Block 2; Week 2 Flashcards
(21 cards)
What does it indicate when the jugular venous pressure is distended?
Backup of fluid.
Usu heart failure
What do bilateral soft carotid bruits usu indicate?
Athersclerotic disease
What do pulmonary crackles usu indicate?
Cardiac asthma
What is one thing that can cause aortic stenosis?
Calcification of the aortic valve over time.
What does PMI displaced laterally indicate?
Hypertrophy of the ventricle.
Aortic stenosis causes left ventricular hypertrophy. This displaces the PMI.
What is a congential explanation for aortic stenosis?
They were born w/ a bicuspid valve & the two started fusing together.
What are 5 important symptoms of aortic stenosis?
Ischemia-->angina congestive heart failure exertional syncope dyspnea upon exertion crescendo-decrescendo murmur radiating to the carotids.
What aortic valve diameter qualifies as stenotic?
less than 1 cm.
Where can you best hear the crescendo-decrescendo murmur indicative of aortic stenosis?
Right Sternal Border
2nd intercostal space
What are some important signs of CHF?
S3 gallop
peripheral edema in the legs
pulmonary edema
jugular vein distention in the upright position
What does the S2 sound mean?
It is a normal sound. It is the closing of the semilunar valves. The aortic valve closes before the pulmonic valve b/c of pressure differences.
What does the S3 sound mean?
You shouldn’t hear this sound.
It is the sound of ventricular filling.
It is associated with heart failure.
What does the S4 sound mean?
This occurs during diastole.
It is the sound of the atrial kick against a hypertrophied ventricle.
If you suspect aortic stenosis what are the 2 most important tests & why?
ECG–check for ischemia & chamber enlargement
Echo–look at the heart valves, esp the aortic valve.
What are 4 important physical exam maneuvers to identify aortic stenosis?
Squatting
Abrupt Standing
Valsalva maneuver
Hand Grip Test
What is ejection fraction & what is a normal LVEF?
Ejection Fraction–>percentage of blood that is pumped out of the ventricle with each beat.
LVEF NORMAL: 55-70%
An LVEF that is much less than this indicates heart failure.
Increased troponins of which type indicate heart damage?
Increased Troponin T & I.
How can heart failure lead to increased levels of BNP in the blood?
So…the heart just can’t eject very much blood b/c it is weak…LVEF will be low.
This means that a lot of blood is just staying in the ventricle & causing overstretching.
BNP is released w/ overstretching.
Why is a catheterization useful in aortic stenosis diagnosis?
This is aka angiogram.
It is the most diagnostically conclusive.
Even if the Echo assured you that there is aortic stenosis, you can do a cath to see if there are any other heart issues that should be repaired at the same time during surgery.
What are some of the treatment options in terms of valve replacement for aortic stenosis?
Mechanical valve–>but you have to always take anti-coagulants…but they last forever.
Bovine or porcine valve. lasts 10-15 years.
Percutaneous Valve.
If the patient is old & has aortic stenosis, what are his chances if he doesn’t get a valve replacement & only relies on medical treatment?
Not good.
