Pericarditis and valvular disorders Flashcards
Most common CV manifestation associated w/ SLE
Pericarditis
Characterized by sharp pleuritic chest pain that is relieved by sitting up and leaning forward
Most common type of pericarditis
Fibrinous pericarditis
Common causes of fibrinous pericarditis
- Viral infection
- Myocardial infarction
- Uremia
- Rheumatologic disease (i.e. SLE/RA)
Most common cause of acute pericarditis
Viral infection
C wave of venous pressure
Occurs due to RV contraction against a closed tricuspid valve, which buldes into the right atrium
A 33-year-old woman with a history of systemic lupus erythematosus presents with the sudden development of fever and anterior chest pain (the pain is worse when lying down and improved by sitting up). Physical examination finds a triphasic scratchy heart sound of varying intensity located over the lower left sternal border. What is the most likely cause of these clinical findings?
Pericarditis
Fibrinous pericarditis, which is the most common type of pericarditis, is characterized by pleuritic chest pain and a triphasic friction rub. Pericarditis, which is the most common cardiovascular manifestation associated with systemic lupus erythematosus, presents with sharp pleuritic chest pain that is relieved by sitting up and leaning forward.
Signs of constrictive pericarditis include:
- Pulsus paradoxus
- Pericardial knock
- JVD on inspiration (Kussmaul sign)
Beck’s triad
- Muffled heart sounds
- Hypotension
- JVD
Signs of cardiac tamponade
A 71-year-old woman presents with increasing chest pain and occasional syncopal episodes (especially with physical exertion). She has trouble breathing at night and when she lays down. Physical examination reveals a crescendo-decrescendo midsystolic ejection murmur with a paradoxically split S2. Pressure studies reveal that the LV pressure during systole is markedly greater than the aortic pressure. What is the best diagnosis?
Aortic stenosis
Aortic stenosis, which is characterized by a crescendo-decrescendo murmur that has a paradoxically split S2 best heard at the right upper sternal border (right second parasternal intercostal space) with radiation to the carotid arteries (sounds like bruits), may cause symptoms (eg, dyspnea on exertion, presyncope) due to restriction of cardiac output.
What is the most likely cause of aortic stenosis that developed in a 79-year-old woman?
Dystrophic calcification
Age-related calcific degeneration of a normal tri-leaflet aortic valve (dystrophic calcification) is the most common cause of aortic stenosis in developed countries, typically affecting patients older than 70.
A 55-year-old man presents with bobbing of his head and signs of congestive heart failure. Physical examination finds a hyperdynamic (water-hammer) bounding pulse. Physical examination finds a murmur that is loudest just after closure of the aortic valve. Which of the listed abnormalities is most likely the cause of these findings?
Aortic regurgitation
Aortic regurgitation is characterized by bounding peripheral pulses and head bobbing. Aortic regurgitation causes a decrescendo diastolic murmur with maximal intensity occurring just after closure of the aortic valve, when the pressure gradient between the aorta and left ventricle is the highest.
A 54-year-old woman presents with exertional dyspnea, dysphagia and hoarseness. A lateral projection of a barium swallow finds that the anterior wall of the esophagus is compressed by an enlarged structure immediately anterior to it, which is noted to be a dilated left atrium. What is the most common cause of this individual’s cardiac valvular disease?
Chronic rheumatic fever
Hoarseness with mitral stenosis (Ortner syndrome) is caused by extrinsic impingement of the recurrent laryngeal nerve by the enlarged left atrium, which can also press on the esophagus causing dysphagia. Chronic rheumatic fever is the most common cause of mitral stenosis, which is characterized by fibrosis of the mitral valve.
Describe the murmur of severe mitral regurgitation
High-pitched holosystolic murmur heard best over the apex with radiation to the axilla
Which one of the following is the most common underlying cause of mitral valve prolapse, which is characterized by a midsystolic click followed by a systolic murmur at the cardiac apex?
Dermatan sulfate deposition in the mitral valve leaflets is characteristic of myxomatous degeneration of the mitral valve in mitral valve prolapse
Murmur of aortic regurgitation
Aortic regurgitation causes a decrescendo diastolic murmur with maximal intensity occurring just after closure of the aortic valve, when the pressure gradient between the aorta and left ventricle is the highest.
Murmur of aortic stenosis
crescendo-decrescendo murmur that has a paradoxically split S2 best heard at the right upper sternal border (right second parasternal intercostal space) with radiation to the carotid arteries (sounds like bruits)
Key differences between cardiac tamponade and constrictive pericarditis
JVD in pericarditis vs. tamponade
Pulsus paradoxus
> 10 mmHg drop in systolic BP during inspiration
Observed in pathologies such as severe asthma, tension pneumothorax, constrictive pericarditis, and moderate to severe cardiac tamponade - outward expansion of the RV is limited as blood flows during inspiration
Pathenogensis of dystrophic calcification seen in aortic stenosis
Erb’s point
Left sternal border in the third intercostal space
Pulsus parvus et tardus
Parvus The pulse has a small volume
Tardus The pulse has a delayed peak
So the pulse is week and peak is delayed
Seen in Pt’s w/ aortic steonsis - harsh crescendo-decrescendo laste systolic ejection murmur
