02.17 Valvular Heart Disease Flashcards Preview

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Flashcards in 02.17 Valvular Heart Disease Deck (70):
1

The abnormal narrowing of the mitral valve causes the dilation of the _____, and this can lead to ____

Left atrium
Atrial fibillation

2

2/3 Female
Hx: exertional dyspnea, paroxysmal norturnal dyspnea, orthopnea, hemoptysis

Mitral stenosis

3

Opening snap
Loud S1
Diastolic rumble at the apex

MS

4

ECG and CXR: left atrial enlargement with normal left ventricular size
2D echo

MS

5

Most common etiology of MS

Rheumatic heart disease

6

Congenital MS

Lutembachers syndrome (+ ASD)

7

Etiology of MS among elderlies

Mitral annular calcification

8

Fibrous thickening of alveolar and pulmonary capillary walls

Pulmonary hypertension

9

Natural hx of MS

Pulmonary HPN
Thrombi and emboli
Pulmonary infections, infective endocarditis

10

D/Dx of MS

Atrial septal defect
Left atrial myxom
Mitral regurgitation
Aortic regurgictation

11

RVE and accentuated pulmonary markings
Widely split S2 fixed vs opening snap
No LAE

ASD

12

Obstructing left atrium emptying
Tumor-plop
No diastolikc murmur

Left atrial myxoma

13

Systolic murmur
Left ventricular hypertrophy

Mitral regurgitation

14

Apical mid-diastolic murmur

Aortic regurgitation

15

Murmur of AR
Becomes louder on handgrip and decreases with amyl nitrate

Austin Flint murmur

16

Prophylaxix of B-hemolytic Streptococcal infections to prevent Rheumatic fever and infective endocarditis

Penicillin

17

To lengthen diastolic LV filling

Heart rate controlling drugs

18

Treatment regimen for MS

Sodium restriction, oral diuretics
Heart rate controlling drugs
Oral anticoagulation
Penicillin

19

For severe cases of MS
Indicated in symtomatic patients with isolated MS
Ideal for mobile thin leaflets with no or little calcium without extensive subvavular thickening and with no or mild mr

MItral valvotomy

20

Used to assess if the patient is a candidate for valvotomy (score is at 8)

Wilkins score

21

For MS with significant MR
Distorted valves from previous transcatheter or operative manipulative

Mitral valve replacement

22

Frequent in males
Easy fatigue then exertional dyspnea
Characteristic holosystolic murmur at the apex with radiation to the axilla

MR

23

Left atrial enlargement
AFib
LVH
ECG, 2D

MR

24

Most accurate non invasive imaging technique

2D echo

25

Common etiologies of MR

Mitral valve leaflet abnormality
Mitral annulus dilatation of any cause
Ruptured chordae tendinae
Papillary muscle disorder

26

Medical tx for MR

Restrict physical activities
Reduce sodium intake and enhance sodium exertion
Increase forward CO
Anticoagulants and leg binders
Endocarditis prophylaxis

27

Indication for sugery among MR patients

When LV dysfunction is progressive (<60) and/or LV end-systolic diameter on echo is >45 mm

28

Surgical tx for markedly shrunken, deformed, calcified leaflets

MV replacement

29

Lessens problem on long-term anticoagulants and thromboembolism
Indicated for patients with ruptured chordae, annular dilatation and IE
Not suitable for MR due to myxomatous degeneration and patients with calcified annulus

MR repair with annuloplasty

30

Barlow's syndrome, floppy-valve syndrome, systolic click-murmur syndrome, billowing mitral leaflet syndrome
Excessive or redundant mitral leaflet tissue
Ventricular arrhythmias

Mitral valve prolapse

31

Females
Most common cause of isolated severe MR requiring surgical treatment in North America
Arrhythmias
Chest pain substernal, prolonged, unrelated to exertion

MVP

32

In echo, systolic displacement of MVL and quantifies mitral regurgitation and LV function

MVP

33

Medical treatment for mvp

IE prophylaxis
Beta-blockers
Antiplatelet for patients with transient ischemic attack
Anticoagulation if recurrent TIAs

