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Clin Med 2 - CARDS > Valvular Disease - Waldron > Flashcards

Valvular Disease - Waldron Flashcards

(73 cards)

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1
Q

What are risk factors for VHD

A

older age
history of infections that can affect the heart
history of heart disease or heart attack- High BP, high cholesterol, DM
congenital heart disease

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2
Q

what are complications of VHD

A

heart failure
stroke
blood clots
heart rhythm abnormalities
death

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3
Q

what is the cardiovascular exam for VHD

A

BP
Carotid pulse - rate, rhythm, rate of rise, compliance
Inspection -JVD
Palpitation - LV apical impulse
Heart sounds - intensity, S1 and S2
MURMUR

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4
Q

what is atresia

A

valve isn’t formed; a solid sheet of tissue blocks the blood flow between the heart chambers

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5
Q

with a murmur, what sided murmur is louder on inspirations

A

Right sided murmurs are louder with inspiration
RINspiration

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6
Q

with a murmur what sided murmur is louder on expirations

A

Left sided murmurs louder on expiration
LEXpiration

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7
Q

what are the common presenting symptoms with VHD

A

chest pain
abnormal swelling (more common with advanced tricuspid regurgitation)
fatigue
SOB, with activity or when lying down
swelling of ankles and feet
dizziness
fainting
irregular heartbeat

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8
Q

what is the SCRIPT evaluation for murmurs

A

S - Site - where the murmur is heard
C - Character - crescendo, decrescendo, blowing, harsh, musical
R - Radiation - carotids (AS), axillary (MR)
I - Intensity - Grading I- VI
P - pitch - high or low
T - timing - systolic vs diastolic, holosystolic, early, late

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9
Q

what is a grade 2 murmur

A

soft, heard in all positions, no thrills

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10
Q

what is grade 3 murmur

A

moderately loud, no thrill

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11
Q

what is grade 4 murmur

A

loud and associated with palpable thrill

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12
Q

what is grade 5 murmur

A

very loud, with thrill, heart with the stethoscope partially off the chest

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13
Q

what is grade 6 murmur

A

loudest, with thrill, heard with the stethoscope entirely off the best

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14
Q

what are the diagnostics tests used for VHD

A

Doppler Echo - TTE, TEE
ECG
CXR
MRI - gated
Exercise stress test
catheterization

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15
Q

what is the most common type of murmur

A

innocent murmur - may disappear and then reappear
caused by rapid ejection of blood across the valve - common in hyperkinetic states

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16
Q

what are common causes of innocent murmurs

A

temporary increase in blood flow: Hyperkinetic states
exercise
pregnancy
fever
hyperthyroidism
anemia
rapid growth spurts in children

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17
Q

always pathologicic if

A

diastolic murmur
holo- or late systolic
continuous - systolic and diastolic
grade > 3
concomitant cardiac symptoms or exam findings

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18
Q

what is one of the most common and most serious valve disease

A

aortic stenosis
- mainly affects older people - results of scarring and calcium buildup
family members may notice decline in patients routine physical activities or significant fatigue

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19
Q

what are symptoms of AS

A

breathlessness (HF)
chest pain (angina), pressure or tightness; progressively worsening ‘exertional fatigue’
fainting/syncope
palpitations or a feeling of heavy, founding, or noticeable heartbeats
decline in activity level or reduced ability to do normal activities requiring mild exertion

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20
Q

what is a classic systolic murmur heard RUSB with patient sitting

A

Aortic stenosis

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21
Q

if a thrill is felt - is it not what kind of murmur

A

a innocent murmur

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22
Q

what is the treatment of AS

A

valve replacement is indicated once symptoms begin, or LV dysfunction occurs
surgical or transcatheter aortic valve replacement (TAVR) are options for many patients
control co-morbidities

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23
Q

what medications can cause dangerous hypertension and should be used with caution for angina in patients with AS

