem --> messed up annulus

Front 12

Chronic MR compensation

Back 12

1. LA compensates by dilating and acomodation increase colume with less LAP
2. LV compensates by dilation and hypertrophy resulting in incr. LVEDV with ner normal LVEDP
3. Decomp results in incr. LVEDP and incr. LAP

Front 13

Volume and pressure overload

Back 13

AR

Front 14

just volume overload

Back 14

MR

Front 15

compensated MR

Back 15

EDV incr afterload decr.
PV curve shifts down, decr. ECM, Incr compliance

Front 16

Decomp MR

Back 16

Incr ESV and incr LAP and EDP
decr. contractility

Front 17

Holosystolic Murmur

Back 17

Chronic MR
C and V waves merge: prominent V Vave
Murmur incr. with clenched fists
incre BV--> S3 sound

Front 18

symptoms of chronic MR

Back 18

1. low cardiac output
w. LA dilation stetches myocytes--increase propenisty for arrhythmias (A Fib)

Front 19

Factors affecting severity of MR

Back 19

1. size of hole
2.LAP and compliance (resistance to backflow)
3. Systemic Vascular resistance (resist to forward flow)

Front 20

Regurge
Sypmtoms = Surgery

Back 20

Fo' Sho'

Front 21

Are stenotic lessions acute or chronic

Back 21

Always Chronic, imcompatible w/life

Front 22

which chambers are affected by:
aortic stenosis
mitral stenosis

Back 22

aortic stenossis: LV
Mitral: LA

not that similar

Front 23

Three main causes of aortic stenosis

Back 23

1. degenerative- old people
2. rheumatic- any age any valve
3. congenital- bicuspid AV

afterload not directly dependent on BP

Front 24

Peak instantaneous gradient

Back 24

highest LVP

Front 25

peak-peak gradient

Back 25

difference between LV peak P and aortic peak P

no phys significance, diff times

Front 26

mean gradient

Back 26

average all through systole

Front 27

Aortic Stenosis Murmur

Back 27

during systole (valve supposed to be open)
crescendo-decresendo diamond
short delay afte S1, dwindles befoer S2: ejection systolic murmur

Front 28

AS Signs

Back 28

mid systolic murmur
delayed and diminished carotid pulse
stiff ventricle--can be an S4

Front 29

AS Symptoms and survival rates

Back 29

Angina: 5 years incre muscle mass and wall stress. EDP compresses coronary ateries and reduces flow

Syncope: 3 years related to exercise CO cant increase

HF 2 years

Front 30

ECG findings in AS

Back 30

LVH
increase voltage precordial leads
t waves inverted (abnormal repol)

Front 31

Treatment of AS

Back 31

Fix valve : replacement or plasty
med mangage: avoid a fib, avoid exercise, avoid things that dec. pre or afterload, use statins?

Front 32

mitral stenosis etiology

Back 32

RHEUMATIC HEART DISEASE
affects LA

Front 33

What is the problem in mitral stenosis?

Back 33

diastolic filling

Front 34

MS murmur

Back 34

diastolic rumble
can be an opening snap timed with openin of mitral valve; earlier if more severe

Front 35

MS signs

Back 35

Loud S1- MV snaps closed
opening snap
mid diastolic rumble
pre-systolic acentuation of murmur
sever: short S2-OS interval, longer mdrumble

Front 36

MS symptoms

Back 36

elevated LAP: dyspnea, exercise intolerance
elevated PA pressure-- pulmonary HTN
diminished CO (LV underfilled)
Hemoptysis- incr LAP, incre pvp, bronchiol veins can rupture
Hoarseness- pressure on recurrnet laryngeal nerve by LA or PA

Front 37

Two mechanisms for elevated PAP in MS

Back 37

passive pulmonary HTN- increase in LAP, incr pulmonary vp, pulmonary artery p increase

reactive pulmonary HTN: passive increase causes reactive increase; not everyone develops it

Front 38

ECG findings in MS

Back 38

LA enlargement RVH (late stages)
V1- p wave deep and wide
right axis deviation, prominent s waves v5 v6

Front 39

MS treatment

Back 39

fix stenosis
medical: volume control with diuretics
prevent an increase in HR
prevent clots with anticoag