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RRCCPA Clin Med Exam 4 > Valvular Disorders > Flashcards

Valvular Disorders Flashcards

1
Q

Name the 4 valves of the heart.

A

Tricuspid (Right atria to Right ventricle)
Pulmonary (Right ventricle to pulmonary circulation)
Mitral (Left atria to left ventricle)
Aortic (left ventricle to aorta)

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2
Q

What are 2 functions of the valves.

A

Allow blood to flow forward

Prevent backward blood flow

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3
Q

T or F: All 4 valves are 3 cusped?

A

False:

all have 3 cusps except the mitral valve

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4
Q

Valve ________ is a narrowing of the valve.

A

Stenosis is a narrowing of the valve

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5
Q

__________ occurs when the valve has trouble closing. What happens to the blood when this occurs?

A

Regurgitation

Blood will flow backwards when this occurs

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6
Q

Which test gives you good information about the valve morphology, LV function, atrial and ventricular chamber size and overall function?

A

Echo

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7
Q

What does TEE stand for?

A

Transesophageal echocardiogram

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8
Q

According to the ACC/AHA classification guidelines for valvular disease: what stage is a patient in when they become symptomatic?

A

Stage D - Patient is symptomatic.

Stage A - is at risk for valvular heart disease
Stage B - is asymptomatic but has mild to moderate disease
Stage C - is asymptomatic but has severe valvular disease
C1 normal LV function
C2 - abnormal LV function

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9
Q

T or false: Aortic stenosis is not very common.

A

False. Aortic Stenosis is very common

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10
Q

What is the most common cause of LV outflow obstruction?

A

Aortic Stenosis

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11
Q

What are the 3 primary causes of Aortic Stenosis?

A
  • Congenital abnormality (bicuspid valve)
  • Calcifications (often from aging)
  • Rhematic Valve disease (fusion between leaflets causes a small central opening)
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12
Q

What is the classic triad of symptoms with aortic stenosis?

A

Dyspnea (usually DOE)
Syncope / exertional dizziness
Angina

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13
Q

What is the most common symptom with aortic stenosis?

A

Dyspnea

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14
Q

Symptoms of aortic stenosis usually don’t occur until stenosis is severe. What values indicate severe stenosis?
Valve are or = _______mm/hg

A

Valve area < 1.0 cm2 (squared, no idea how to superscript in here!!!!)
Aortic velocity > or = to 4.0 m/s
Mean transvalvular gradient > or = to 40mm/hg

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15
Q

According to the ACC/AHA a patient that is asymptomatic but has mild-moderate valvular disease would fall into which classification stage?

A

Stage B - patient is asymptomatic but has mild-moderate valvular disease

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16
Q

Which stage of valvular disease is a patient in that has severe valvular disease with Abnormal LV function but is still asymptomatic?

A

Stage C2 - patient is asymptomatic but has severe disease

C2 is abnormal LV function

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17
Q

T or F: a patient that has been classified to have Stage C1 will have abnormal LV function and have severe symptoms.

A

False

Stage C1- patient is asymptomatic but has severe valvular disease; normal LV function

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18
Q

Aortic Stenosis has a harsh systolic ejection murmur heard best where?

A

Right 2nd intercostal space

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19
Q

T or false: Aortic stenosis has Crescendo- decrescendo sound.

A

True

It is a crescendo-decresendo murmur

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20
Q

Aortic stenosis manifests as a harsh systolic crescendo-decrescendo ejection murmur that radiates where?

A

Radiates to the carotids

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21
Q

What does Parvus et tardus pulse mean? In aortic stenosis which vessels is this especially seen in?

A

Pulses are weak and delayed

seen at the carotids

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22
Q

How do you diagnose aortic stenosis?

A

echo

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23
Q

T or F: Severe aortic stenosis would not qualify a patient for hospice care.

A

False

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24
Q

What 2 conditions do you need to manage in a patient with aortic stenosis?

A

Manage HTN

Manage heart failure

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25
Q

Avoid the use of what 3 meds in patients with aortic stenosis? Why?

A

Nitrates
Hydralazine
Nitroglycerine

Can exacerbate syncope from vasodilation

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26
Q

What is the mainstay treatment for aortic stenosis?

A

AVR - aortic valve repair (surgery)

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27
Q

What do SAVR and TAVI stand for?

A

SAVR - surgical aortic valve repair

TAVI - transfemoral transcatheter aortic valve implantation

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28
Q

T or F: SAVR is most recommended surgical treatment for aortic stenosis.

