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Clin Med II- Exam 1 > Valvular HD > Flashcards

Valvular HD Flashcards

1
Q

Types of valvular disease

A 
Aortic stenosis (AS)
Aortic Regurgitation (AR)
Mitral stenosis (MS)
Mitral regurgitation (MR)
Mitral valve prolapse (MVP)
Pulm & tricuspid valvular disease
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2
Q

Sx of valve disease

A 
fatigue
dyspnea, orthopnea, PND
angina
syncope
palpitation
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3
Q

PE for valve disease

A

murmurs

venous & arterial pulses

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4
Q

Best diagnostic tool of valve disease

A

Echo (w/ doppler)

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5
Q

Dx for valve disease if concerned for concomitant CAD

A

Angiography

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6
Q

Aortic stenosis

A

narrow of aortic outflow tract

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7
Q

3 types of aortic stenosis

A

Subvalvulal
aortic valve (most common)
supravalvular

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8
Q

Cause of supravalvular AS

A

congenital or POST-OP!

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9
Q

Cause of subvalvular AS

A

congenital or HCM!

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10
Q

Etiology of AS

A

AGE!
below 30: congenital, unicuspid
30-65: congenital bicuspid which becomes calcified and stenotic (rheum. disease)
>65: degeneration & sclerosis of valves (most common)

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11
Q

Prognosis of AS

A

asymptomatic; when sx develop, mortality is significant (2-3 yrs w/o valve replacement)

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12
Q

Sx of AS

A

early: DOE, fatigue, decreased exercise tolerance
Later: dyspnea w/ normal activity, triad: angina, syncope, HF

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13
Q

PE for AS

A

systolic ejection murmur (crescendo-decrescendo)
max at 2 ICS or apex
transmitted up carotids (radiates to neck)
Thrill at 2nd RICS or suprasternal notch
SMALL PULSE PRESSURE
Vigorous LA contraction can lead to S4

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14
Q

Dx of AS

A

ECG: normal; may have LVH
CXR: normal, may have dilated aorta, calcification
Echo: immobile, calcified leaflets, LVH, aortic gradient and reduced valve area

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15
Q

Managment of AS

A

Aymptomatic: mild (follow), moderatue (annual ECG, Echo, CXR), moderate-esevere (cardiology eval, follow-up)

Symptomatic: cardiac cath. (gradient >50 is significant and may need valve replaced)

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16
Q

Education for AS

A

avoid strenuous activity, avoid dehydration (reduced CO), signs of worsening (dizziness, dyspnea, palpitation)

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17
Q

Valve replacement done

A

Symptomatic severe AS

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18
Q

Types of aortic valves

A

Prosthetic: ball & cage, tilting valve
Tissue: Porcine (pig) AV

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19
Q

Prosthetic valves

A

last longer

lifelong anticoagulation on Warfarin (INR 2.5-3.5)

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20
Q

Tissue Valves

A

don’t last long (replacement)

no lifelong anticoagulation

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21
Q

HCM murmur

A

systolic (cres-dec) like normal AS…EXCEPT it is louder w/ standing or valsalvas (decreased venous return and ventricular filling)

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22
Q

Tx for HCM

A

BB (then CCB)

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23
Q

Aortic Regurgitation (insufficiency)

A

leakage of blood back through aortic valve during diastole

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24
Q

Etiology of aortic regurgitation

A 
RHEUMATIC VALVE DISEASE
bicuspid valve
dilated aortic root (dissection)
bacterial endocarditis
senile degeneration
CT DISEASE (RA, Marfan, Ehlers-Danlos)
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25
Q

Acute AR

A

less common than chronic
aortic dissection, infective endocarditis
LV pressure rises rapidly
pulm edem and/or cardiogenic shock (heart can’t compensate for volume overload)
Traumatic rupture of valve cusp rare

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26
Q

Tx for acute AR

A

URGENT CARDIOLOGY CONSULT for meds & consideration of valve replacement

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27
Q

Chronic AR

A

LV overload w/ gradual dilation & hypertrophy

28
Q

Sx of chronic AR

A

asymptomatic 20+ years, then mild DOE; eventually s/sx of HF (increasing DOE, diaphoresis, angina, fluid accumulation)

29
Q

Prognosis of Chronic AR

A

once sx develop, deteriate rapid (<2 years w/ HF)

30
Q

PE for AR

A

high-pitched diastolic decrescendo (aortic area & left sternal border)
WIDE PULSE PRESSURE (increased systolic & decreased diastolic pressures): “water hammer” or “corrigan” pulse
can be w/ harsh systolic ejection murmur
AUSTIN-FLINT MUMUR- soft, low-pitched diastolic murmur at apex that sounds like mitral stenosis

31
Q

Corrigan pulse

A

rapid carotid

32
Q

Dx for AR

A

ECG: LVH if chronic
CXR: normal heart size if acute, LVH if chronic, possible HF/pulmonary edema
Echo: doppler shows regurgitation and can estimate severity

