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Cardiology (inpatient) > valvular disorders > Flashcards

valvular disorders Flashcards

1
Q

aortic stenosis murmur location

A

2cd right ICS ; radiates to neck and LSB; often loud w/ thrill; grade 4-6, crescendo-decrescendo, midsystolic

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2
Q

AS

A

M>W,most common murmur in US, sx onset when narrowed around 1-1.2 cm; may see LVH and left-sided atrial enlargement, thready pulses in carotid

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3
Q

Aortic regurge

A

biscuspid valve, rheumatic infxn, aortic root dz, sever Htn

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4
Q

AR CP

A

DOE, PND, orthopnea, 1 out of 4 angina,

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5
Q

AR murmur

A

high pitched, blowing, decresendo, diastolic murmur heard at 3-4th ICS along LSB

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6
Q

AR evaluation

A

LVH, LAD “strain pattern”

CXR: CMG, possible aortic enlargment

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7
Q

MS etiology

A

rheumatic fever, lupus, RA, calcification

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8
Q

MS sx

A

when valve is 1.4-2.5 cm wide; onset can be 20-40 years from rheumatic dz ; dyspnea, orthopnea, PND, fatigue, palpitaions, hemoptysis

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9
Q

MS murmur

A

pronouced S1, opening snap, low pitched diastolic rumble at apex (decubitus position)

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10
Q

MS EKG/CXR

A

may how enlarged P wave in II or uprighe in vV1 or atrial fib; LA, RV enlargment

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11
Q

MS rx

A

rate control afib, anticoag, manage CHF prevent recurrent R. fever

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12
Q

MR etiology

A

anything that disrupts MR compoenents (leaflets, annulus, myocardium cordae, paipillary)

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13
Q

MR PP

A

measured in terms of severity (trace, mild, mod, sever)

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14
Q

MR CP

A

fatigue, dyspnea, DOE, orthopnea, PNd, palpitaions

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15
Q

MR murmur

A

holosystolic best heard at apex and radiates to axilla, S2 may be widlely split

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16
Q

Mitral prolapse PP

A

connective tissue disease, genetics, idopahtic, HCM

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17
Q

MP CP

A

largley asx, but isolated MR most commonly associated with MVP

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18
Q

MP Murmur

A

mid-systolic click, possilbe late cresendo-decresecndo murmerr at apex

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19
Q

what is the cause of most valvular dz in US?

A

degenerative calcific changes; same process as atherosclerosis

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20
Q

what murmurs occur in systole

A

aortic/pulmonary stenosis

Mitral and tricupsid regurg

21
Q

diastolic murmurs?

A

M/T stenosis

A/P regurg

22
Q

timing of sx in stenosis

A

sx precede LV dysfxn; typically intervene for sx

23
Q

timing of sx in regurg

A

LV dysfxn may precede sx, monitor LV fxn, intervene for sx and to preserve cardiac fxn

24
Q

PP of valvular dz

A

excess load on mycardium (increased pressure, increase volume)
compensatory : hypertrophy from stenotic dz (pressure is problem), dilation in regurg (volume is problem)

25
Q

AS etiology

A

calcific valve dz (tx with statins

26
Q

calcific valve dz

A

proliferative and inflammatory changes w. lipid accumulation, up-regulation of ACE, infiltration of macrophages and T-lymphocytes

27
Q

AS summary

A

o WHO  older / calcific or younger / bicuspid
o SYMPTOMS  angina, syncope, CHF
o PE  harsh, systolic ejection murmur at right upper sternal border with radiation to neck
o DIAGNOSIS  transthoracic echo, then cardiac cath
o MANAGEMENT  surgery for symptoms

28
Q

AR PP?

A
  • Regurgitant volumed = increased LV EDV = dilatation =increased LV EDP = pulmonary congestion
29
Q

AR etiology

A

congenital, infxn, marfan sydrome, inflammatory (SLE , RA), phentermine

30
Q

Aortic Root Syndrome

A

Marfan, syphilis, ankylosing spondylitis, cystic medial necrosis, arotic dissection, trauma

31
Q

AR PE

A

wide pulse pressure, s3 gallop, diastolic murmur, high pitched

32
Q

Water-hammer/ Corrigan’s pulse (AR)

A

abrupt distension/quick collapse of pulses (radial/carotid)

33
Q

Quincke’s pulse (AR)

A

capilarry pulsations seen in fingernails or lip

34
Q

Mussets sign (AR)

A

head bob w/ each heart beat

35
Q

Muller sign (AR

A

systolic pulsations of the uvula

36
Q

Traube sign (AR)

A

booming systolic and diastolic sounds heard over the femoral arther

37
Q

Duroziez sign (AR)

A

systolic murmur heard over the femoral artery when compressed proximal, diastolic murmur when compressed distally

38
Q

Hill sign

A

popliteal cuff SBP >20 over breacheal cuff SBP

39
Q

Austin Flint rumble

A

a mid-diastolic, low frequency murmur that is best heard at the apex with little radiation. It mimics rheumatic mitral stenosis in its characteristics and physiology. The murmur is the result of competition between the regurgitant jet of the aortic valve and the attempt to fill the left ventricle from the left atrium—in essence, functional mitral stenosis. It differs in that it occurs in the presence of a murmur of aortic valve insufficiency and in the absence of the rheumatic, mitral opening snap

40
Q

AR medical therapy

A

afterload reduction= ACE, ARB, or hydralazine+ntrates (vasodilators)
endocarditis prophylzxix in appropriate patients

41
Q

Rule of 55

A

AR tx: LVEF < 55% or LVESD > 5.0 cm

42
Q

AR summary

A

WHO : no classic patient, think bicuspid or Marfan syndrome
SYMPTOMS : CHF symptoms (dyspnea, fatigue)
PE : wide pulse pressure, soft / decrescendo diastolic murmur, bounding pulses – “water-hammer,” Musset’s head bob, Quincke’s pulse
DIAGNOSIS : Echo
MANAGEMENT : medical therapy, surgery for acute AI, symptoms or evidence of LV changes in chronic AI

43
Q

MS hemodynamics

A

elevated LA pressure and LA enlargment, pulmonary venous congestion, reduced CO, pulm HTN, may progress to Right sided failure

44
Q

what can develop from MS? (arrhythmias/ pregnancy)

A

paroxysmal/chronic atrial fibrillation develops in 50-80% of pts

sudden increase in HR may precipitate pulmonary edema (HR control is more important)

In pregnancy, there is an associated increased in CO=increased transmitral pressure gradient=sx; pts w/ moderate to severl MS should have intervention poror to becoming prego, or if already prego

45
Q

MS epidemiology

A

think rheumatic heart dz first

2/3 are women

46
Q

MS PP

A

fibrosis, scarring and thickening of leaflets, commissural fusion, chordae fusion and shortening, decrease in orifice size

47
Q

MS gradient

A

normal: 0
mild: <8
moderate: 8-12
severe: >12

48
Q

MS dx

A

echo-need to look at pressure gradient and velociyt

cardiac cath- directly measure left atrial and left ventricular pressure

Cardiology (inpatient) (14 decks)

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