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Medicine > CVS Medicine Pulse➡️murmur > Flashcards

CVS Medicine Pulse➡️murmur Flashcards

1
Q

Components of mitral valve

A 
5 components
2 leaflet ant and post 
2 commissure 
1 annulus
Chordae tendinae 25 primary
2 papillary muscle
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2
Q

Important function of annulus in mitral valve

A

Provides anchor for leaflet
Annular contraction for leaflet approximation
K a co aptation zone

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3
Q

What happens when annular dilation occurs in mitral valve

A

Zone of co aptation not formed

Mitral regurgitation

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4
Q

Most common site of prolapse of mitral valve

A

Posterior leaflet

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5
Q

Attachment of primary secondary tertiary chordae to leaflet

A

Primary to tip
Secondary to body
Tertiary to base

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6
Q

What is the cause of seconds MR in inferior wall MI

A

Posteromedial papillary muscle has single blood supply from RCA which also supplies inferior wall

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7
Q

Causes of MS

Most common

A 
Mc rheumatic 
Other
Atrial myxoma left 
Infective endocarditis 
Congenital parachute mitral valve
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8
Q

Fish mouth appearance is seen in

It is due to

A

Seen in MS
due to valve thickening& calcification
chordae and commisure fusion and shortening

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9
Q

Mc site of thrombosis in MS

A

LA appendage

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10
Q

Classification criteria for severe MS

A

50/1
More than 50 mm Hg systolic pulmonary artery pressure
Less than 1 cm2 valve surface area

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11
Q

First symptom of MS

A

Dyspnea on exertion

HR increase, diastolic time increase, LA pressure increase, dyspnea

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12
Q

Why is there RV hypertrophy and pulmonary artery hypertension in MS

A

LV filling pressure not adequate
LA pressure increase to compensate
Increase pulmonary artery pressure
RVH and Pulmonary HTN

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13
Q

Complications of MS

A 
Atrial fibrillation 
Recurrent bronchitis
Hemoptysis 
Hoarsness of voice
Cough
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14
Q

Ortner syndrome

A

LA enlargement leads to Left RLN compression causing hoarsness of voice

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15
Q

Mitral facies

A

In severe MS,

PINK PURPLISH FACE due to decreased cardiac output

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16
Q

Pulse
BP
JVP
In MS

A

Pulse normal except in atrial fib irregular
BP normal in severe MS narrow pulse pressure
JVP
a wave - pulmonary HTN
v wave Tricuspid regurgitation

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17
Q

Inspection and palpation finding of MS

A

Parasternal heave

Palpable P2 tapping apex

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18
Q

Heart sounds in MS

A

S1 loud
S3 loud P2
S3 and S4 not heard in MS
Added sounds - Opening snap

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19
Q

How to assess severity of MS

A

Duration of murmur

Shorter S2 -OS Interval

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20
Q

Characterstic murmur in MS

A

Low pitched rough rumbling
Mid diastolic murmur
Heard at apex no radiation
Best heard in expiration

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21
Q

Mitral valve replacement if if echo shows?

A

Transthoracic echo show
Calcification
Associated MR
Clot

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22
Q

Xray in MS

A

Enlarged LA
Double density sign due to overlapping of LA RA
Straightening of left heart border
Left main bronchus lifted up- splaying of carena

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23
Q

Graham steel murmur is seen in

A

MS rarely in pulmonary regurgitation
High pitched blowing
Diastolic decrescendo
Loud palpable P2

24
Q

Organic MR is known as

A

Primary MR

Leaflet or chordae relates problem

24
Q

Organic MR is known as

A

Primary MR

Leaflet or chordae relates problem

25
Q

Secondary MR occurs due to

A

Chordae and leaflet are normal

Annular dilation mc occurs in heart failure

26
Q

Causes of primary MR

A

Mitral valve prolapse
Rheumatic
SLE, RA

27
Q

Pathophysiology of MR

A 
LV to LA retrograde flow 
LA dilates to maintain pressure
LV compliance increase - Extensive LV dilation
LV filling pressure doesn't increase
EDV increase SV increase
28
Q

What is earliest symptom of MR

A

Palpitations

29
Q

Severe MR leads to pulmonary HTN due to

A

Left atrial pressure increase due to decrease LV contractility leading to pulmonary artery hypertension

30
Q

Pulse
Bp
JVP
IN SEVERE MR

A

Hypokinetic pulse
Narrow pulse pressure
a wave

31
Q

Inspection finding of MR

A

Parasternal heave in severe MR

32
Q

Heart sounds of MR

A

S1 soft
S2 normal (in severe MR - widening)
S3 heard in moderate to severe MR

33
Q

Murmur of MR

It is best heard in

A

Pan systolic murmur
High pitched, soft blowing

Left lateral decubitus with diaphragm

34
Q

What is the sign for bad prognosis in MR

A

Ejection fraction less than 60

LV end sys diameter more than 40 mm

35
Q

Cause of MVP

A

From najeeb

36
Q

Absolute indication for surgery in MVP

A

MVP WITH MR

37
Q

Murmur in MVP

A

High pitched musical murmur

Systolic murmur crescendo decrescendo

38
Q

Sound in asymptomatic MVP

A

Non ejection click

39
Q

Cause of acute MR

A

Papillary muscle rupture( inferior wall MI)
Chordal rupture( inf endocarditis)
Trauma

40
Q

Acute MR C/F

A

Acute pulmonary edema or
Cardiogenic shock
Murmur- short Early systolic decrescendo

41
Q

Pericardial space contains?

A

50 ml serous fluid which is ultrafiltrate of plasma

42
Q

Pulmonary vein is intra_____, It is not intra_____

A

It is intrathoracic, not intrapericardial

43
Q

Pulmonary vein is intra_____, It is not intra_____

A

It is intrathoracic, not intrapericardial

44
Q

What happens to CO during inspiration and expiration

A

Inspiration
VR increase, RV pressure increase septum bulge towards left side, LV volume decrease, CO decrease
Vice versa in expiration

45
Q

C/F of acute Pericarditis

A

Sharp, stabbing, pleuritic chest pain
Relieved by sitting up and leaning forward
Pericardial rub present
Global ST elevation diffuse T wave inversion

46
Q

Most common cause of acute pericarditis

A

Post viral

47
Q

Other cause of acute pericarditis

A 
Hiv tb coxsackie 
Post mi 
Uremia
Hydralazine 
IgG4, SLE, Sjogrens
48
Q

Dresslers syndrome is seen in

A

Late pericarditis -1wk to few months after MI
Autoimmune
Fever ,pleuritic pain+ polyserositis
RUB PRESENT

49
Q

Treatment of acute pericarditis

A

Nsaids only
Ibuprofen
Indomethacin
Aspirin

50
Q

Causes of chronic constrictive pericarditis

A

Tb mc

Repeat episode of acute pericarditis

51
Q

What is CCP

A

Obliteration of pericardial cavity by formation of granulation tissue, which contracts to form scar that calcifies

52
Q

Other name for chronic constrictive pericarditis

A

Thickened calcific inelastic pericardium

53
Q

Why is kussmaul sign seen in chronic constrictive pericarditis

A

Due to fall in intrathoracic pressure on inspiration
Chamber pressure fails to fall due to constrictive pericarditis leading to decrease venous return thus,
Jvp doesn’t fall on inspiration

54
Q

Septal bounce is seen in

It is due to

A

Exaggerated ventricular interdependence seen in 1/3rd pt

Causes septal bounce in CCP

Medicine (11 decks)

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