Valvular HD Flashcards
(76 cards)
1
Q
VHD
Main two types
A
- Congenital
- Acquired
2
Q
VHD
S1
A
Mitral and tricuspid closure
3
Q
VHD
S2
A
aortic and pulmonary V closure
4
Q
VHD
Apex beat
A
5th ICS just medial to the midclavicular line
5
Q
VHD
Peds murmurs heard above the nipple line
A
ejection systolic
6
Q
VHD
peds murmurs heard below the nipple line
A
Pansystolic
7
Q
VHD
Mitral valve normal size
A
4-6 cm2
8
Q
VHD
Mitral stenosis PC
A
- SOB
- Orthopnea
- PND
9
Q
VHD
Pulse in MS
A
irregularly irregular due to AF
10
Q
VHD
JVP in MS
A
prominent “a” wave if complicated by Pulm HTN
11
Q
VHD
Palpation in MS
A
tapping apex, parasternal heave
12
Q
VHD
Auscultation findings in MS
A
- Loud S1
- Opening snap
- Rumbling low- pitched mid diastolic murmur with presystolic accentuation
- Best heard in mitral area w expiration and left lateral position
- Pulm HTN - Loud P2
13
Q
VHD
S1 in MS
A
Loud
14
Q
VHD
Murmur in MS
A
rumbling low pitched mid diastolic murmur w presystolic accentuation
15
Q
VHD
murmur is MS is heard on
A
mitral area with expiration on left lateral position
16
Q
VHD
Signs of Pulm HTN
A
- Parasternal heave
- Loud palpable P2
17
Q
VHD
DDs of MS
A
- Carey coombs Murmur in acute rheumatic carditis
- Austin flint murmur in severe AR
- Atrial myxoma
18
Q
VHD
whats a carey coombs murmur
A
mitral V is swollen
19
Q
VHD
Atrial myxoma
A
a tumor growing through the mitral valve
20
Q
VHD
main cause of MS
A
Rheumatic fever
21
Q
VHD
MS is mostly affected among
A
Females> males
22
Q
VHD
severe stenosed MS
A
<1 cm2
23
Q
VHD
Complications of MS
A
- A fib
- Pulm edema
- IE
- Stroke ( AF can form thrombus)
24
Q
VHD
Ix of MS
A
- ECG
- 2D echo
- CXR
25
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ECG on MS
P mitrale ( bifid P wave)
26
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Ix of choice in Dx MS
2D echo
27
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CXR on MS
small heart w an enlarged L/ atrium
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Mx of MS
* Mx A fib
* interventional Mx
29
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Interventional Mx of MS
* PTMC ( Percutaneous transluminal mitral commisurectomy)
* Valvotomy
* Valve replacement ( rarely)
30
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When is PTMC considered in MS
* isolated MS
* Minimal MR
* L/atrium free of thrombus
* MV mobile and pliable
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Most Pts w MS present during
PG
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Two types of valve replacement
* metallic- Pt should be on long- standing warfarin
* Bioprosthetic - durability is ~ 10 years.
