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41 Cards in this Set

  • Front
  • Back
Etiology of Aortic stenosis
-Degenerative (atherosclerosis)
-Congenital (bicuspid)
-Rheumatic
Pathophysiology of Aortic stenosis
-Stenotic valve=decreased area for bf=increase in velocity to maintain flow....P gradient develops
-LVP increases causing LVH=diastolic dysfnx leading to systolic dysfnx
Clinical presentation of Aortic stenosis
-Systolic ejection murmur
-Ejection click
-Paradoxical splitting of A2
-S4
Diagnostic studies for Aortic stenosis
-Echo
-Cath lab
-Valve area <2cm, P gradient develops
Management of Aortic stenosis
-Sx for moderate to severe Sx
-F/U for asymptomatic pts
Etiology of Mitral stenosis
-Rheumatic heart Dz
-Mitral annular calcification in elderly (rare)
-Congenital (rare)
Pathophysiology of Mitral stenosis
-Decreased area of bf due to stenotic valve causes LAP to rise-->LA dilates-->Pulmonary A P increases-->SOB from pulmonary congestion
Clinical presentation of Mitral stenosis
-Loud S1, opening snap
-Diastolic murmur
-Signs of pulmonary HTN
-A Fib
Management of Mitral stenosis
-BB
-Diuretics
-Antocoagulation for A Fib pts, dilated LA, or prior embolic event
-Balloon valvuloplasty or Commisurotomy for moderate to severe
Etiology of Pulmonic stenosis
-Usually congenital
Pathophysiology of Pulmonic stenosis
-P gradient develops between RV & pulmonary A
Clinical presentation of Pulmonic stenosis
-Mild: asymptomatic
-Mod-Sev: Exertional fatigue, dyspnea, & syncope
-Harsh systolic ejection murmur @ LSB +/- thrill
-P2 soft or absent
Management of Pulmonic stenosis
-Balloon valvuloplasty for mod-sev stenosis w/ Sx
Etiology of Tricuspid stenosis
-Rare, ass'd w/ Rheumatic mitral stenosis
Pathophysiology of Tricuspid stenosis
-P gradient develops between RA & RV-->elevated RAP-->systemic venous congestion & low CO
Clinical presentation of Tricuspid stenosis
-Elevated neck veins
-Edema
-Hepatomegaly
-Diastolic murmur
-Opening snap
Management of Tricuspid stenosis
-No ballooning
Etiology of Aortic regurgitation
Leaflet problems:
-Endocarditis
-Rheumatic Dz
Congenital bicuspid valve
-Trauma
-Myxomatous
Annulus problems:
-HTN
-Aortoannular ectasia
-Marfan's
-Aortic dissection
-Osteogenisis imperfecta
Pathophysiology of Aortic regurgitation
-Regurgitant flow causes V load on LV & increases LVDP-->increase in pulmonary venous P
-LV dilates over time, coronary bf may be compromised
Clinical presentation of Acute Aortic regurgitation
Acute:
-Tachycardia
-HOTN
-PE
-Diastolic murmur
-Soft, short, or absent A2
Clinical presentation of Chronic Aortic regurgitation
-Long asymptomatic pd
-Wide PP
-Laterally displaced PMI
-Diastolic decrescendo murmur
-Austin Flint murmur (diastolic rumble)
Peripheral pulses in chronic aortic regurgitation
-Corrigan's pulse: Waterhamer pulse
-Traube's sign: pistol shots over Femoral A's
-de Musset's sign: head bobbing
-Muller's sign: pulsating uvula
-Quincke's pulses: capillary pulsations
-Duroziez's sign: systolic & diastolic femoral murmurs
Management of Aortic regurgitation
-No medical Tx
-Rule of 55: operate before LVEF <55% or LV end diastolic dimension >5.5cm
Etiology of Mitral regurgitation
-Myxomatous degeneration
Pathophysiology of Mitral regurgitation
-Elevation of LAP causing backflow into pulmonary circulation
-Supranormal LV fnx but decreased CO due to LV dilation
Clinical presentation of Mitral regurgitation
-Long asymptomatic pd
-SOB
-Fatigue
-Weakness
-Laterally displaced PMI
-Systolic murmur radiates to axilla
Management of Mitral regurgitation
-Sx: repair or replacement (must keep chords)
-Improved survival if Sx performed before EF <60%
-Indicated for pt's w/ severe Sx
Etiology of Pulmonic regurgitation
-Pulmonary HTN
-Endocarditis
-Congenital
-Connective tissue
-Carcinoid
-Trauma
Clinical presentation of Pulmonic regurgitation
-Soft, diastolic decrescendo murmur @ LUSB, increases w/ inspiration
Management of Pulmonic regurgitation
-It is a rare presentation
-Sx rarely needed b/c it is well tolerated
Etiology of Tricuspid regurgitation
-Usually secondary to RV dilation +/or pulmonary HTN
Pathophysiology of Tricuspid regurgitation
-RV volume overload
Clinical presentation of Tricuspid regurgitation
-Neck vein distension
-Pulsatile liver
-Carvallo's sign: Holosystolic mumur, increased w/ inspiration
-Leg edema
Management of Tricuspid regurgitation
-Usually well tolerated
-Sx occasionally required
Etiology of Mitral valve prolapse
Connective tissue disorders:
-Marfan's
-Osteogenesis imperfecta
-Ehlers-Danlos Syndrome
Pathophysiology of Mitral valve prolapse
-Excessive mitral leaflet tissue prolapses toward the LA during systole causing the click & murmur
Clinical presentation of Mitral valve prolapse
-Most are asymptomatic
-Palpitations
-Atypical CP
-Midsystolic click +/or murmur increased w/ valsalva
Management of Mitral valve prolapse
-Abx prophylaxis
-BB for CP
-Sx rarely required
Valvular surgical repair is usually performed in....
Mitral valve regurgitation
Types of valve repairs
-Balloon valvuloplasty
-Commisurotomy
Types of valve replacements
Mechanical prostheses:
-Made of metal & plastic
-Is thrombogenic
Biologic valves:
-Heterografts (bovine, porcine)
-Human (no tissue matching or immunosuppression required)