cardiovascular: valvular, cardiomyopathy, aneurysm and cardiac surgery click here- click here- heart...

Download Cardiovascular: Valvular, Cardiomyopathy, Aneurysm and Cardiac Surgery Click here- Click here- Heart valves at work! Review of Heart Valve sounds (etc)Heart

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  • Slide 1
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  • Cardiovascular: Valvular, Cardiomyopathy, Aneurysm and Cardiac Surgery Click here- Click here- Heart valves at work! Review of Heart Valve sounds (etc)Heart Valve sounds A&P Heart Valves- A&P Heart Valves- Click here
  • Slide 3
  • Valvular Heart Disease (Access to Helpful Interactive Sites) HeartPoint: HeartPoint GalleryHeartPoint: HeartPoint Gallery (many resources here!) Valvular DiseaseValvular Disease (great introductory video!) Valvular Heart DiseaseValvular Heart Disease: Heart Valves at Work Heart Valves at Work *UTube FlashcardsFlashcards (Test your knowledge!)
  • Slide 4
  • Pathophysiology Stenosis- narrowed valve, sloews forward blood flow increases afterload, dec. CO Regurgitation (insufficiency) increases preload heart pumps same blood again blood volume and pressures reduced in front of affected valve; increased behind affected valve results in heart failure
  • Slide 5
  • Caused by Rheumatic Heart Disease Acute conditions (infective endocarditis) Acute MI Congenital Heart Defects A ging, etc * All valvular diseases have characteristic murmurs (click to hear!) murmurs Damaged valve disrupts blood flow=turbulence & sound !
  • Slide 6
  • Mitral Valve Stenosis
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  • Etiology/Pathophysiology: Most cases due to rheumatic fever Contractures and adhesions of valve leaflets- fish mouth Dec. flow into LV>LA hypertrophy>inc. pulmonary pressures> pulmonary hypertension Dec. CO-lead to Rt. Heart failure
  • Slide 8
  • Mitral Valve Stenosis Clinical Manifestations: Early symptom-dyspnea on exertion (DOE) Cough, hemopysis, etc. Late- Signs Rt. Heart failure (dec. CO) Atrial fib. (enlarged atrium) Murmur- loud S1, low pitched diastolic murmurdiastolic murmur Hoarseness, seizures, stroke (emboli risk) Management Mitral Valve Stenosis
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  • Treatment for Mitral Stenosis (non-surgical) Balloon Valvuloplasty
  • Slide 11
  • Heart Surgery Innovations - Heart Surgery Innovations - (27 min) 11:22 valves 20 beating heart 20 aortic valve Valvular Surgery Access site to see and hear the newest information !
  • Slide 12
  • Mitral Regurgitation Etiology/Pathophysiology/Manfesations Valve does not close fully Regurgitation of blood into LA during systole Dev. LA dilation and hypertrophy > pulmonary congestion > RV failure LV dilation and hypertropy-accommodate increased preload (from regurgitation) Dec. CO Acute and chronic MR Acute-poorly tolerated-fulminating pulmonary edema Chronic- Lt. ventricular failure, S3 sound, pansystolic murmurS3 soundpansystolic murmur
  • Slide 13
  • Mitral Regurgitation
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  • Treatment of Mitral Valve Regurgitation Innovations (Percutaneous) MitraClip Repair MitraClip 3D AnimationMitraClip 3D Animation View video -procedure to correct mitral valve regurgitation! Non-invasive
  • Slide 15
  • Mitral Valve Prolapse Etiology/Pathophysiology/Manifestations Mitral valve cusps billow into atrium during ventricular systole Most common form valvular disease, associated with Marfans syndrome (Michael Phelpsdoes he have it?)Marfans syndrome (Michael Phelpsdoes he have it?) Usually benign-complications- MR, infective endocarditis (IE), SCD Usually asymptomatic- mid systolic click, and last holosystolic murmur Chest pain (atypical)-does not respond to antianginals Dysrhythmia risk ?Need for prophylactic antibiotics (IE risk)
  • Slide 16
  • Midsytolic click & late systolic murmurMidsytolic click & late systolic murmur (Click here to hear characteristic sounds of MVP) UTube- Mitral Valve Prolapse (brief lecture- informative)Mitral Valve Prolapse UTube- Mitral Valve Prolapse (current research-re prophylactic antibiotics)Mitral Valve Prolapse Endocarditis Endocarditis and MVP Mitral Valve Prolapse
  • Slide 17
  • Aortic Stenosis Etiology/Pathophysiology/Manifestations Congenital or due to rheumatic fever or aging May be asymptomatic for years Obstruction LV to aorta > inc afterload > L. ventricular hypertrophy > dec. CO Eventual pulmonary hypertension, myocardial ischemia and later right heart failure *DOE, angina, syncopy (SAD)- Classic Symptoms *Poor prognosis-if symptoms and obstruction not relieved *Nitroglycerin contraindicated Normal to soft S1; absent S2; harsh systolic crescendo-decrescendo murmur, loud S4 (click for sound)harsh systolic crescendo-decrescendo murmur, loud S4
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  • Classic Symptoms S yncope A ngina D yspnea