33
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why is bioprosthetic V not replaced on young females
it can get damaged during PG. so they are usually put in elderly
34
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MR apex
thrusting displaced apex
35
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Murmur in MR
pansystolic murmur at the apex radiating to the axilla
36
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Etiology of MR
* RF
* IE
* Degenerative
* IHD
* dilated cardiomyopathy
37
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Why does IHD cause MR
ruputre of papillary muscles
38
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Complicated MR can lead to
heart failure
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Ix for MR
* ECG - P mitrale, AF
* CXR- LV and LA dilated
* 2D echo
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Mx of MR
* MV repair, MV replacement
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Indications for surgery in MR
* Severe acute MR
* Severe chronic symptomatic MR
* ASx Chronic MR w evidence of progression of LV dilatation
42
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How can an austin flint murmur in severe AR cause MS
When blood backflows through the aortic V, it can hit the MV causing a MS
43
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PTMC
send a guiding wire and cute the stenosed V
44
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Isovolumic contraction
The Ventricles will be contracting as a closed chamber until it's pressure increases to snap open the aortic and pulmonic valves
45
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Ejection systole
When the pressure increases in the ventricles to open, blood will enter into the aorta and pulmonary artery
46
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Pressure changes in the cardiac cycle is reflected in the
internal jugular V
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waves in JVP
* a wave
* c wave
* v wave
48
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Two descents in JVP
* X descent
* Y descent
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a wave
**due to atrial systole**. SVC and IVC are valveless. So when the atria is contracting during systeole, some of the blood will regurgitate and see a pulsatile wave
50
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c wave
**during isovolumetric contraction.** when the ventricles contract as a closed chamber, due to the force, the TV and MV will be pushed out while remaining shut. this causes a reflex wave
51
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V wave
during atrial filling
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X descent
atrial relaxation
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Y descent
ventricular filling
54
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Abnormalities of JVP
* Non- pulsatile raised JVP
* Loss of a wave
* Prominent a wave
* canon a wave
* cv wave
* sharp x descent
55
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non- pulsatile raised JVP
SVC obstruction. due to the block, nothing from the atria will be transmitted to the int. jugular V. Also because of the block, blood gets backedup increasing JVP
56
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loss of a wave
no proper atrial contraction like in A fib
57
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Prominent a wave
tricuspid stenosis
Pulm HTN
58
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How can Pulm HTN cause a prominent a wave
Pulm artery pressure increase overtime. RV will undergo hypertrophy. High pressure in atria to push blood into RV coz the pressure in RV increase due to the hypertrophy. More blood regurgitated to the SVC
59
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Canon a wave
in complete heart block
No connection netween the atria and ventricles. Atria is unaware of what happened in the ventricles. So atria will contract while the TV and MV closed. ( It's the SA node that tells TV and MV to open for atrial systole) since there is a heart block, cardiac process not in sync. Pressure in atria increase more blood regurgitate to SVC.
60
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cv wave
tricuspid regurgitation. c & v become one large wave together
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sharp x descent
constrictive pericarditis
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AR Sx
* Exertional dyspnea
* palpitations
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Pulse AR
* collapsing pulse
* Prominent peripheral pulses
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AR apex
* displaced and hyperkinetic ( thrusting )
* Palpitations
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Murmur in AR
early diastolic M best heard at lower left sternal edge and patient sitting up and holding the breath on expiration
66
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Peripheral signs of AR
* head nodding ( de Musset's sign)
* Visible carotic pulsations ( Corrigan's sign)
* Capillary pulsations (Quincke's sign)
* Pistol shot femorals
* examination of the pupils - argyll robertson ( syphillis)
* Examine the joints and back for RA, ankylosing spondylitis
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etiology of AR
* Acquired
* Congenital
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Congenital causes for AR
* Marfans - aortic root dilatation
* Osteogenesis imperfecta
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Acquired causes of AR
* Rheumatic heart disease
* IE
* Trauma
* Aortic dissection
* Severe HTN
* Syphillid
* Seronegative arthritis
* Rheumatoid Arthritis
70
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a longer and a louder murmur
severe lesion
71
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How would you say is an AR is severe
* the longer the murmur the louder the murmur
* Presence of the austin - flint murmur
* Wide pulse pressure
* Features of LV failure
72
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Ix for AR
* ECG - LVH in advanced cases
* CXR- LV dilatation and aortic rootdilatation in some cases
* Echo
73
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Mx of AR
* Medical - Mx HF ( ACEI, diuretics)
* Surgical
74
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When to consider surgery in AR
* acute AR
* Sx patients
* ASx pts w progressively increasing ventricular dilatation and declining LV function
75
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PC of AS
* syncope
* SOB
* Chest pain
76
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