Test 3 - Valvular disease, congenital defects, ACS Flashcards Preview

MS1 - CPR > Test 3 - Valvular disease, congenital defects, ACS > Flashcards

Flashcards in Test 3 - Valvular disease, congenital defects, ACS Deck (18)
Loading flashcards...
1
Q

You hear a crescendo-decrescendo systolic murmur in a 78 year-old man. What is at the top of your DDx and what is the most likely etiology?

A

Likely aortic stenosis from degeneration

2
Q

What type of valvular disease is Marfan’s syndrome associated with? How does Marfan’s cause this valvular disease?

A

Aortic regurgitation. Marfan’s can result in aortic root dilation, which makes it so the aortic valves can’t close tightly

3
Q

Your 24 year-old patient has a low-pitched, rumbling diastolic murmur best heard at the cardiac apex. What is at the top of your DDx what what is the most likely etiology?

A

Most likely mitral valve stenosis from rheumatic heart disease

4
Q

Name five causes of mitral valve regurgitation.

A
  1. Myxomatous degeneration (weakening of the proteoglycans in the CT)
  2. Chordae tendinae rupture
  3. Ischemia/infarction of papillary muscles
  4. Dilation of the anulus fibrosus
  5. Rheumatic heart disease (causes stenosis first that can progress to regurgitation)
5
Q

What are the pathophysiological consequences to the myocardium as a result of aortic stenosis?

A

Stenosis –> high LV pressure –> high LV wall tension –> concentric hypertrophy –> impaired LV filling –> LA dilation –> a-fib risk and pulmonary congestion

6
Q

What are the pathophysiological consequences to the myocardium as a result of aortic regurgitation?

A

Increased LV volume and pressure –> LV dilation –> LA dilation –> a-fib risk and pulmonary congestion

7
Q

What are the pathophysiological consequences to the myocardium as a result of mitral stenosis?

A

Increased LA filling pressure –> LA dilation –> pulmonary hypertension, a-fib risk, thrombus formation risk from stasis in the big LA

8
Q

What are the pathophysiological consequences to the myocardium as a result of mitral regurgitation?

A

Increased LA pressure –> increased LA size –> a-fib risk

9
Q

Describe the murmur caused by aortic stenosis and where it is best heard.

A

Crescendo-decrescendo between S1 and S2 (during systole).

Heard best at the 2nd intercostal space just lateral to the sternum.

10
Q

An S4 heart sound is most likely associated with which valvular disease?

A

Aortic stenosis. Because it causes LV hypertrophy and S4 sounds are heard with hypertrophic, stiff ventricles.

11
Q

What is pulsus parvus et tardus?

A

Weak and late carotid pulse associated with aortic stenosis

12
Q

What valvular disease is associated with syncope during exercise?

A

Aortic stenosis

13
Q

What valvular disease is associated with a forceful carotid pulse that suddenly collapses? What is the name for this?

A

Aortic regurgitation - widened pulse pressure means the carotid can easily collapse during diastole. Corrigan’s pulse

14
Q

What is the significance of head bob (de Muset)?

A

A sign of aortic regurgitation

15
Q

What extra heart sound could be heard in a patient with aortic regurgitation?

A

Aortic regurgitation can cause LV dilation –> S3 heart sound

16
Q

Describe the murmur heard in a patient with mitral stenosis.

A

Low-pitched rumble during diastole, heard at the cardiac apex

17
Q

What is a mid-systolic click suggestive of?

A

Mitral valve prolapse

18
Q

Your 34 year-old patient comes in complaining of shortness of breath, fatigue, and palpitations. On exam, you note a holosystolic murmur heard at the apex as well as a diastolic murmur, and his PMI is laterally displaced. What is at the top of your DDx and what is the likely etiology?

A

Likely mitral valve regurgitation from rheumatic disease. Increased LA filling pressure –> LA dilation (risk for a-fib) –> increased volume rushing into the LV during diastole results in the diastolic murmur. The systolic murmur is from the regurgitation.