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Cardiology > Valvular Heart Dz > Flashcards

Valvular Heart Dz Flashcards

1
Q

What is the majority of defects in valvular heart disease?

A

1) aortic valve

2) mitral valve

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2
Q

What is rheumatic heart disease?

A
  • repeated inflammation on the heart that causes the weakening of the chordeae tendinea that can results to valve damage (stenosis/regurgitation)
  • d/t strep
  • most common but now is decreased in developed countries
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3
Q

Who are at high risk of complication w/ valvular dz?

A

pregnant women b/c the changes in the body can harm the heart:

  • BV incr 40-50%
  • CO incr 30-40%
  • SV incr 25-30%
  • HR incr 15%
  • they should see a cardiologist and fix the valve issue before getting pregnant
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4
Q

What are the the types of valvular dz?

A
  • valvular stenosis
  • valvular regurgitation/insufficiency
  • valvular atresia (congenital pulm trunk dz)
  • valvular prolapse
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5
Q

What is valvular stenosis?

A

the valve is narrow cxing the heart to overwork (b/c the body is not getting perfused)
valve is having a hard time opening but able to SNAP shut

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6
Q

What is valvular regurgitation/insufficiency?

A

when the blood leaves the valve but comes back in b/c the valve isn’t CLOSING properly

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7
Q

What is valvular atresia?

A

when the valves don’t develop properly and is closed at birth

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8
Q

What is valvular prolapse?

A

when the chordeae tendinae is ‘broken’ cxing the valve leaflet to not close correctly (bulge) and leak into the ventricle

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9
Q

What are the two etiology of valvular heart dz?

A
  • congentinal

- acquired

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10
Q

What is heritable?

A
  • congenital
  • marfan syndrome
  • biscupsid aortic valve
  • hypertrophic cardiomyopathy
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11
Q

What is marfan syndrome?

A

CT disorder

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12
Q

What is inflammatory?

A
  • rheumatic arthritis
  • NBTE (aids)
  • kawasaki’s dz
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13
Q

What is endocardial disorders?

A
  • infective endocarditis

- NBTE (aids)

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14
Q

What is myocardial dysfunction?

A
  • ischemic heart disease (papillary m. ischemic dysfunction)
  • dilated cardiomyopathy (stretched valve annulus)
  • hypertrophic cardiomyopathy
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15
Q

What are disease and disorders of other organs?

A

-chronic renal failure

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16
Q

What is aging valvular dz?

A

-calcific aortic stenosis

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17
Q

Drug and physical agents of valvular dz?

A
  • ergotamine products
  • fen fen
  • radiation
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18
Q

What are causes of aortic stenosis?

A
  • bicuspid aortic valve (usually 3)

- calcific senile

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19
Q

What are sx of aortic stenosis?

A

CLASSIC: ANGINA, DYSPNEA, EXERTIONAL SYNCOPE

-pts may be asymptomatic for years but once symptomatic, mortality is high

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20
Q

PE of aortic stenosis?

A
  • systolic ejection murmur w/ radiation to neck
  • murmur peaks at mid systole
  • carotid upstroke is diminished and delayed
  • LVH
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21
Q

Management of aortic stenosis?

A
  • follow progression: CXR, ECG, echocardiogram
  • valve replacement BEFORE LV dysfunction
  • endocarditis prophylaxis
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22
Q

What is the cause of aortic regurgitation?

A
  • bicuspid aortic valve
  • infective endocarditis
  • floppy aortic valve
  • rheumatic fever
  • aortic dissection
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23
Q

What are the sx of aortic regurgitation?

A

aysmptomatic until SEVERE LV dysfunction

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24
Q

What are LV heart failure sx?

A
  • pulmonary edema
  • dyspnea
  • fatigue
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25
Q

PE of aortic regurgitation?

A
  • diastolic murmur along sternal border
  • diastolic rumble at apex
  • wide pulse pressure
  • water hammer pulse
  • quinke’s pulse
  • musset’s sign
  • LVH
26
Q

What are the different grades of murmurs?

A

Grade I, II, III, IV, V, VI

27
Q

What is Grade I?

A

VERY faint

28
Q

What is Grade II?

A

quite but hearable

29
Q

What is Grade III?

A

kinda of loud

30
Q

What is Grade IV?

A

same as grade III w/ thrill

31
Q

What is Grade V?

A

VERY loud w/ thirll

32
Q

What is Grade VI?

A

VERY loud (w/o stethoscope) w/ thrill (visible)

33
Q

What is management of Aortic Stenosis?

