Lilly Chapter 8 part 1 Valvular Heart Disease
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- 3 Etiologies of Aortic stenosis.
- Congenital, Rheumatic Valve Disease, Age-related calcification
- What is the physiologic compensation mechansim for Aortic Stenosis?
- Concentric LV hypertrophy leading to concomitant LA hypertrophy
- What are 3 the major symptoms, not structural changes, in advanced Aortic Stenosis and Why do they occur?
- Angina (supply can't meet demand); Syncope (can't increase CO with exercise), CHF (with time LVEDV increase, insurmountable AL, leading to congestion)
- What are the PE findings (murmurs, carotid pulse change, S2 effect) in Aortic Stenosis?
- coarse late peaking systolic ejection murmur; weak Carotid upstroke pulse; S4; loss of aortic portion of S2
- What is used to confirm AS? Treatment for Aortic Stenosis?
- Confirmed by Cardiac catherization, treatment by AVR onces LV dysfunction is great enough + prophylaxis
- What are the 2 mechanisms that cause Aortic Regurgitation?
- Aortic leaflet disease; dilatation of the aortic root
- How does Acute Aortic Regurgitation present? Treatment?
- MEDICAL emergency appears with normal LV but quick volume overload has caused pulmonary edema; AVR STAT!
- Describe compensation in Chronic Aortic Regurgitation.
- Compensatory adaptation to volume overload has occurred (dilatation and to a lesser degree LV hypertrophy);
- What condition gives you a Widened Pulse Pressure?
- Hallmark of Aortic Regurgitatoin
- What are the most frequent patient complaints when presenting with chronic Aortic Regurgitation?
- dyspnea on exertion, fatigue, forceful heartbeat;
- Describe Treatment for Asymptomatic & Symptomatic AR.
- If Asymptomatic follow closely LV function and prophylaxis for endocarditis; Symptomatic: some efficacy with VDs/CCBs/diuretics to delay AVR prior to decompensation;
- TRUE/FALSE - Tricuspid Stenosis is common and often a complication related to Rheumatic Heart Disease.
- False - rare but related to RHD
- What are the Common PE findings (JVP, murmurs, palpations, etc) in Tricuspid Stenosis.
- JVD with large a wave; Opening Snap with diastolic murmur; hepatomegaly/abdominal distention
- Treatment for Tricuspid Stenosis.
- Valvuloplasty or Replacement
- Describe what usually causes Tricuspid Regurgiation.
- Functional, in that RV dilatation prevents full closure.
- Common PE findings (JVP, murmurs, palpations,etc) in Tricuspid Regurgitation.
- Prominent v waves in jugular veins (RA dilation), systolic murmur, pulsatile liver (back pressure from ventricle)
- TRUE/FALSE - Often treatment for Tricuspid Regurgitation requires complete replacement.
- False - treat the underlying RV enlargement
- TRUE/FALSE - Pulmonic Stenosis is rare and usually a congenital lesion treated by ballon valvuloplasty.
- TRUE
- What is the most frequent cause of pulmonic regurgitation?
- Severe pulmonary HTN
- What is main negative for the long lasting mechanical valves when compared to bioprosthetic valves? Often recommended to what group?
- thrombogenic surface requiring lifelong anticoagulation; Younger patients
- What is the main negative for porcine valves when compared to mechanical valves? Often recommended to what group?
- less durable requiring more frequent replacement; the elderly( more negatives with anticoagulation)
- TRUE/FALSE - All valve replacements require lifetime abx prophylaxis for endocarditis.
- True
- Describe the 2 conditions for Acute Bacterial Endocarditis.
- Acute, fulminant endocardial infection with highly virulent and invasive microbe (if less virulent, SBE)
- Describe the pathogenesis of Endocarditis.
-
1. endocardial surface injury (often via turbulent flow);
2. thrombus formation;
3. bacteria entry into circulation (usually G+);
4. bacterial adherence to fibrin laid down by Platelets (then coated and protected);
5. Possible embolism leading to infarcts; - Right Sided Infective Endocarditis is seen often in (blank).
- Intravenous Drug users
- What is the Treatment strategy for infective endocarditis?
- 1st obtain blood culture, 2nd IV abx can be directed at the microorganism,3rd if persistent bacteremia then valve replacement
-
? - Normal Aortic Valve
-
? - Congenital Pulmonary Stenosis
-
? - Combined aortic and mitral stenosis seen with LA dilation and LV hypertrophy
- TRUE/FALSE - Marantic Endocarditis is non inflammatory, non destructive and non infective but can still cause thrombotic embolization.
- True
-
Disease process? - Marantic Endocarditis
- What heart disease process is associated with SLE & Collagen Vascular Disease?
- Libman-Sacks Endocarditis
-
? - Libman Sacks Endocarditis
- Carcinoid Heart tumors from the GI tract cause valvular fibrosis via production of (blank).
- vasoactive metabolites (serotonin)
- What disease condition is Distinguished by large atrial gelationous mass?
- Cardiac Myxoma