A

False

TAVI is recommended over SAVR for most patients

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29
Q

SAVR is preferred in patients with: (3)

A
  • Bicupid or unicuspid aortic valve
  • Poor transfemoral access
  • severe LV outflow tract calcification
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30
Q

What is an alternative procedure to open surgery in aortic stenosis?

A

Balloon Valvuloplasty

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31
Q

T or F: Balloon valvuloplasty has a low complication rate.

A

False - has a high complication rate

MI, perforation, aortic regurgitaiton

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32
Q

4 major complications of aortic stenosis?

A
  • Heart failure (diastolic dysfunction common)
  • sudden cardiac death
  • Increased bleeding risk (Heyde syndrome)
  • Pulmonary HTN
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33
Q

Patients with aortic stenosis have a ________ prognosis if they do not undergo valve replacement.

A

Poor prognosis

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34
Q

T or F: aortic stenosis mortality increases dramatically after developing symptoms.

A

True
Mean survival after onset of CHF – 0.5 - 2.8 yrs
onset of syncope – 0.8 - 3.8 yrs
onset of angina – 2 - 4.7 yrs

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35
Q

Where does a homograft valve come from?

A

Valve from a cadaver, deceased heart donor, or the patient

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36
Q

Where does an allograft valve come from?

A

Valve from pigs or cows

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37
Q

What is a bioprosthetic valve?

A

a valve from animal valves or reconstructed

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38
Q

What is a mechanical valve?

A

a valve from non-living material

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39
Q

________ _________ is recommended to prevent valve thrombosis and thrombotic events for mechanical valves.

A

Antithrombotic therapy

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40
Q

What combination anticoagulation therapy is recommended for mechanical valve patients?

A

Warfarin + ASA (75-100mg/day)

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41
Q

T of F: patients with mechanical valves CANNOT use NOAC’s.

A

True
NOAC = non-vitamin K antagonist oral anticoagulant
(yeah NOAC is much better)

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42
Q

After the mechanical valve is placed you bridge with _______ until INR is within therapeutic for _____ consecutive days.

A

Heparin

2 consecutive days

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43
Q

INR goal after mechanical valve placement?

Except for those with__ - __ __________ aortic valve.

A

2.5-3.5 INR

Except in On-X mechanical AORTIC valve

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44
Q

For patients with implanted bioprosthetic valves the ACC/AHA guidelines for anticoagulation therapy is _____mg/day and _______ for 3 months with INR goal of _____-____.

A

ASA 75-100 mg/day

Warfarin for 3 months, INR goal of 2-3

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45
Q

______ _______ is the condition where blood leaks backwards though the aortic valve due to inadequate closure of the valve.

A

Aortic Regurgitation

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46
Q

Aortic Regurgitation can lead to which 2 conditions?

A

LV dilation

LV hypertrophy

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47
Q

What are 4 causes of Aortic regurgitation?

A

Rheumatic Heart Disease
Aortic root dilation
Congenital bicuspid valve
Calcific Valve disease

48
Q

Signs and symptoms of aortic regurgitation

A

Asymptomatic
Exertional dyspnea
Exertional angina
Symptoms of Heart Failure

49
Q

What are some clinical manifestations of aortic regurg?

A

Wide pulse pressure
Bounding pulses
Displaced apical impulse (lateral and inferior)

50
Q

What type of murmur will you hear with aortic regurgitation?

A

Diastolic decrescendo murmur, high pitched and blowing

51
Q

T/F: An aortic regurgitation murmur is heard best when the patient is sitting straight and inhaling

A

False: heard best with patient leaning forward and exhaling

52
Q

Traube Sign

A

Pistol shot pulse (systolic & diastolic sounds) heard over the femoral arteries

53
Q

Mitral stenosis causes dilation and increased pressure of the ________ atrium, pulmonary vasculature and _______ side of the heart. This can lead to ______

A

Mitral stenosis causes dilation and increased pressure of the LEFT atrium, pulmonary vasculature and RIGHT side of the heart. This can lead to A-FIB. (due to stretching of the electrical fibers)

54
Q

Mitral stenosis is almost exclusively secondary to ______ ________ _______.

A

Rheumatic heart disease

55
Q

What is the most common and often the only symptom of mitral stenosis?

A

Exertional dyspnea

56
Q

What are some other symptoms seen with mitral stenosis?

A
  • Decreased exercise tolerance
  • Hemoptysis
  • Palpitations/a-fib
  • Thromboembolic event
  • Right HF (increased JVP, edema)
  • Hoarse voice (from compression of recurrent laryngeal n.)
57
Q

T or F: To evaluate aortic regurgitation you would do a TTE?

A

True

58
Q

What position should the patient be in to best hear a mitral stenosis murmur? What side of the stethoscope should you use?

