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Cardiovascular 4 > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

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1
Q

This is an inflammatory condition as a complication of group A strep.

A

Acute Rheumatic Fever (ARF)

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2
Q

What is it in the strep that causes the autoimmune reaction against cardiac antigens?

A

bacterial antigens

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3
Q

How many of these major criteria must you have to serve the Dx of rheumatic fever?

Carditis
Polyarthritis
Syndenham chorea
Erythema marinatum
SubQ nodules
A

2

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4
Q

If you only have 1 major criteria, how many of these MINOR criteria must you have to serve the Dx of rheumatic fever?

Migratory arthralgias
Fever
Increased acute phase reactants
Prolonged PR interval on EKG

A

2

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5
Q

What drugs do you give for the inflammation in rheumatic fever? infection?

A

ASA for inflmammation

PCN for infection

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6
Q

Which antibodies can u screen for to see if the pt has a strep infection, leading to rheumatic fever?

A

Antistreptolysin 0 Ab’s

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7
Q

Where can u swab to get a culture for Strep A?

A

throat

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8
Q

What should be given to pt’s who have had ARF before until early adulthood?

A

low-dose PCN

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9
Q

This is an area of focal fibrinoud necrosis surrounded by inflammatory cells that eventually form scar tissue in ARF,

A

Aschoff body

buzz word!

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10
Q

Rheumatic fever can cause what type of valvular problem, leading to a murmur?

A

MS

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11
Q

MS can lead to what problem in the lungs?

A

pulmonary edema from increased back pressure

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12
Q

What type of pulmonary HTN can form from back pressure?

A

passive pulomnary HTN

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13
Q

What type of pulmonary HTN can form from medial hypertrophy and intimal fibrosis of the pulmonary arterioles?

A

reactive pulmonary HTN

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14
Q

Reactive pulmonary HTN can cause hypertropy of which heart chamber?

A

RV

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15
Q

And reactive pulmonary HTN can cause pulomonary edema, and subsequently what 3 conditions?

A

dyspnea, CHF, hemoptysis

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16
Q

This is the stage of MS where you likely only have dyspnea on exertion.

A

Mild MS

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17
Q

This is the stage of MS where you have dyspnea at rest, increasing fatigue, and more severe signs of pulmonary congesting.

A

More severe MS

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18
Q

This is the stage of MS where you have signs of R-sided heart failure, including JVP, hepatomegaly, ascites, and peripheral edema.

A

Advanced MS

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19
Q

How do u treat the vascular congestion in MS?

A

Diuretics

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20
Q

How do u Tx Afib if it develops in MS? (3 drugs)

A

B-blockers, CCB, or digoxin

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21
Q

What theraphy is recommended to prevent clots if the pt has both MS and Afib?

A

Chronic anticoagulation

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22
Q

What surgical treatment can u do to treat MS?

A

Percutanous baloon mitral valvuloplasty (PBMV)

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23
Q

In MR, the volume leaks back into the LA, but then returns to the LV during diastole, causing what to the SV to compensate for ↓ CO?

A

↑ SV

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24
Q

What is the eqn for the regurtitant fraction?

A

RF = (volume of MR)/(total LV SV)

