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