A

Heard at the apex with the patient in left lateral decubitus position while patient exhales. Use the BELL of the stethoscope

59
Q

You should anticoagulate a patient who has mod-severe mitral stenosis and at least one of what 3 conditions?

A

Mod-severe stenosis PLUS:

  • Afib
  • Prior embolic event -or-
  • LA thrombus (new sports team name? The LA thrombi?)
60
Q

What three complications from mitral stenosis can generally lead to death?

A
  • progressive right-sided heart failure -and/or-
  • pulmonary edema -and/or-
  • thromboembolic event (CVA/PE)
61
Q

Mitral stenosis can lead to ______ ________ from stretching of the electrical fibers.

A

Atrial fibrillation

62
Q

What is the most common cause of secondary mitral regurgitation?

A

Coronary heart disease

63
Q

What are 3 other causes of mitral stenosis (other than rheumatic heart disease)?

A

Annular calcification
Radiation
congenital

64
Q

What are 5 common mitral regurgitation symptoms?

A
  • Asymptomatic
  • Weakness
  • Fatigue
  • Exercise intolerance
  • Symptomatic HF or pulm edema
65
Q

Symptoms of mitral stenosis (7)

A 
exertional dyspnea
Decreased exercise tolerance 
Hemoptysis 
Palpitations / afib
Thromboembolic event
Right heart failure (increased JVP, edema)
Hoarse voice
66
Q

Where does a mitral regurg murmur radiate to?

A

To the left axilla

67
Q

Best place and best patient position to hear mitral stenosis during auscultation?

A

Best heard at the apex

Left lateral decubitus position while patient exhales

68
Q

When is surgical repair indicated for mitral regurgitation?

A 
If symptomatic (i.e. dyspnea or fatigue)
-Asymptomatic patients should be monitored with echo
69
Q

T/F: surgical repair of mitral regurgitation improves symptoms and survival

A

FALSE: repair only improves symptoms, there is no evidence that it improves survival

70
Q

What do patients with ACUTE mitral regurgitation present with? What is the treatment?

A

Acute pulmonary edema (SOB), they may need emergency surgery.
(Acute MR develops rapidly due to: valve perf from endocarditis, papillary muscle dysfunction after MI, trauma, ruptured chordae tendinae from MVP)

71
Q

What type of valvular disorder is almost always due to a congenital defect?

A

Pulmonic stenosis (often associated with Tetralogy of Fallot)

72
Q

what are some complications of mitral stenosis?

A

Afib
Thromboembolic event
Development of tricuspid regurgitation

73
Q

What type of murmur is heard with pulmonic stenosis? Where is it heard best?

A

Crescendo-decrescendo systolic ejection murmur with an ejection click. Splitting of the 2nd heart sound increases with severity of stenosis.
-Heard best at left upper sternal border

74
Q

T/F: An S4 heart sound can be heard with pulmonic stenosis

A

TRUE

75
Q

What is the treatment for mod-severe pulmonic stenosis?

A

Balloon valvotomy

76
Q

T/F: Prognosis is very poor in patients with pulmonic stenosis

A

FALSE, prognosis is pretty good, survival into adulthood is common even without surgical intervention.
There is increased incidence of arrhythmias, however.

77
Q

What are 3 causes of PRIMARY pulmonic regurgitation?

A
  • Iatrogenic (usually from valvotomy when repairing Tetrology of Fallot)
  • infectious (endocarditis)
  • immune-mediated (Rheumatic fever)
78
Q

What condition commonly causes SECONDARY/functional pulmonic regurgitation when the pulmonic valves are morphologically normal?

A

Pulmonary HTN

79
Q

Pulmonic regurgitation leads to volume overload in which ventricle? What can this lead to?

A

Right Ventricle volume overload–> RV enlargement, RV dysfunction, and triscuspid regurgitation (the whole right side has issues)

80
Q

Ascites and edema are symptoms of what type of valvular abnormality?

A

Pulmonic regurg

81
Q

An early diastolic decrescendo murmur heard over the left 2nd and 3rd ICS is associated with what type of valve disorder?

A

Pulmonic regurgitation

82
Q

Graham-Steele murmur of pulmonic regurgitation is associated with _______ ________.

A

Pulmonary HTN

83
Q

T/F: Tricuspid stenosis is very common.

A

FALSE: it’s uncommon, especially alone. Usually occurs in combination with tricuspid regurg and/or other valvular abnormalities

84
Q

What usually causes tricuspid stenosis?

A

Rheumatic heart disease

85
Q

Abdominal discomfort from hepatomegaly and hepatic congestion is associated with what type of valvular disorder?

