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Medicine > CVS Medicine Pulse➡️murmur > Flashcards

CVS Medicine Pulse➡️murmur Flashcards

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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

Study These Flashcards
A

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

24
Q

Organic MR is known as

Study These Flashcards
A

Primary MR

Leaflet or chordae relates problem

24
Organic MR is known as
Primary MR | Leaflet or chordae relates problem
25
Secondary MR occurs due to
Chordae and leaflet are normal | Annular dilation mc occurs in heart failure
26
Causes of primary MR
Mitral valve prolapse Rheumatic SLE, RA
27
Pathophysiology of MR
``` 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
What is earliest symptom of MR
Palpitations
29
Severe MR leads to pulmonary HTN due to
Left atrial pressure increase due to decrease LV contractility leading to pulmonary artery hypertension
30
Pulse Bp JVP IN SEVERE MR
Hypokinetic pulse Narrow pulse pressure a wave
31
Inspection finding of MR
Parasternal heave in severe MR
32
Heart sounds of MR
S1 soft S2 normal (in severe MR - widening) S3 heard in moderate to severe MR
33
Murmur of MR | It is best heard in
Pan systolic murmur High pitched, soft blowing Left lateral decubitus with diaphragm
34
What is the sign for bad prognosis in MR
Ejection fraction less than 60 | LV end sys diameter more than 40 mm
35
Cause of MVP
From najeeb
36
Absolute indication for surgery in MVP
MVP WITH MR
37
Murmur in MVP
High pitched musical murmur | Systolic murmur crescendo decrescendo
38
Sound in asymptomatic MVP
Non ejection click
39
Cause of acute MR
Papillary muscle rupture( inferior wall MI) Chordal rupture( inf endocarditis) Trauma
40
Acute MR C/F
Acute pulmonary edema or Cardiogenic shock Murmur- short Early systolic decrescendo
41
Pericardial space contains?
50 ml serous fluid which is ultrafiltrate of plasma
42
Pulmonary vein is intra_____, It is not intra_____
It is intrathoracic, not intrapericardial
43
Pulmonary vein is intra_____, It is not intra_____
It is intrathoracic, not intrapericardial
44
What happens to CO during inspiration and expiration
Inspiration VR increase, RV pressure increase septum bulge towards left side, LV volume decrease, CO decrease Vice versa in expiration
45
C/F of acute Pericarditis
Sharp, stabbing, pleuritic chest pain Relieved by sitting up and leaning forward Pericardial rub present Global ST elevation diffuse T wave inversion
46
Most common cause of acute pericarditis
Post viral
47
Other cause of acute pericarditis
``` Hiv tb coxsackie Post mi Uremia Hydralazine IgG4, SLE, Sjogrens ```
48
Dresslers syndrome is seen in
Late pericarditis -1wk to few months after MI Autoimmune Fever ,pleuritic pain+ polyserositis RUB PRESENT
49
Treatment of acute pericarditis
Nsaids only Ibuprofen Indomethacin Aspirin
50
Causes of chronic constrictive pericarditis
Tb mc | Repeat episode of acute pericarditis
51
What is CCP
Obliteration of pericardial cavity by formation of granulation tissue, which contracts to form scar that calcifies
52
Other name for chronic constrictive pericarditis
Thickened calcific inelastic pericardium
53
Why is kussmaul sign seen in chronic constrictive pericarditis
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
Septal bounce is seen in | It is due to
Exaggerated ventricular interdependence seen in 1/3rd pt | Causes septal bounce in CCP

Medicine (11 decks)

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