Exam 3, valvular heart disease Flashcards Preview

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Flashcards in Exam 3, valvular heart disease Deck (58):
1

1/6 blowing murmur and Lower L sternal border
3/6 diastolic rumble
both increased with inspiration
wha type of murmur is systolic one and how would it appear on jugular venous tracing

tricuspid stenosis
large cannon a wave

2

what is the normal values for mean Right atrial P and right ventricular pressure

mean right atrial pressure is 0-5 mmHg
right ventricular pressure is 25/5

3

what medications do you give for tricuspid stenosis?
types of surgeries?

diuretics (torsemide because better absorbed form gut)
spironolactone for ascites
balloon, valvotomy, open commissurotomy, biprosthetic valve

4

55 y.o female with history of previous Right MI has fatigue and abdominal fullness
peripheral edema ans ascites
3/6 systolic blowing murmur at left lower sternal border with audible S3
increased with inspiration
what would venous tracing look like

prominent cV wave
tricuspid regurg

5

what can cause cV wave enlargement on jugular venous tracing

RV dilation: pulm HTN, pulmonic regurg, LV failure where PA or RV systolic pressure is above 40 mmHg

6

What is Tx for tricuspid regurg

treat primary issue LV failure or pulm HTN

7

why do you not use mechanical valves for tricuspid

will clot with low flow state

8

male with COPD and pulm HTN presents with split S2 and diastolic 2/6 murmur at L 2nd ICS that increases with a deep breath
what type of murmur

graham steell

9

describe what can cause low pressure Pulm insufficiency-

pulm regurg: little murmur from trauma with dilated pulmonary annulus, carcinoid plaque, bicuspid valve or repaired tetralogy

10

what is high pressure Pulm insufficiency, pulmonic regurg

prolonged RV systole with split S2 from pulm HTN (mitral stenosis Graham Steell murmur)
COPD

11

how do you Tx high pressure pulmonic regurg? low pressure?

high- treat pulm HTN
low- watchful expectancy

12

what is the a wave in venous tracing

atrial contraction

13

what is the x in jugular venous tracing

atrial relaxation

14

what is the v wave in jugular venous tracing

atrial filling

15

35 y.o female has exertional dyspnea, orthopnea
prominant p wave, tall R waves in inferior wall, large negative p wave in V1
what is murmur type

left atrial enlargement
right ventricular enlargement
right atrial enlargement
backpressure- mitral setenosis

16

which murmur has hockey stick sign of leaflet

mitral stenosis

17

What are sounds heard from mitral stenosis

loud M1
opening snap- earlier after S2 with worsening LA pressure
rumbling diastolic murmur
presystolic accentuation of diastolic rumble

18

if mitral valve stenosis is mild, acute what are other Sx

pulmonary edema

19

if mitral valve stenosis is chronic, what are other Sx

pulmonary HTN leading to R sided CHF, AF and low CO

20

What is graham steell murmur

left sternal border pulm insufficiency with mitral valve stenosis

21

what is typical EKG of mitral stenosis

nep P wave in V1, RAD
sometimes R ventricular or right atrial hypertrophy

22

high pitch pan systolic murmur with S3 at apex
murmur?

mitral regurg

23

S3 in tricuspid or mitral regurg means what

severe

24

What can cause mitral regurg

defective papillary muscles
defective chordae tendinae
defective leaflets
defective annulus

25

how are preload and afterload affected in mitral regurg

increased preload
decreased afterload

26

what occurs long term with increased preload

enlarged LV, increased EF but eventually LV fails and EF drops= increased ESV

27

What is EKG look like with mitral regurg

LVH, LAH or AF

28

how is BNP affected by mitral regurg

increased

29

how does squatting or handgrip change mitral regurg murmur

increases

30

describe valsalva on mitral regurg

squatting increases murmur
standing decreases murmur

31

how does amyl nitrate affect afterload and mitral regurg

decreases afterload, so decreases mitral regurg murmur

32

what occurs with chronic mitral regurg

atrial stretches to extreme amount-- leads to a fib
straight line border on L side heart in CXR

33

how does mitral valve regurg affect venous jugular tracing read from pulm capillary wedge tracing

cV wave enlargement

34

cV enlargement measured in neck veins is what

tricuspid regurg

35

in mitral regurg what percent EF is time to replace valve?
amount of ESV?

40

36

What is ERO

effective regurginant orifice >40 mm squared

37

What is Tx for mitral regurg

repair if there is no calcification in annulus or valve and chordae can be maintained

38

patient with mitral valve prosthtetic has onset dyspnea, Tx?

replace valve

39

chest pain, palpitations
mid systolic click with alte systolic murmur which shortens with lying down, handgrip and squatting
joint laxity and skin changes
murmur?

mitral valve prolapse

40

how does standing. valsalva and nitrate affect mitral prolapse murmur

make in longer and louder

41

how come with standing prolpase mitral valve murmur decreases

decreases VR, dec amount of blood

42

what is myxomatous degeneration of mitral valve

associated with marfans, ehlers danlos
aortic regurg, skel changes

43

how do we treat mitral valve prolapse

beta blockers
mitral valve repair
replace if cannot repair

44

syncope with murmur since childhood. now has ejection sound with diamond shaped harsh systolic murmur at base and high pithced systolic murmur at apex
former murmur increases afer ectopic beat and decreases with squatting
most likleymurmur?

aortic stenosis

45

What is gallaverdin phenomenon?

aortic stenosis that has high pitched component that refere to apex. so seems likt two murmurs, one at base and one at apex

46

What is most common cause of aortic stenosis

bicuspid valve

47

why does aortic stenosis lead to syncope

peripheral vasodilation from high ventricular pressures stimulating baroreceptros in LV
reduced afterload increases SV and it rejected from stenosis so BP drops

48

What is parvus et tardus in aortic stenosis

late and slow pulse in carotids

49

how do we know how bad aortic stenosis is

measure flow across flow
flow squated x 4 m

50

What is peak valvular flow gradient of LV failure, angina and syncope?
how do we measure this?

peak gradient reaches 64 mmHg
mean 40mmHg
measure via doppler

51

how is it possible for a patient with severe aortic stenosis to have valve fradient of <30mmHg

heart is starting to fail
low gradeint low flow aortic stenosis with reduced EF

52

What is Tx for aortic stenosis

young- percutaneous valvulopathy
older- bovine valve
middle- mechanical(blood thinner)

53

what must you check for in aortic stenosis before surgery

CAD

54

bicuspid aortic valve and HTN with new onset PND
2/6 systolic murmur at base
3/6 decresencdo diastolic murmur at base
1/6 late diastolic low pitched murmur at apex

aortic regurg

55

what occurs in aortic regurg with squatting of handgrip

gets louder

56

What is pulse like in aortic stenosis

wide pulse pressure
icnreased pressure too- bounding

57

what are other causes of wide pulse pressure besides aortic insufficiency

atherosclerosis, AV fistula, anemia, thyrotoxicosis, fever and heart block

58

when do you know when to replace aortic valve replacement

EF50
BNP>130