A

Tricuspid stenosis

86
Q

T/F: elevated JVP is not associated with tricuspid stenosis

A

FALSE, you will see an elevated JVP with prominent A waves in tricuspid stenosis

87
Q

An early/mid diastolic murmur with an opening snap heard at the left sternal border during inspiration is associated with what valvular disorder?

A

Tricuspid stenosis

88
Q

What type of symptoms might you see with tricuspid regurgitation?

A
  • Asymptomatic
  • Distended/pulsatile jugular veins
  • Symptoms of Right HF (edema, HSM, ascites)
89
Q

What sound might you hear over the jugular vein in someone with tricuspid regurgitation?

A

Systolic thrill

90
Q

T/F: a holosystolic murmur is heard with tricuspid regurgitation

A

TRUE, you may also hear an S3 or S4 with tricuspid regurg

91
Q

What would you use to treat the S/sx of heart failure associated with tricuspid regurgitation?

A

Diuretics

92
Q

Severe tricuspid regurgitation is an __________ predictor of mortality in those with LVEF < ___%

A

Severe tricuspid regurgitation is an INDEPENDENT predictor of mortality in those with LVEF < 35%

93
Q

Corrigan’s Pulse (aka water-hammer pulse)

A

A pulse that is forceful and then suddenly collapses

94
Q

DeMusset’s Sign

A

Rhythmic head bobbing along with the heartbeat

95
Q

Traube Sign

A

Pistol shot pulse (systolic & diastolic sounds) heard over the femoral arteries

96
Q

Quincke’s Sign

A

Capillary pulsation in the fingertips

97
Q

Bounding pulses are a clinical manifestation of Aortic regurgitation. What are the 4 types of bounding pulses you can see?

A

Corrigan’s Pulse (Water-hammer pulse)
DeMusset’s Sign
Traube Sign
Quincke’s Sign

98
Q

What murmur would you hear in Aortic regurgitation?

A

Diastolic decrescendo murmur

  • High pitched and blowing
  • heard best with patient sitting, leaning forward
99
Q

Describe an Austin Flint Murmur. What condition would you hear it in?

A

Low pitched mid to late diastolic rumble at the apex

Severe Aortic Regurgitation

100
Q

T or F: To evaluate aortic regurgitation you would do a TTE?

A

True

101
Q

What is the treatment for severe symptomatic aortic regurgitation?

A

AVR

102
Q

_______ _______ is a narrowing of the mitral valve.

A

Mitral stenosis

It blocks blood flow from LA to LV.

103
Q

T or F: Mitral stenosis causes dilation and decreased pressure of the LA, pulmonary vasculature and right heart.

A

False - causes dilation and INCREASED pressure of the LA, pulm vasculature and Rt heart

104
Q

Mitral stenosis can lead to ______ ________ from stretching of the electrical fibers.

A

Atrial fibrillation

105
Q

Mitral stenosis is almost exclusively secondary to what condition?

A

Rheumatic heart disease

106
Q

What are 3 other causes of mitral stenosis (other than rheumatic heart disease)?

A

Annular calcification
Radiation
congenital

107
Q

What is the most common and often the only symptom of mitral stenosis?

A

Exertional dyspnea

108
Q

Symptoms of mitral stenosis (7)

A 
exertional dyspnea
Decreased exercise tolerance 
Hemoptysis 
Palpitations / afib
Thromboembolic event
Right heart failure (increased JVP, edema)
Hoarse voice
109
Q

how does mitral stenosis cause a horse voice?

A

compression of the recurrent laryngeal nerve

110
Q

Best place and best patient position to hear mitral stenosis during auscultation?

A

Best heard at the apex

Left lateral decubitus position while patient exhales

111
Q

What will you hear during auscultation of mitral stenosis?

A

Opening snap
Accentuated / loud S1
Rumbling low pitched mid-diastolic murmur

112
Q

Give you one guess what test is used to evaluate mitral stenosis….

A

ECHO

are you surprised???

113
Q

The definitive treatment for mitral stenosis.

A

surgery; either

- PMBC (percutaneous mitral balloon commissurotomy)
- concomitant mitral valve surgery
114
Q

How do you medically manage patients with mitral stenosis?

A

Anticoagulate if have moderate-severe mitral stenosis and one of the following:
Afib
prior embolic event
LA thrombus

115
Q

T or F: Rheumatic MS is generally progressive.

A

True

116
Q

Deaths from mitral stenosis are generally from…

A

Progressive right-sided heart failure
and/or
pulmonary edema, thromboembolic events (CVA or PE)

RRCCPA Clin Med Exam 4 (20 decks)

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