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Chapter 18
Pathophysiology: Valvular Disorders
Term | Definition |
---|---|
valve disorders increase the risk for (2) | clot formation and infection |
normal heart sounds heard during systole and diastole are called | lub and dub |
lub (first sound) | heard at beginning of systole; closure of tricuspid and mitral valves |
dub (second sound) | heard at the beginning of diastole; closure of pulmonary and aortic valves |
stenosis | narrowing of the valve; increased resistance to flow and blood backs up (stiffened) |
regurgitation | loose valve; leakage of blood backwards because valve will not shut properly |
two most common valve disorders | mitral and aortic stenosis because fibrotic tissue thickens with age |
the sounds heard during turbulent blood flow through the heart or great vessels | murmurs |
physiologic murmurs | innocent/functional, heard during states of high blood flow to the heart, asymptomatic (examples are anxiety, fever, pregnancy) |
pathologic murmurs | caused by the valve deformity/dysfunction, medical intervention is needed |
complications of valvular disorders | dysrhythmias, thrombus formation, stroke/MI, heart failure |
dysrhythmias (valvular disorder leads to) | disruption of conduction with overstretching heart chambers |
thrombus formation (valvular disorder) | turbulent/static blood flow --increased clot risk |
stroke/ MI (valvular disorder) | elevated thrombus formation follows |
heart failure (valvular disorder) | hypertrophies- ischemia and infarction |
common causes of valvular disorders | congenital (marfan's), acquired (astheroscelerosis, hypotension, rheumatic disease), or infective endocarditis (IV drug use) |
major causes of rheumatic heart disease (RHD) | acute streptococcal infection leading to rheumatic fever can cause RHD even years later |
gold standard of valvular disorders | echocardiography |
TTE: transthoracic echocardiography | noninvasive, transducer placed on chest wall (Most common method) |
TEE: transesophageal echocardiography | transducer inserted into the esophagus (more sensitive, sedated) |
mitral stenosis caused by | rheumatic fever or mitral annular calcification |
mitral stenosis valve problem and fluid back up | narrow mitral valve hinders blood flow into LV; backs up into left atrium causing enlargement and backs up into pulmonary veins |
mitral stenosis S+S | pulmonary edema |
mitral regurgitation caused by | commonly after myocardial infarction |
mitral regurgitation valve problem and fluid back up | loose mitral valve allows for back flow of blood during systole; back into left atrium instead of left ventricle fluid backs up into lungs because increased resistance |
mitral regurgitation S+S | back: dyspnea, paroxysmal nocturnal dyspnea, orthopnea forward: confusion, cool extremities, low urine, weak |
aortic stenosis caused by | aortic sclerosis, RHD, congenital valve defect |
aortic stenosis valve problem and fluid back up | LV cannot eject blood due to increased resistance; poor closure of aortic valve during diastole; blood backs up into LA and pulmonary veins |
aortic stenosis S+S | pulmonary edema |
pulmonic regurgitation caused by | increased workload on the right ventricle |
pulmonic regurgitation valve problem and fluid back up | failure of the valve to close completely; blood backs up into the RA causing right sided heart failure |
pulmonic stenosis valve problem and fluid back up | narrowing of the pulmonic valve meaning that less blood is being oxygenated by the lungs and will flow back into the right side |
tricupsid stenosis caused by | infective endocarditis (IV drug use) |
tricupsid stenosis valve problems and back up | blood cannot enter RV as expected due to narrow tricuspid valve and it will back up into the RA atrium causing enlargement and many backwards effects |