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MTB 3 Flashcards

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1
Q

MCC Mitral Stenosis

A

Rheumatic Fever

MC in young adults

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2
Q

When do we treat Mitral Stenosis

A

Symptomatic

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3
Q

Pregnant and Immigrant - Valvular dz?

A

Mitral Stenosis

Pregnancy - 50% increase in plasma volume

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4
Q

Presentation of Mitral Stenosis

A 
SOB/Dyspnea/Orthopnea
CHF
Dysphagia- Esophagus
Hoarseness - Laryngeal N
A fib/Stroke
Hemoptysis
Right sided HF
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5
Q

Presentation of Right sided HF

A

Hepatomegaly
Ascites
Peripheral Edema

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6
Q

Murmur with Mitral Stenosis

A

Diastole right after opening snap
Loud S1 = MV opens when ventricle contracts, slams the valve shut
Opening Snap = MV opening after S1

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7
Q

What increases the intensity of Mitral Stenosis

A

Squatting
Leg raising
Increased venous return to the heart

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8
Q

Best initial test for Mitral Stenosis

A

TTE

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9
Q

Most accurate test for Mitral Stenosis

A

Catheterization

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10
Q

EKG of Mitral Stenosis

A

A fib very common

LA Hypertrophy = biphasic P wave in V1 and V2

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11
Q

CXR of Mitral Stenosis

A

LA Hypertrophy

  • Straightening of left heart border
  • Elevation of left main-stem bronchus
  • Second bubble behind heart
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12
Q

TX for Hypertrophy

A
  1. Diuretics + Sodium restriction if fluid overload in lungs
  2. Balloon Valvuloplasty done with catheter
  3. Valve replacement if catheter cannot be done
  4. Warfarin for A fib
  5. Rate control of a fib
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13
Q

AE of Diuretics in pregnancy

A

IUGR

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14
Q

Causes of Aortic Stenosis

A

Congenital bicuspid valve

Calcifications with aging

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15
Q

Pathophys of Calcifications in Aortic Stenosis

A

Calcium leaves bones and enters aorta

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16
Q

Presentation of Aortic Stenosis

A 
Angina = MC 
Syncope
CHF 
Pulsus tardus et parvus
Carotid thrill
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17
Q

What is Pulsus tardus et parvus

A

Pulse that is small and late

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18
Q

TX for Aortic Stenosis

A 
If SAD (Syncope, Angina, Dyspnea) = Valve replacement
No good medical TX
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19
Q

Test for Aortic Stenosis

A

TTE
TEE
Catherization

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20
Q

Murmur of Aortic Stenosis

A 
Systolic 
Crescendo-decrescendo 
Peaks mid-systole
Heart best at 2nd right IC space
Radiates to Carotid
Valsalva/standing - decrease murmur/improve
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21
Q

Why does Valsalva/standing decrease or improve murmur in Aortic Stenosis

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A

Decreased venous return to heart

22
Q

What softens murmur of Aortic Stenosis

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A

Handgrip b/c of decreased ejection of blood

23
Q

What is carotid thrill

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A

Palpable vibration of murmur

24
Q

EKG of Aortic Stenosis

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A

LVH

S wave in V1 + R wave in V5

25
How long will stenotic valve survive
12-24 months
26
Causes of Mitral Regurgitation
HTN Endocarditis MI w Papillary muscle rupture Any cause of heart dilation
27
Presentation of Mitral Regurgitation
CHF sx's - distended neck veins
28
Murmur of Mitral Regurgitation
Holosystolic - obscure both S1 and S2 Best heard along sternal border Radiates to Axilla
29
What worsens murmur of Mitral Regurgitation
Handgrip pushes more blood backwards through the valve | Squatting and leg raising -increase venous return to heart
30
Handgrip worsens which murmurs | Impact on preload/afterload
MR AR Handgrip increases afterload
31
Valsalva and standing do what to blood flow
Decrease venous return to heart
32
Squatting and leg raising do what to blood flow
Increase venous return to heart
33
Do all left sided murmurs increase w expiration
No | NOT HOCM + MVP
34
If the EF is < 60%, what does this mean for LV? | Management?
LV End systolic Diameter (LVESD) is > 40 mm Unable to empty ventricle Replace or repair valve before dilates more
35
EKG for Mitral Regurgitation
LVH and LA Enlargement
36
Echo for Mitral Regurgitation
LA and/or LV Dilatation
37
TX for Mitral Regurgitation
``` 1. Vasodilators - ACE, ARBs = BEST. Increase EF Hydralazine if can't tolerate. 2. Digoxin, diuretics 3. Valve Replacement - symptomatic pt. ASAP when heart starts to dilate If LVESD > 40 mm OR EF < 60% ```
38
Causes of Aortic Regurgitation
``` Heart of Aorta Dilated MI HTN Endocarditis Marfan Cystic Medial Necrosis Inflammatory Dz - Ankylosing Spondylitis, Reiter Syphilis - Tertiary ```
39
Presentation of Aortic Regurgitation
``` CHF Si/Sx's Wide pulse pressure Water-hammer pulse (wide, bounding) pulse Quincke pulse (pulsations in nail bed) Hill sign (BP in legs > arm BP) Head bobbing (de Musset sign) ```
40
Murmur of Aortic Regurgitation
Diastolic Decrescendo Heard best at lower left sternal border Duzoziez sign - S/D thrill/murmur over Femoral Area
41
Diagnostic test for Aortic Regurgitation
Echo - TTE, TEE | Catheterization
42
TX for Aortic Regurgitation
1. ACEi/ARBs, Nifedipine as Vasodilators - increase forward flow and delay progression 2. Digoxin, diuretics - little benefit 3. Valve replacement if acute valve rupture - EF < 55% or LVESD > 55mm
43
What improves murmur of Aortic Regurgitation
Valsalva and standing
44
What worsens murmur of Aortic Regurgitation
Handgrip increase afterload, compressing arteries of the arms
45
What is PPX for Endocarditis
Amoxicillin | Clindamycin
46
MVP causes
Anatomic variant - esp women Marfan Ehlers-Danlos Myxamatous degeneration of MV leaflets/chordae
47
Presentation of MVP
``` Asymptomatic When Sx's - CHF sx's ABSENT - Atypical chest pain - Palpitations - Panic Attack ```
48
Murmur of MVP Worse w? Improved w?
Midsystolic click Valsalva and standing Worsen Squatting and handgrip Improve
49
What can MVP progress to
Endocarditis Arrhythmias Valve Calcifications TIAs
50
TX for MVP
1. Beta blockers when symptomatic for pain, palpitations, panic attack 2. Valve repair w catheter - place clip to tighten
51
Is endocarditis PPX needed for MVP
Not recommended

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