Z-Patho Of Valvular Heart Disease

Front 1

What is the predominant cause of mitral stenosis?

Back 1

Rheumatic fever

Front 2

What is the sex distribution of Px with MS from rheumatic fever?

Back 2

2/3 are female

Front 3

What happens to S1 in patients with Rheumatic Fever?

Back 3

Because of severe thickening of leaflets they may not be able to open or shut, reducing the first heart sound and leading to combined MS and MR

Front 4

Patients with rheumatic fever can develop MS years after infection. What 5 things may result from MS?

Back 4

MS can cause:
1. enlargement of the L atrium
2. calcification of the left atrial wall
3. development of mural thrombosis
4. obliteration of pulmonary vascular bed

Front 5

How is the LV ejection fraction in MS?

Back 5

It is maintained.

Front 6

What is the principal symptom of MS? Secondary sympt? (2)

Back 6

dyspnea from reduced compliance of the lung. Secondary - coughing and wheezing.

Front 7

What causes pulmonary edema in a Px with MS?

Back 7

Anything that either increases CO or reduces time for flow of blood to occur (ie preg, infection, sex, A-fib)

Front 8

VIP

Patients with MS are also at risk for thromboembolism - explain.

Back 8

Thromboembolism results from a-fib that can occur in a px with MS.

Front 9

How does the symptom of hoarseness occur in a Px with MS?

Back 9

Because of a dilated left atrium, hoarseness can occur from compression of the L recurrent laryngeal nerve and dilated pulmonary artery.

Front 10

What heart disease are px with MS predisposed to?

Back 10

Infective endocarditis because of the distortion of the anatomy of the mitral valve

Front 11

What is "pressure half time" and how does help diagnose the severity of MS?

Back 11

Pressure half time is the time in ms from the peak gradient of blood across the mitral valve to half that value.

The larger the number the more sever the mitral stenosis.

Front 12

Compare and contrast acute and chronic etiologies of mitral regurgitation:

Back 12

pg6-7 in 11/7

Front 13

Compare the ventricular functioning in mitral stenosis vs. mitral regurge:

Back 13

In MS - ventricular function is not impaired, no dilitation occurs

In MR - ventricle is not protected and permanent dilitation occurs from chronic volume overload.

Front 14

Compare the prognosis of acute MR vs chronic MR:

Back 14

Acure MR has a better prognosis since valves have incurred as much damage.

Front 15

What are the three clinical findings of a Px with MR?

Back 15

1. holosystolic murmur to axilla
2. CXR showing enlarged heart
3. V waves in EKG when you have severe MR

Front 16

When do symptoms develop in patients with chronic MR?

Back 16

Symptoms don't develop until left ventricle FAILS!

Front 17

Compare the development of symptoms in MR vs MS?

Back 17

MR - development takes longer, often more than two decades

MS - can develop in as short at 2 years (have benefit of "early warning system" since pulmonary symptoms often develop before irreversible damage is done)

Front 18

In which is pulmonary edema more common, MR or MS?

Back 18

MS

Front 19

Two main treatments all patients with MR (acute and chronic) are on:

Back 19

1. antiboitic prophylaxis
2. afterload reduction (angiotensin inhibitory or oral hydralazine)

Front 20

What is the best treatment in patients with chronic MR?

Back 20

MV ring repair with valvular PLASTY (VIP)

Front 21

What is one indicator of a Px with MR's survival rate post surgery?

Back 21

Ejection fraction - the better the px's EF was prior to surgery the better the 10y survival

Front 22

What causes MVP and how bad is it to have?

Back 22

Cause of MVP: myxomatous degeneration (fibrous thickening of mitral leaflets)

It is most often benign - 90% don't need surgery

Front 23

Five causes of AS?

Back 23

AS caused by:
1. congential bicuspid valve but often it does not cause the actually stenosis for decades
2. Rheumatic fever - which causes adhesions and fusions of leaflets as well as calcifications thus these px's usually have AS and AR
3. Degenerative calcific deposits (as in MVP) that cause valves to be immobile. Diabetes and hypercholesterolemia are risk factors for this.
4. Severe atherosclerosis can put sclerotic plaques on the valves (aka aorticsclerosis)
5. congenital unicuspid

Front 24

What are the three symptoms of AS?

Back 24

1. syncope
2. CHF
3. angina

Front 25

What is the main treatment for px with symptomatic AS?

Back 25

Valve replacement

Front 26

VIP
Four clinical findings of AS?

Back 26

1. systolic ejection murmur with ejection click
2. late peak of the murmur is muscial and severe
3. Cresendo-decreshendo murmur
4. S2 disappears with severe AS

Front 27

Where is the best place to listen for an AS?

Back 27

Suprasternal notch

Front 28

Why isn't balloon aortic valvuloplasty done in px with AS? What px may still get this?

Back 28

Since in AS the valves are calcified restenosis usually occurs due to scarring. This is only done in px with severe CHF.

Front 29

What are the 4 main clinical finding of patient with AR?

Back 29

1. diastolic murmur that is hard to hear
2. enlarged heart
3. dialated aortic root
4. echo shows diastolic blow

Front 30

Since timing is key in valve replacement in Px with AR - what are the two criteria for a px to get the surgery before irreversible damage is done?

Back 30

1. valve must be replaced before EF is lower than 60%
2. and LVESD is 40mm

Front 31

What is the most common cause of tricuspid regurgitation?

Back 31

Right ventricular dilatation secondary to pulmonary hypertension.

Front 32

What is Carvallo's sign? What does it signify?

Back 32

It's when the intensity of a murmur is increased just following inspiration. This sign translates into a diagnosis of tricuspid regurgitation.

Front 33

Completely understand MR and AS since they are the most important in his lecture

Back 33

MR and AS