33
Q

Management of acute AR

A

URGENT: stabilize (IV diuretics, vasodilators), surgery w/i 24 hours

34
Q

Managment of chronic aortic regurgitation

A

asymptomatic/mild: follow 6-12 mo, vasodilators to reduce regurg volume and increase EF (ACEI*, or hydralazine & nifedipine); avoid isometric exercises

35
Q

Valve replacement for AR

A

advisable if symptomatic; refer to cardiology; vasodilators may delay need for surgery

36
Q

Mortality of Chronic AR

A

50% die in 2 years when HF sx. develop

Operative mortality: 3-10%

37
Q

Surgery for AR

A
  • symptomatic w/ severe AR regardless of LVEF

- Asymptomatic w/ severe and LVEF <50% at rest

38
Q

Bentall-aortic root/valve replacement

A

fake aorta piece; prevents dilation of aorta in AR

39
Q

Ross procedure

A

pulmonary autograft; switch aortic and pulmonary valves

40
Q

MR

A

leakage of blood from LV into LA due to any abnormality of valve apparatus (leaflets, chordae, papillary mm, valve annulus); acute or chronic

41
Q

Etiology of MR

A 
Death of papillary muscle secondary to MI
Inherited: MVP, Marfan
CT disease: SLE
Rheumatic
calcification in elderly
congenital maldevelopment of valve
42
Q

Acute mitral regurgitation etiology

A

papillary mm. necrosis/rupture from MI ;

Endocarditis

43
Q

Chronic MR

A

LV adapts to large blood volume by enlarge and increasing SV –> over time more than 1/2 blood ejects into LA during systole (a fib can develop due to LAE)

heart may compensate for years w/ normal CO, but eventually can’t keep up and HF develops

Pulm HTN and RVH may also develop

Progressive: MR begets MR

44
Q

Sign of MR

A

Massive LAE

45
Q

Cause LVH

A

AS and AR

46
Q

Cause LAE

A

MR

47
Q

Sx of MR

A

mild/mod: asymptomatic
sx appear over years: dyspnea, fatigue, orthopnea, arrhythmias (palpitations);

w/ LAE and RVH, pulmonary HTN develops (DOE, PND, pulm edema)

48
Q

PE for MR

A

pansystolic (holosystolic) murmur, loudest at apex, radiates to axilla;
S3 gallop

Pulm HTN: S4 gallop, loud P2 and RV heave/lift

Late disease (RV failure): JVD, heaptomegaly, edema

49
Q

Dx of MR

A

ECG: LAE, often LVH, a. fib possible; may see RVH if severe
CXR: LAE & LVH
Echo: LAE, LVH, hypderdynamic LV wall motion; doppler shows regurg

50
Q

LAE =

A

possible a. fib

51
Q

Management of acute MR

A

URGENT STABILIZATION (IV nitroprusside - decreases BP); & prep for surgery

52
Q

Management of chronic MR

A

limit activities that worsen sx
ACEI & vasodilator, if HTN (reduce afterload)
Reduce preload: sodium restriction, diuretics if hypervolemic
digitalis: a. fib
Anticoagulation: a. fib (warfarin 2-3 INR)

53
Q

Surgery for MR

A

Symptomatic severe acute MR

54
Q

Types of surgery for MR

A

valvuloplasty (repair)

valve replacement

55
Q

Mitral valve prolapse

A

ballooning of mitral leaflet into LA during systole (extra valve tissue); MR might also occur, w/ late systolic murmur; COMMON, usually benign

56
Q

Murmur for MVP

A

mid-systolic click

57
Q

Sx of MVP

A

atypical or non-anginal chest pain (no relief w/ rest)

Others: palpitations, dyspnea, DOE, syncope, panic/anxiety disorders, numbness/tingling, akeletal abnormalities, abnormal resting and exercise ECG

58
Q

MVP Dx

A

Echo shows prolapse

59
Q

Management of MVP

A

most cases are mild;
REASSURANCE (aerobic exercise, avoid stimulant, alcohol, stress reduction)

Betablockers: if palpitations/arrhythmias

If MR: follow

60
Q

Mitral stenosis etiology

A

rheumatic disease! (ARF, peri/myocarditis, valvular lesion, GAS)

61
Q

Signs of MS

A

thickened valve, pulmonary congestion (kerly B lines, edema, hemoptysis), LAE, laters: RVH, A. fib

62
Q

Murmur for MS

A

opening diastolic snap followed by rumble

63
Q

Dx of MS

A

angiography/cath

64
Q

Tx for MS

A

Mild: diuretic/Na restriction
Afib: anticoagulation
Severe: valvuloplasty, mitral comissurotomy, prosthetic valve

65
Q

Tricuspid and pulmonic disease

A

Etiology: congenital, Reu, CT

CXR: prominent R. heart border, dilated SVC
ECG: right axid deviation, RAE, RVH

66
Q

Dx for tri and pulmonic

A

echo and cath

67
Q

Tx for tricupsid and pulmonic

A

Na restriction
Diuretic
Surgery

Clin Med II- Exam 1 (7 decks)

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