A

nitrates

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24
Q

what are diastolic murmurs always

A

pathologic

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25
what is the diameter of a normal Aortic valve
3.0-5.0 cm
26
what is the diameter of severe AS
1.0cm or less
27
with severe AS - when is the murmur peaked
late systolic
28
with mild AS. - when is the murmur peaked
early to mid systolic
29
what is aortic regurgitation
leakage of the aortic valve each time LV relaxes; volume overload of LV occurs because the LV receives blood regurgitated from the aorta during diastole in addition to blood from the left atrium
30
what are causes of aortic regurgitation
valvular - calcifications, bicuspid, endocarditis Aorta - dilation, dissection
31
what is the most common cause of chronic aortic regurgitation in children
Ventricular septal defect (VSD) with aortic valve prolapse
32
what are symptoms of aortic regurgitation
mild may produce few symptoms more severe AR may: palpitations, chest pain, fatigue, SOB other symptoms include orthopnea, weakness, fainting or LE edema
33
what are the osculatory findings with aortic regurg
heard best with the patient supine normal S1, slapping/sharp S2, diastolic murmur mild: soft, high pitched, blowing; decrescendo diastolic murmur, usu. early at the RUSB or LUSB moderate to severe: louder, low pitched (*may be absent); systolic ejection murmur
34
what is a corrigan's pulse
wild pulse pressure
35
what is seen with severe AR
wild pulse pressure - corrigan's pulse brisk carotid pulse hyperdynamic, displaced apical impulse length of murmur correlates with severity soft or absent S1 and S2 S3 and S4 gallops austin-flint murmur
36
what is the treatment of AR
acute AR: requires prompt aortic valve replacement or repair chronic AR: requires aortic valve replacement/repair when symptoms or LV dysfunction develops those who are not candidates for surgery benefit from treatment of HF
37
what is the normal mitral valve area
4-6cm
38
what is the pathophysiologic effect of mitral regurgitation
volume overload
39
what does volume overload cause with mitral regurgication
change in LV geometry (remodeling) remodeling = LV enlargement = hypertrophy
40
what are the symptoms of MR
SOB (dyspnea), especially on exertion and when lying down fatigue palpitations swollen feet or ankles
41
what are the causes of MR
mitral valve prolapse damaged tissue cords rheumatic fever endocarditis MI cardiomyopathy: HOCM Trauma Congenital heart disease medications (ergotamine) Radiation AFib age Connective tissue disease
42
what are complications of MR
HF, Afib, pulmonary HTN in more severe cases
43
what is heard on osculatory evaluation of MR
classic systolic murmur presentation heard best with patient supine mild - systolic murmur may be abbreviated or occur late in systole mod/severe - holosytolic, high pitched, heard best at apex with diaphragm of stethoscope with patient in L lateral decubitus position radiation to axilla or to left sternal border increases in intensity with handgrip and decreases intensity with standing or valsalva maneuver
44
what is found with moderate to severe MR
brisk carotid pulse hyperdynamic, displaced apical impulse soft or absent S1, S3 and S4 gallops, widely split S2, diastolic rumble
45
what is the treatment of MR
acute MR: may cause acute pulmonary edema or cardiogenic shock or SCD chronic MR: causes slowly progressive symptoms of heart failure and if afib develops, palpitations valve replacement or repair
46
what is mitral valve prolapse
most common cause of isolated MR thickened leaflets billow more than 5mm posterior to annulus associated with MR: anterior prolapse - posteriorly directed jet (axilla) posterior prolapse - anteriorly directed jet (LSB)
47
what is heard on auscultation with MVP
normal S1 and S2 mid to late sharp systolic click - most specific sign of MVP - click heard earlier with valsalva maneuver classic murmur presentation best heard with patient supine - mild to late systolic murmur following the click
48
what is the treatment of MVP
