Pathophys Of Cardiac Valve Disease

Front 1

What is compensated aortic stenosis?

Back 1

The LV generating higher systolic pressure to overcome obstacle of stenosed valve. There is LV hypertrophy.

Front 2

What is decompensated aortic stenosis?

Back 2

The LV fails to generate high enough pressure to overcome obstruction at valve. The EF and CO declines ---> LV dilates ---> Pulmonary edema with dyspnea

Front 3

Physical signs of aortic stenosis?

Back 3

Weak arterial pulse

Click on ejection due to fibrosed valve (only if fibrosed, not just calcified)

Front 4

Aortic regurgitation due to an incompentent aortic valve causes what change in LV volume?

Back 4

increased LV diastolic volume

Front 5

What happens in compensated aortic regurgitation?

Back 5

LV dilation and hypertrophy due to increased LV volume --> LV ejects greater than normal volume of blood (increased SV) to compensate for regurgitant volume.

Front 6

What happens in decompensated aortic regurgitation?

Back 6

LV reaches limit of adaptation thru hypertrophy and dilation --> EF and SV and CO decreased -> elevation of ventricular diastolic, left atrial, and pulmonary venous pressure --> pulmonary edema.

Front 7

Aortic regurgitation: physical signs

Back 7

Due to rapid ejection of large amount of blood: vigorous pulse, high systolic pressure.

Low diastolic pressure.

(aka <b>widened pulse pressure</b>.)

Diastolic murmur due to turbulence of aortic regurgitation.

Front 8

What is the sequence of events that leads to decreased cardiac output in mitral stenosis?

Back 8

1) Obstruction to blood flow from LA-> LV due to stenosed mitral valve.

2) Elevated LA pressure to force blood thru the stenosed valve --> LA dilation

3) Elevated pressures in pulmonary veins --> pulmonary edema with dyspnea

4) Pulmonary arterial HTN --> elevated RV and RA pressures

5) Decreased CO

Front 9

How will a fibrosed but mobile mitral valve change the heart sounds?

Back 9

Loud S1 with an opening snap

Front 10

How will a calcified and immobile mitral valve change the heart sounds?

Back 10

Soft S1 with absent opening snap.

Front 11

Fibrosis causes (increase, decrease) in sounds while calcification causes an (increase, decrease)

Back 11

Increase ; Decrease

Front 12

A diastolic murmur in mitral stenosis is caused by what?

Back 12

turbulent flow across the valve.

Front 13

What are the two components of an incompetent mitral valve that increase LA systolic volume, eventually resulting in a dilated LA?

Back 13

1.) mitral regurgitation into LA during systole

2.) normal systolic flow from pulmonary veins into LA

Front 14

What happens in compensated mitral regurgitation?

Back 14

1.) There is increased LA systolic volume.

2.) There is increased flow across mitral valve into LV.

3.) There is increased LV diastolic volume.

4) There is dilated and hypertrophed LV.

5) There is increased LV SV.

6) There is a regurgitant portion of blood into the LA, and a normal volume into aorta

7) LV maintains normal forward CO.

Front 15

What happens in decompensated mitral regurgitation?

Back 15

1.) There is progressive LV dilation and hypertrophy

2) LV reaches limit of adaptation.

3) LV EF decreases.

4) LV SV decreases.

5) LV fails to maintain normal forward CO into aorta.

6) There is elevation of LA pressure

7) There is pulmonary edema.

Front 16

Physical signs of Mitral Regurgitation

Back 16

a pansytolic regurgitant systolic murmur caused by turbulence during LV regurgitation.

Front 17

What happens in mitral valve prolapse?

Back 17

1) Myxomatous degen. of mitral valve

2) Voluminous redundant leaflets

3) Redundant mitral leaflets partially prolapse into LA

4) Systolic click +/- regurgitation

Front 18

physical signs of mitral valve prolapse

Back 18

Mid systolic click, mid-late sytolic regurgitation

Front 19

Obstruction to RV ejection by stenosed pulmonic valve

Back 19

Pulmonic stenosis

Front 20

3 causes of pulmonary valve stenosis

Back 20

1) Congenital heart disease - most common

2) rheumatic heart disease

3) carcinoid tumor

Front 21

How does the RV compensate for pulmonary valve stenosis?

Back 21

Hypertrophy with development of elevated systolic pressure to overcome obstruction.


(Defn of compensated is that normal ejection fraction , stroke volume, and forward CO is maintained).

Front 22

How does the RV compensate for pulmonary valve stenosis?

Back 22

Hypertrophy with development of elevated systolic pressure to overcome obstruction.


(Defn of compensated is that normal ejection fraction , stroke volume, and forward CO is maintained).

Front 23

What happens in decompensated pulmonary stenosis (when the RV is unable to further adapt)?

Back 23

EF, SV decreases. There is dilation and CO decreases.

There is elevation of RV diastolic, RA and systemic venous pressure --> <b>peripheral edema </b>.

Front 24

Physical signs of pulmonic stenosis

Back 24

If the valve is mobile but fibrosed --> ejection (opening) click


If the valve is calcified and immobile --> Soft/absent S2 with no ejection click

Either way, there is <b> systolic turbulence and ejection murmur. </b>

Front 25

Pulmonic regurgitation results in what?

Back 25

Increased RV diastolic volume

Front 26

Compensated pulmonic regurgitation is characterized by what?

Back 26

Dilated and hypertrophied RV that ejects greater than normal volume of blood into pulmonary artery to compensate for regurgitating volume.

Of course, by defn, the EF and CO is maintained.

Front 27

Decompensated pulmonic regurgitation is characterized by what?

Back 27

Dilation and hypertrophy of RV reaches max and RV is unable to adapt further.

EF, SV, CO decreases.

There is extra dilation.

There is <b> elevation of RV diastolic, RA, and systemic venous pressure that causes peripheral edema. </b>

Front 28

Physical signs of pulmonic regurgitation.

Back 28

The turbulence of the pulmonic regurgitation causes a diastolic murmur.

Front 29

Obstruction to blood flow from RA to RV by stenosed tricuspid valve

Back 29

Tricuspid stenosis

Front 30

What happens in tricuspid stenosis?

Back 30

There is elevated RA pressure --> RA dilation --> Elevated pressures in systemic veins --> peripheral edema.

Front 31

Physical signs of tricuspid stenosis

Back 31

If the valve is mobile but fibrosed --> opening snap and loud S1

If the valve is calcified and immobile --> Soft S1 with no opening snap.

Either way, there is turbulent flow across the valve that leads to a diastolic murmur.

Front 32

Tricuspid regurgitation results in what?

Back 32

Increased RA volume --> Dilated RA

Front 33

Compensated tricuspid regurgitation is characterized by what?

Back 33

Increased flow across tricuspid valve into RV --> increased RV volume ---> Dilated and hypertrophied RV --> Increased RV SV --> There is a regurgitant portion that goes into the RA and normal volume into Pulm. artery --> RV maintains normal CO.

Front 34

Decompensated tricuspid regurgitation is characterized by what?

Back 34

RV is unable to adapt further ---> results in decrease in EF, SV, and CO


--> Elevation of RV diastolic, atrial and systemic venous pressure --> <b>peripheral edema</b>.

Front 35

Physical signs of tricuspid regurgitation

Back 35

There is a pansystolic regurgitant murmur due to turbulence during RV systolic regurgitation.