Cardiology Flashcards
(50 cards)
Mitral valve prolapse / floppy valve sydrome / barlow syndrome
Balooning of mitral valve leaflets - pushed higher. Than its normal , extra stress on chorda tendinae & pappilary muscles - resulting in subendocardial ischemia - hypoxia
Causes of mitral valve prolapse
Myxomatous degeneration of mitral valve tissue
Type 3 collagen defect
Broken myofibrils
. End result is valve bulges up causing primary mitral regurgitation
- connective tissue disorder A) marfans syndrome . Chr 15 defect . Fibrilin 1 . Arachanodactyly . Mortality d/ t aortic dessection B) ehler danlos syndrome C) osteogenisis imperfecta
-
Causes of mitral valve prolapse
Straight back syndrome
- thoracic kyphosis - antero poster diameter of chest is less
- rheumatic fever ( aschkoff body ) dilated cardiomyopathy
Pathphysiology of mitral valve prolapse ?
1 ) auscultatory findings - mid systolic click
- due to extra tension on chorda tendinae pressure develops in middle of systole
2 ) ischemic damage in subendocardial area causing ventricular arythmia complaints of chest pain
Clinical features of mitral valve prolapse ?
1) asymtomatic
2) chest pain substernal
3) palpiations due to premature ventricular contractions
4) infective endocarditis
5 ) transient ischemic attack - platelet plugs fibrin deposits
6 ) sudden cardiac death - MR , LVF
On auscultation in mvp ?
After s1 ejection click - mid systolic clicks
Chordate tendinae may be damaged & MR will be developing blood leaks from LV - LA
- sound of this blood leaking will be heard mid systolic clicks - late systolic crescendo descendo murmur
Murmur in mitral valve prolapse
Late systolic murmur
Murmur in aortic / poulmonary stenosis
Ejection systolic murmur
Murmur on squating and standing in mvp becomes
Shorter - squating
Larger - standing
Posterior leaflet defect in mvp ?
Bllod moves anteriorly murmur radiates to base
Anterior leaflet defect in mvp
Bloodmoves posteriorly murmur radiates to axilla/ back
Treatment for mvp
1 . Beta blockers
2. Profylaxis - infective endocarditis
3 . Mitral valve repair to prevent regurgitation
4 .
Golden period of MI ?
1st hour
Causes of sudden cardiac. Death in post MI. Patients. & toc. ?
1) tachyarythmia - vf
Toc - defibrillation
2) bradyarythmia - mobitz 2 heart block
Toc - atropine - to accelerate heart
Patient with st elevation MI , thrombus in right coronary artery evaluation ?
St elevation in leads 2, 3 , avf ( inferior leads ) - helps in identifying inferior wall mi , min st elevation should be
> 2mm males
> 1.5 mm females
Troponin 1 rise shows increasing trend
Troponin value usually starts doubling by ?
3 - 4 hours
Pci ( baloon angioplasty ) procedure ?
Ideally done within 90 min ,
Guidewire will be navigated from radial artery - subclavian artery - root of aorta - right coronary artery - steered tgrough thrombus - inflate - destroy the clot - revascularization obtained
To prevent development of atgerosclerosis from progressing further we have to give ?
Statins
Deployment of stent
What are drug eluting stent
They are coated with medicines that will prevent the restenosis
- it is coated with 2 medicines
Everolimus
Zoterolimus
Advantages of drug eluting stent ?
Modify atherosclerotic process
Prevent development of stenosis
Biodegradable stents ?
Get incoparated in walls of blood vessels
Rotatory atherectomy ?
For patients with chronuc stable angina
Thrombus will ne removed so stent can be deployed
To check characyer of pulse ?
Carotid artery
To check rate / rythm ?
Radial artery