does not usually require treatment BB relieve symptoms of excess sympathetic tone and reduces risk for tachyarrhythmias (atenolol or propranolol) treatment of AF may be required treatment of MR depends on severity and associated LA and LV changes abx prophylaxis against endocarditis is no longer recommended
49
what is mitral stenosis
rare symptoms most often appear between 15-40 yo in developed nations and they can occur at any age, even childhood
50
what are the symptoms of MS
SOB especially with exertion of laying down faitgue, during increased Physical activity swollen feet or legs palpitations dizziness or fainting coughing up blood chest discomfort/pain
51
what is the pathophysiology of MS
pressure builds up in the LA and sent back to lungs, resulting in congestion and SOB 1. thickened leaflets, commissural fusion and sub valvular thickening 2. annular calcification
52
what is the etiology of MS
rheumatic or annular calcification
53
what are the complications of MS
pulmonary hypertension HF - pulmonary edema heart enlargement - LA dilation atrial fibrillation blood clots
54
what are major manifestations found with rheumatic fever
carditis polyarthritis chorea erythema marginatum subcutaneous nodules
55
what are the minor manifestations found with rheumatic fever
fever arthralgia previous rheumatic fever or rheumatic heart disease elevated ESR or positive CRP prolonged PR interval
56
what is heard with auscultation with MS
S1 loud and snappy - hallmark of MS opening snap-heard best at apex w/ diaphragm at end expiration with patient in left lateral decubitus position mid-diastolic
57
what is the treatment of MS
mild symptomatic pts usually response to diuretic and if sinus tachycardia or afib is present: BB or CCB for rate control anticoagulation for AF commissurotomy or valve replacement
58
What is the most common cause of Pulmonary stenosis (PS)
usually rare among adults, usually congenital heart defect moderate to severe PS is most often diagnosed during childhood
59
when are PS symptoms first noticed
while exercising fatigue, SOB, chest pain, LOC
60
what are the risk factors for PS
carcinoid syndrome rheumatic fever noonan syndrome pulmonary valve replacement
61
what are complications of PS
infection -higher risk of infective endocarditis RVH R sided heart failure arrhythmia - unless PS severe, arrhythmia not usually life threatening
62
what is the treatment of PS
balloon valvulopolasty for symptomatic pts and asymptomatic pts with normal systolic function and a peak gradient > 40 to 50 mmHg
63
what is the most common cause of pulmonary insufficiency
pulmonary hypertension or congenital heart defect (most specifically tetralogy of fallot)
64
what is tricuspid stenosis almost always due to
rheumatic fever; tricuspid regurg and mitral stenosis are often also present may be related to cancer (tumors, carcinoid syndrome)
65
what are the symptoms of TS
severe tricuspid stenosis - fluttering discomfort in the neck, fatigue and cold skin, elevated JVD, and R upper quadrant abdominal discomfort
66
what is the treatment of TS
diuretics and aldosterone antagonists; surgical repair or replacement is rarely needed
67
what is the congenital defects associated with tricuspid insufficnency
ebsteins anomaly marphans syndrome idiopathy myxomatous degeneration
68
what is secondary Tricuspid regurgitation due to
leaflet tethering, caused by annular dilation and/or papillary muscle displacement
69
what is the perferred method for evaluating tricuspid Insufficiency
Cardiac MRI - should be done when echo quality is inadequate - evaluates RV size and function
70
what is the tx of TR
usually well tolerated, but severe cases may require annuloplasty, valve repair or valve replacement
71
what are the lifestyle changes for VHD
smoke-free more active aim for healthier weight eat a healthy balanced diet drink less alcohol manage stress
72
what are medication options for VHD
diuretics blood thinners/anti-thrombotics anti-arrhytmics antibiotics - chronic and prophylactic
73
what are the surgery options for VHD
valve repair: ballon valvuloplasty or annuloplasty valve replacement: mechanical, biologic, transcatheter aortic valve implantation (TAVI/TAVR)

Clin Med 2 - CARDS (11 decks)

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