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  • Aortic Stenosis Aortic Valve animation Aortic valve *N ormal aortic valve has 3 leaflets-not 2 (bicuspid) (Arnold Schwarzenegger- lead to aortic stenosis and require valve replacement)Arnold Schwarzenegger-
  • Slide 21
  • Aortic Stenosis Access these sites to learn about procedures to treat/replace damaged aortic valves Aortic Stenosis Minimally Invasive Aortic Heart Valve Replacement
  • Slide 22
  • Percutaneous Aortic Valve Replacement Percutaneous aortic valve replacement (AVR)- new treatment being investigated for select patients with severe symptomatic aortic stenosis Research at Cleveland Clinic is evaluating a percutaneous technique for implanting a prosthetic valve inside diseased calcific aortic valve. The procedure is performed in catheterization laba catheter is placed through femoral artery (in the groin) and guided into chambers of the heart. A compressed tissue heart valve is placed on the balloon-mounted catheter and is positioned directly over the diseased aortic valve. Once in position, the balloon is inflated to secure the valve in place. *For patients with severe peripheral vascular disease, surgeons and cardiologists are testing an alternative approach through the left ventricular apex of the heart. Percutaneous AVR a) Balloon valvuloplasty; b) Balloon catheter with valve in the diseased valve; c) Balloon inflation to secure the valve; d) Valve in place
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  • Heart Valve replacement (Aortic valve, patient resource, mechanical, biological)
  • Slide 25
  • Aortic Regurgitation Etiology/Pathophysiology/Manifestations Congenital valvular defect Acute causes- trauma, aortic dissection (life threatening) Chronic- rheumatic heart disease, bicuspid valvular disease Retrograde blood flow (inc. preload) from ascending aorta > L ventricle dilation, hypertrophy Eventual dec. myocardial contractility > dec. CO Develop pulmonary hypertension, Rt. Ventricular failure (*inc. L. ventricular end diastolic pressure=LVED) If severe- characteristic *water hammer pulse (Corrigans pulse), wide pulse pressure, and Mussets sign Soft or absent S1, presence of S3, S4; soft, high pitched diastolic murmur, systolic ejection click; Austin Flint murmurAustin Flint
  • Slide 26
  • Water Hammer pulse Pulse- water hammer -jerky pulse that is full, then collapses due to aortic insufficiency/regurgitation (blood ejected into aorta regurgitates back through aortic valve into L. ventricle ). AKA-called a Corrigan pulse or a cannonball, collapsing, pistol-shot, or trip- hammer pulse. (Click to view video)(Click to view video)
  • Slide 27
  • Aortic Regurgitation Echocardiography
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  • Tricuspid and Pulmonic Valve Disorders Etiology/Pathophysiology/Manifestations Tricuspid stenosis (more common than regurgitation) Result in R. atrial enlargement > inc. systemic venous pressure > atrial fibrillation, peripheral edema, ascites, etc. Found mostly in rheumatic heart disease, IV drug users Pulmonic stenosis Result in R. ventricular hypertension and hypertrophy Fatigue, loud midsystolic murmur Uncommon valve disorders
  • Slide 29
  • Collaborative Care Keys Prevent recurrent rheumatic fever, infective endocarditis Identify by characteristic murmur Aware of effect of stenosis, regurgitation on cardiac hemodynamics (preload, afterload) Appropriate prophylactic therapy (antibiotics before invasive procedures-at risk patients) Manage heart failure if present Manage complications-ie dysrhythmias, risk for emboli (a- fib) etc. *Treatment depends upon valve involved Adequate follow-up care.
  • Slide 30
  • Medications/Diet Manage complications (ie heart failure, dysrhythmias) ACE, Dig Diuretics Vasodilators Beta blockers Anticoagulants *a-fib common *Prophylactic antibiotics Treatment specific for disease (ie no *nitroglycerin if aortic stenosis) Diet Low sodium-if risk for heart failure
  • Slide 31
  • Diagnostic Tests EchoEcho- assess valve motion and chamber size TEE CXR EKG Cardiac cath- Cardiac cath- measure pressure gradients (hemodynamic function)
  • Slide 32
  • Transesophageal echocardiogram
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  • Surgical Intervention *Not all types valve disease require surgical intervention Valvuloplasty-general term valve repair, invasive/non-invasive methods Percutaneous balloon valvuloplasty (non-invasive) Surgery Open commissurotomy- open stenotic valves Annuloplasty- repair of valves outer ring-used for stenosis, regurgitant valve Valve Replacement Mechanical-need anticoagulant Biologic-only last about 15 years Ross Procedure-transfer pulmonic valve for aortic
  • Slide 34
  • Valve Replacement Surgery Patient

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