Valvular Heart Disease

Front 1

What is the usual cause of mitral stenosis?

Back 1

Rheumatic carditis, which can cause valve thickening by fibrosis and calcification

Front 2

What happens in mitral stenosis?

Back 2

The valve opening narrows, preventing normal blood flow from the left atrium to the left ventricle.

Front 3

What side effects can be seen from mitral stenosis?

Back 3

Pulmonary congestion, and right side heart failure. Then the left ventricle receives insufficient blood volume, preloaded and cardiac output fall.

Front 4

What is happening during mitral regurgitation?

Back 4

Fibrotic and calcific changes prevent the mitral valve from closing completely during systole, allowing back flow of blood into the left atrium when the left ventricle contracts

Front 5

Can mitral regurgitation happen during diastole?

Back 5

Yes, backflow from the left atrium to the left ventricle along with normal blood flow can occur. This increased volume and pressure can cause the left atrium and ventricle to dilate and hypertrophy.

Front 6

What is the primary cause of mitral regurgitation?

Back 6

Degeneration due to aging and infective endocarditis. Or rheumatic fever. Affects women more than men

Front 7

What are the symptoms of mitral regurgitation?

Back 7

Slow onset. Fatigue, chronic weakness and dyspnea develop due to reduced cardiac output. Can get chest pains, palpitations and anxiety.

Front 8

Patient comes in with a normal BP, AFIB, and chest pain. The patient is very anxious and you learn they have a history of right sided heart failure. When you listen to their heart you hear a high-pitched systolic murmur at the Apex, what might be causing the noise you hear?

Back 8

Mitral regurgitation

Front 9

How does a mitral valve prolaspe occur?

Back 9

Valvular leaflets enlarge and prolapse into the left atrium during systole. Usually benign but can progress to pronounced mitral regurgitation.

Front 10

What causes mitral valve prolaspe?

Back 10

Marfan syndrome and other congenital cardiac defects

Front 11

What are the symptoms of mitral valve prolapse?

Back 11

Most are asymptomatic, but can cause activity intolerance, chest pain (on left side of chest, sharp), dizziness, and syncope. Found with normal HR and BP. Midsystolic click and late systolic murmur can heard at Apex of the heart.

Front 12

What is aortic stenosis?

Back 12

Aortic valve orifice narrows and obstructs left ventricular outflow during systole. This causes increased resistance to ejection or after load results in ventricular hypertrophy. As stenosis worsens the CO becomes fixed, not able to meet demands during excertion.

Front 13

What happens as aortic stenosis develops?

Back 13

Eventually the left ventricle fails, blood backs up in the left atrium, and the pulmonary system becomes congested. Right sided HF can occur.

Front 14

A patient is seen for syncope after attempting to race their grandkids. Patient is seen with peripheral cyanosis and a narrowed pulse pressure is seen when the BP is measured. A diamond-shaped, systolic crescendo-decrescendo murmur is noted on auscultation, what caused the syncope?

Back 14

Aortic stenosis caused syncope from a fixed cardiac output.

Front 15

What is aortic regurgitation?

Back 15

Aortic valce leaflets do not close properly during diastole and the annulus may be dilated, loose or deformed. This allows blood to flow from the aorta back into the left ventricle during diastole. This can cause a hypertrophy of the left ventricle.

Front 16

What are the causes of aortic regurgitation?

Back 16

Nonrheumatic conditons, like infective endocarditis, congenital anatomic aortic valvular abnormalities, HTN, and Marfan syndrome

Front 17

Your patient comes in complaining of severe orthopnea and palpitations when they lay on their left side. They also have been having angina and diaphoresis at night. You notice a bounding arterial pulse with a widened pulse pressure. When you auscultate you hear a high-pitched, blowing, decrescendo diastolic murmur. What might be wrong?

Back 17

Aortic regurgitation

Front 18

Simplied** what does mitral stenosis do?

Back 18

Increased left atrial and pulmonary pressure.

Front 19

Simplied*** what are the symptoms of mitral stenosis?

Back 19

Dyspnea, orthopnea, can cause AFIB.

Front 20

Simplied*** what does mitral regurgitation do?

Back 20

Increased left atrial and ventricular work load.

Front 21

Simplified*** what are the symptoms of mitral regurgitation?

Back 21

Pulmonary congestion

Front 22

Simplified*** what are the symptoms of mitral valve prolapse?

Back 22

Palpitations, atypical chest pain, it is usually benign

Front 23

Simplified*** what does aortic stenosis do?

Back 23

Increased left ventricular work load.

Front 24

Simplified*** what are the symptoms of aortic stenosis?

Back 24

Angina and fainting during exercise.

Front 25

Simplified*** what does aortic regurgitation do?

Back 25

Increased left ventricular work load.

Front 26

Simplified*** what are the symptoms of aortic regurgitation?

Back 26

Large pulse amplitude, ("waterhammer pulse"), head bobbing, pistol shot sounds above arteries., And pulsatile blushing of nail beds.

Front 27

What does your assessment look like for heart valves?

Back 27

Fatigue/weakness, dyspnea during expercise/laying flat, characteristic murmurs, echocardiogram, chest XRay

Front 28

What medications should you give for heart valve problems?

Back 28

Oxygen as needed, digoxin, beta blockers, diuretics, and anticoagulants

Front 29

Why might you be cautious of giving nitrates to a patient with aortic stenosis?

Back 29

There is a risk for syncope with a reduction in left ventricle volume (preload)

Front 30

Should you use a calcium channel blocker with aortic or mitral stenosis?

Back 30

Yes, vasodilation is used to reduce the regurgitant flow.