Valvular Heart Disease notes
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Valvular Heart Disease notes Document Transcript

  • 1. Valvular Heart Disease by LazikLargest Valve: Tricuspid Valve2nd Largest Valve: Mitral Valve (4 cm squared)Smallest Valve: Aortic Valve (3 cm squared)Coronary Arteries come from the valsalva sinusAortic Valve gives off two coronary arteriesPulmonary Valve in front of the Aortic ValveCommissures of the aortic valve separate the cuspsCardiac Cycle 1) Mitral Valve closing makes 1st heart sound (primary component) 2) During systole, there is no sound 3) Aortic Valve closing makes 2nd heart sound (snaps closed) 4) During diastole, there is no sound 5) Leaky mitral valve: Abnormal sound in systole a. Systolic murmur starts earlier than an aortic stenotic murmur 6) QRS: Ventricular depolarization 7) ST: Ventricular diastole 8) (EDV-ESV)/EDV = Ejection Fraction [remember that (EDV-ESV) = stroke volume] a. About 55% Ejection Fraction is normal b. Impaired Left Ventricular Systolic Function: < 55% 9) Must access the ventricular function when considering valvular repair 10) Number #1 parameter to access Ventricular Systolic Function a. Left Ventricular Ejection Fraction 11) Echocardiogram a. Send out sound waves (millions of cycles/second), bounces off of a surface, and it is rebounded b. Transmits sound waves 1/1000 seconds c. The rest of the time, it acts as a receiver d. Bounce off of the heart, as well as Doppler off the RBC’s e. Echocardiogram waves are dispersed by the lungs i. In persons with lung disease (COPD) it can be a problem ii. Must use a special transducer through esophagus (Trans- Esophageal Echocardiogram) (TEE) 1. Two-dimensional f. Transthoracic Echocardiogram (TTE) i. Surface ii. Can determine LV volume, ejection fraction, etc. 12) Doppler a. Bounces off of the RBC’s b. Tells us the velocity of the blood c. When the blood vessel or valve becomes narrow, there’s increased speed, so there’s a bigger Doppler signal
  • 2. d. (P1 – P2) = 4[(V2)2 – (V1)2] i. V = velocity (1 = ventricle; 2 = aortic) ii. P = pressure (want to calculate pressure gradient across valve) iii. Especially used equation for aortic stenosis iv. Ventricular systolic pressure can be taken by blood pressure cuff and you can use that to calculate the aortic pressure. This is assuming you calculated the pressure gradient already using the equation above 13) Mitral Valve Stenosis caused by Rheumatic Fever 14) Thrill: Vibrations felt through the chest wallAortic Stenosis 1) The valve leaflets normally don’t have blood vessel flowing through them a. Get their nutrients from the blood stream 2) Most common cause (in US and people under 65) is a Bicuspid Aortic Valve 3) Rheumatic Aortic Valve (calcification around the valve) a. Caused by autoimmune reaction to Streptococcus 4) Degenerated Tricuspid Aortic Valve a. Most common cause in people over 70 b. Risk of atherosclerosis increases when you have a degenerated tricuspid aortic valve 5) Signs & Symptoms a. Fainting b. Heart Pain (angina) c. Heart Failure (WORSE PROGNOSIS) 6) Treat by replacing the valve a. Otherwise, mortality is very HIGH b. Two Types of Valves i. Tissue valve 1. Problem in younger people: Calcification can occur. 2. Better suited for older people 3. Blood thinner is NOT needed, but may not last as long ii. Mechanical valve 1. But the person must be on blood thinners the rest of their lives 2. Valves last longer 3. Better suited for younger peopleVentricular Failure 1) Poor Ventricular Ejection Fraction (during systole) a. Systolic Heart Failure b. Cannot contract 2) In Diastole, if the ventricle is very thick, or ischemic, or soaked in alcohol, the ventricle will by very stiff (cannot relax) a. Residual blood, and the blood goes back into the lungs b. Ventricle very stiff
  • 3. c. Called Diastolic Heart Failure 3) Both can be determined by an echocardiogram 4) Both can occur during aortic stenosis 5) Treat by relieving the obstructionAortic Regurgitation 1) Causes a. Bicuspid Aortic Valve i. Leaflets often don’t close completely b. Infected Valve i. Perforations in the valve due to bacterial infection c. Rheumatic Valve i. Stenotic AND regurgitative ii. Know the Jones Criteria for Rheumatic Fever d. Systemic Hypertension Valve e. Marfan’s Valve (connective tissue disorder) 2) Soft, myxomatous tissue and the aorta becomes weak (becomes pulled apart) 3) The murmur present in aortic regurgitation is during Diastole (decrescendo) a. Starts during the 2nd heart sound 4) The pulse pressure in aortic regurgitation is VERY large (PP = SP – DP) a. Because diastolic pressure DECREASES b. Bounding pulses will be seen 5) Can result from Endocarditis of the aortic valve due to IV drug useMitral Stenosis 1) LV is typically normal 2) The mitral valve becomes thick and stenotic 3) LA pressure becomes VERY high  high pressure in the lung circulation 4) The walls will then thicken in order to adapt to the increase in pressure a. Remember Laplaces Law b. Pulmonary Arteries become very THICK  coughing up blood as a result because the capillaries rupture c. Right side of the heart will dilate, thicken, and its pressure increases 5) Signs & Symptoms a. Systemic Emboli b. Right Heart Failure c. Coughing d. Fatigue e. Pulmonary Venous Congestion f. Acute Pulmonary Edema g. Hemoptysis h. Palpitations 6) Mitral valve makes a rumbling noise following the second sound a. Know difference between rumble in mitral stenosis and murmur in aortic regurgitation 7) Can treat with Beta-Blockers
  • 4. 8) Endocardiographic Score (4-16) a. Rigidity, Thickening, Calcium, Subvalvular Apparatus (1-4 each) b. 8 points or less  Good candidate for Balloon Valvuloplasty i. Same prognosis than if the valve were replaced ii. Inflate balloon across the mitral valve to correct the stenosis c. Score greater than 8  SurgeryMitral Regurgitation 1) MOST COMMON 2) Very complicated valve with many reasons for the cause 3) The pressure in the LA can go down because over a long period of time, the LA loses compliances with the gradual increase in volume. 4) Systolic murmur happens after the 1st heart sound a. Holosystolic Murmur (throughout all of systole) b. Cannot hear regular heart sound because it is masked by the murmur 5) Most Common Causes a. Mitral Prolapse b. Ischemic Heart Disease (Rheumatic Fever too) c. Endocarditis