What can cause a disease affecting the heart?
Dental procedures
IV drug use
Congenital deformities
Infection - endocarditis
Disease - rheumatic fever, coronary thrombosis
What is a stenosis
Impudence of forward flow due to an incomplete or narrowed opening of the valves
What is insufficiency/regurgitation
An incomplete closing of the valve leading to regurgitation of blood (backflow)
What are murmurs
Turbulence of flow that can be heard via auscultation of the heart valves, turbulence caused by stenosis or regurgitation
What would happen if there was a MI (or cell death) in the papillary muscles or chordae tendineae
Leaflets would flop backwards causing regurgitation
How is the severity of valve dysfunction scored by what criterias?
By valve diameter
Degree of regurgitation
Calculation of blood flow across the valve
How is the severity of the valve dysfunction determined/diagnosed?
Echo and cardiac catheterization
If severity of the valves dysfunction progress, what structural changes to the heart are at risk?
Ventricular hypertrophy
Chamber dilation
Progressive valve involvement (high pressure system on the lungs)
What is the pathophysiology of aortic stenosis
- Narrowing of the valve
- Outflow restriction + INCREASE after load
- Left ventricular systolic pressure + LV volume overload
- LV hypertrophy (increase systolic pressure)
- Decreased at STROKE VOLUME decreased compliance (diastolic dysfunction)
- Systolic function maintained for a while
- Systolic + diastolic dysfunction
What can cause mitral regurgitation
Sudden rupture of the papillary muscles
Endocarditis
Rheumatic fever *
UNTREATED STREP INFECTION*
What is the pathophysiology of chronic mitral regurgitation
- Incomplete closure of valve
- Increased blood volume in left atrium
- If so, blood can go back to the pulmonary veins
- LA dilates over time to accommodate increased volume
- hoe is stretched - Reduced atrial pressure
- Reduce atrial kick, reduced EDV, reduce cardiac output
What causes mitral stenosis
Progressive calcium deposits
Congenital defect
Rheumatic fever
What is aortic insufficiency caused by
Weakened valve closure
Stiffened leaflets
What are some clinical manifestations of valve dysfunctions
Often asymptomatic for many years
EASY FATIGUE (most common, non-specific)
SOB
Dyspnea
Exhaustion
Peripheral swelling
What are some PT clinical assessments for valve dysfunction
Auscultation ***
Exercise tolerance + VS response
Orthostatic hypotension
ECHO to confirm!
What is S1 (heart sounds)
The lub of lub-dub
Closure of the mitral and tricuspid valves at the onset of the ventricular SYSTOLE
What is S2 (heart sounds)
The dub of the lub-dub
Closure of the aortic and pulmonary valves at the START of ventricular DIASTOLE
How are heart murmurs categorized ?
Caused by forward flow through CONSTRICTED or DEFORMED valve, or flow into dilated vessels or chamber
Caused by backflow through a valve
What are the 4 properties of an abnormal heart sound
- Location of where the sound is the LOUDEST***
- Timing: systolic vs diastolic ***
- Intensity: graded on 1-6 scale
- Quality and “shape” of the sound
What are some systolic murmurs
Aortic stenosis
Mitral insufficiency
Mitral valve prolapse
What are some diastolic murmurs
Aortic insufficiency (regurgitation)
Mitral stenosis
If there is an AORTIC valve dysfunction, what are the systolic and diastolic murmur
Systolic : aortic stenosis
Diastolic : aortic regurgitation
If there is an PULMONIC valve dysfunction, what are the systolic and diastolic murmur
Systolic: pulmonic stenosis
Diastolic: pulmonic regurgitation
If there is an MITRAL valve dysfunction, what are the systolic and diastolic murmur
Systolic: mitral regurgitation
Diastolic: mitral stenosis