34

Surgical treatment for MVP

For severe asymptomatic MR, MV repair or rarely replacement is indicated

35

Most common cause of AS in adults

Age-related degenerative calcific AS

36

Most common etiology of AS

Valvular (RHD, degenerative calcification, bicuspid AV stenosis)

37

Subvalvular etiology of AS

Hypertrophic obstructive CM

38

Cardinal manifestations of acquired AS

Syncope
Heart Failure
Exertional dyspnea
Angina

39

LV diastolic dysfunction, with an excessive rise in end-diastolic pressure leading to ____

Pulmonary congestion

40

In patients without CAD, angina results from the combination of

Increased O2 needs of hypertrophied myocardium
Reduction of O2 delivery secondary to the excessvie comression of coronary vessels

41

Syncope is most commonly caused by the ____

Reduced cerebral perfusion that occurs during exertion

42

Key features of the PE in patients with AS

Palpation of the carotid upstroke
Evaluation of systolic murmur (harsh late peaking crescendo-decresdo)
Assessment of splitting of the second heart sound
Examinations for signs of heart failure

43

Findings in carotid upstroke

Slow rising, late-peaking, low-amplitude carotid pulse, the parvus and tardus carotid impulse

44

Ejection systolic murmur of AS

Late-peaking
Heard best at the base of the heart
Radiation to the carotids

45

Murmur that comes from the vibration of the valve and subvalvular structures which can be heard in the LV cavity

Gallavardin phenomenon

46

Key finding in AS

LV hypertrophy

47

Medical treatment for AS

Avoid strenuous physcial activity
Sodium restriction
Cautious admin of diuretics and digitalis in CHF
Nitroglycerins to relieve angina
Statins

48

Severe AS

<0.5 cm2/m2

49

Indication for surgery in AS

Severe AS
Symptomatic with LV dysfunction
Expanding poststenotic aortic root
Those who undergo CABG even if asymptomatic

50

Preferred in children and young adults with congenital noncalcific AS
High re-stenosis rate in calcific AS
Bridge to operation

Percutaenous Balloon Aortic Valvuloplasty

51

Easy fatigue then exertional dyspnea
Wide pulse pressure with bounding pulses
Diastolic decrescendo murmur at the base of the heart
Midsystolic ejection murmur at the base of the heart
Austin Flint murmur

AR

52

Soft, low pitched rumbling mid-diastolic bruit at the apex

Austin Flint murmur

53

Primary valve diseases that can cause AR

Rheumatic
Infective endocarditis
Trauma
Bicuspid valve

54

Primary aortic root diseases that can cause AR

Degenerataive heart disease
Syphilis
Marfan's syndrome
Ankylosing spondyitis
Aortic aneurysm with dissection
Systemic hypertension
Giant cell arteritis

55

Pulses with abrupt distension and quick collapse of peripheral pulse

Corrigan's pulse (Water hammer pulse)

56

Head bobbing

De Mussets sign

57

Pistol shot sound on the femoral artery

Traube's sign

58

Systolic murmur heard over the femoral artery when compressed proximally

Duroziez's sign

59

Systolic pulsations of the uvula

Muller's sign

60

Capillary pulsation
Blanching and flashing of the nail bed on light compression

Quincke's sign

61

Popliteal cuff BP> bracial cuff SBP by 60mmHg

Hill's sign

62

Peripheral signs of chronic AR

Corrigan's pulse
De Musset's sign
Traube's sign
Duroziez's sign
Muller's sign
Quincke's sign
Hill's sign

63

Lab exam for AR

LV hypertrophy
2D echo + myocaridal contractility and function
Cardiac catherization and angiography

64

Medical tx of AR

Same as HF
Salt restriction
Diuretics
Vasodilators
Penicillin

65

Definitive tx for AR

Surgery

66

Occurs when the septal leaflet is lower than the lateral leaflet which causes severe tricuspid regurgitation

Ebstein anomaly

67

Medical tx of TS

Intensive salt restriction
Diuretics

68

For surgery among px with TS, diastolic pressure gradient _____, tricuspid orifice ____

>4mmHg
<1.5 to 2.0 cm

69

Most common abnormality of the PV secondary to dilatation of PV ring as a consequence of PHPN

Pulmonic regurgitation

70

High pitched decrescendo, diastolic blowing murmur along the left sternal border

Graham Steell murmur