A
  • valve replacement BEFORE LV dysfunction

- endocarditis prophylaxis

34
Q

What is Mitral Stenosis?

A
  • valve is having a hard time opening
  • affects women
  • slow and progressive
35
Q

What are sx mitral stenosis?

A
  • dyspnea
  • orthopnea
  • paroxysmal nocturnal dyspnea
  • a fib
36
Q

PE of mitral stenosis?

A
  • apical rumbling diastolic murmur

- loud S1

37
Q

What are cx of mitral stenosis?

A

rheumatic heart dz

38
Q

What are the cx of mitral regurgitation?

A
  • ischemic heart dz
  • dilated cardiomyopathy
  • floppy mitral valve/mitral prolapse
  • mitral annular calcification (mitral valve is dying)
39
Q

Management aortic regurgitation?

A
  • blood cultures
  • valve replacement
  • after load reduction
  • endocarditis prophylaxis
40
Q

PE of mitral stenosis?

A
  • apical rumbling diastolic murmur w/ opening snap

- loud S1

41
Q

Cx of Tricuspid regurgitation?

A
  • dilated cardiomyopathy w/ RIGHT ventricle enlargement/dysfunciton
  • ischemic cadiomypoathy
  • floppy tricuspid valve/tricuspid valve prolapse
  • infective endocarditis
42
Q

What is tricuspid regurgitation?

A

valve is not closing so there is backflow into the atria

43
Q

Tricuspid regurgitation is seen in?

A
  • LV failure cxing overworking RV –> dilation of the venticle
  • inferior MI (heart dies slowly)
  • infective endocarditis (IV drug users)
44
Q

Sx of tricuspid regurgitation?

A

RV failure

45
Q

PE of tricuspid regurgitation?

A

JVD, hepatomegaly, pretibial edema (d/t Right HF)

46
Q

Management of tricuspid regurgitation

A

tx underlying cx

47
Q

What are the cx of COMBINED mitral regurgitation and tricuspid regurgitation?

A
  • dilated cardiomyopathy
  • ischemic cardiomyopathy
  • heritable CT disorder (marfan syndrome)
48
Q

What are the cx of COMBINED mitral stenosis and aortic regurgitation?

A

rheumatic heart dz

49
Q

What are tx of valvular heart dz?

A
  • abx prophyalxis (including dental)
  • valve replacement BEFORE cardiac starts to die off
  • Periodic reassessment
  • acute tx or chronic tx
  • balloon valvulotomy
  • valve repair
  • valve replacement
50
Q

PE of valvular dz?

A
  • Respiration
  • Valsalva maneuver
  • Exercise
51
Q

What is respiration PE?

A
  • Inspiration: right sided murmurs are LOUDER

- Expiration: left sided murmurs are LOUDER

52
Q

What is valsalva maneuver PE?

A
  • decrease preload
  • bearing down
  • MURMURS get LOUDER in Hypertrophic cadiomyopathy
53
Q

What is hand grip PE and squatting PE?

A

-increases preload and afterload

54
Q

What is hand grip PE good for?

A

distinguishing between systolic murmur: aortic stenosis murmur decrease and mitral regurgitation murmur increase

55
Q

Diastolic rumble, Loud S1, Normal S2?

A

Mitral stenosis

  • having trouble opening –> diastolic fill is abnormal –> able to close real well = loud S1
  • aortic and pulmonary valves are closing well –> normal S2
56
Q

Blowing diastolic, Soft S1, normal S2, wide pulse pressure, systolic HTN?

A

Aortic regurgitation

  • less blood in the ventricle so SOFT S1
  • S2 is normal b/c the aortic and pulm is still able to close, they just can’t STAY closed
57
Q

Holosystolic, soft S1, normal/split S2, +/- S3?

A

Mitral regurgitation

  • less blood in ventricle so SOFT S1
  • S2 is normal b/c aortic and pulm is FINE
  • S3 maybe b/c blood splashes back d/t mitral
58
Q

20 yo, female?

A

mitral valve prolpase

59
Q

Sx for mitral valve prolapse?

A

-vague: chest pain, dypsnea, anxiety, palpitaiton

60
Q

PE for mitral valve prolapse?

A

-CLICK by LATE systolic murmur

61
Q

Management for mitral valve prolapse?

A
  • reassurance
  • beta blockers
  • cessation of ETOH, smoking, caffeine
  • NO abx

Cardiology (10 decks)

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