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25
This is the type of MR where there is sudden rupture of the chordae tendineae, the LA is stiff, and there is rapid pulmonary congestion and edema.
Acute MR | very bad
26
This is the type of MR where there is rheumatic valve disease, the LA is dilated and compensatory, ↓ CO, and possible Afib.
Chronic MR
27
In acute MR, what can u give to treat the pulmonary edema?
vasodilators (IV Na nitroprussides)
28
What is the best treatment for chronic MR?
Mitral valve repair
29
What causes the mid-systolic click in MVP?
tensing of the mitral leaflet or chordae tendineae as the leaflet is forced back toward the LA
30
And then what causes the actual murmur in MVP?
regurgitant flow through the incompetent valve
31
True or False: the clinical course of MVP is usually benign.
True
32
What is the age-related change of the aortic valve, leading to AS?
calcification
33
Which chamber can be hypertorphic in AS?
LV
34
If the LV becomes concentrically hypertrophied, what happens to the compliance?
decreases
35
And a decreased compliance of the LV can lead to hypertrophy in which chamber?
LA
36
What are the 3 classic Sx of AS?
Angina Exertional syncope CHF
37
What is the 1 year survival rate for pts with severe AS?
1 year
38
What is the only Tx for AS?
Replacement.
39
What are the 2 indications for AS surgery?
1. pt has AS and Sx | 2. Progressive LV dysfxn in the absence of Sx
40
What are the 2 causes of AR?
diseases of the aortic leadlets of dilation of the aortic root.
41
Why is there dilation of the LV in chronic AR?
Because the LV has to pump both the volume from the LA + the regurgitant blood from the aorta.
42
What happens to the pulse pressure in chronic AR?
Widens (high systolic, low diastolic)
43
Due to decreased aortic diastolic pressure and less perfusion to the coronary arteries, what is a classical Sx of AR?
Angina
44
True or False: it is common for pts with chronic AR to be aymptomatic and have normal LV fxn.
False.
45
What 2 drugs can u give for pts with asymptomatic AR + preserved LV fxn + HTN?
CCB's and ACEI's
46
What 2 types of AR pt's get surgery?
1. symptomatic pts | 2. impaired LV fxn with an ejection fraction <0.50
47
What is the most common cause of TR?
RV elargement
48
Which bowel syndrome can cause TR?
carcinoid syndrome
49
Which waves on JVD is prominent in TR?
v wave | when the RV is contracting
50
True or False: TR is louder during inspiration.
True! it's on the R side of the <3
51
What makes mechanical valves great?
They're durable.
52
What is the big problem with mechanical valves?
Thrombus formation and hemolysis
53
So what must the pt's with a mechanical valve be placed on for life?
Anticoagulation
54
Bioprosthetic valves have the advantage over mechanical ones in that they don't cause what as easily?
Thrombi
55
What is the problem with bioprosthetic valves?
structural failures
56
What is the most common organism to cause native valve endocarditis (NVE)?
Oral strep and enterococci
57
What is the most common organism to cause early prosthetic valve endocarditits (PVE)?
Coagulase-neg staph
58
What is the most common organism to cause late PVE?
Oral strep and enterococci
59
What is the most common organism to cause endocarditis in IV drug users (IVDU)?
Staph aureus
60
What does HAECK stand for the caustive organisms for subacute endocarditis?
``` Haemophilus Actinobacillus Cardiobacterium hominis Eikenella corrodens Kingella ```
61
Haemophilus- characteristics
pleomorphic, coccobacilli
62
Actinobacillus- characteristics
immotile, non-spore forming, oval to rod shape
63
Cardiobacterium hominis- characteristics
Catalase neg, oxidase +, indole producing
64
Eikenella corrodens- characteristics
faculative anaerobe, oxidase +, catalase 0, urease -, indole -
65
Kingella- characteristics
Aerobic coccobacilli, oxidase +, catalase -, B-hemolytic
66
Endocardial surface injury, thrombus formation, bacterial entry form the circulation, and bacterial adherance to injured endocardial surface can all lead to what condition?
infective endocarditis
67
What is the most common mechanism for endothelial injury?
Turbulent blood flow from valvular disease
68
What it is on injured endocardium that the bacteria adheres to?
fibrin-platelet deposits
69
What may protect the bacteria from phagocytosis once they adhere?
fibrin
70
What are the Sx to acute infective endocarditis (IE)?
explosive and rapidly progressive illness with high fever and shaking chills
71
What are the Sx to aubacute IE?
low-grade fever with nonspecific Sx like fatigue, anorexia, weakness myalgia and night sweats.
72
R-sided valvular lesions (TR) is common in endocarditis associated with what?
IV drug use
73
Where is the common place for embolism in a R-sided IE?
lung
74
Embolitic infarction of the vasa vasorum can lead to what condition of arteries?
aneurysm
75
These are small longitudinal hemorrhages found beneath the nails, and are indicative of septic embolism or immune complex deposition.
Splinter hemorrhages
76
These are painless, flat, irregular discolerations found on the palms and soles and are indicative of septic embolism or immune complex deposition.
Janeway lesions
77
These are tender, pea-sized erythematous nodules on the fingers and toes and are indicative of septic embolism or immune complex deposition.
Osler nodes
78
These are emboli to the retina that produces inroinfarctions, appear as white dots surrounded by hemorrhages, and are indicative of septic embolism or immune complex deposition.
Roth spots
79
What is the most common mechanism to get PVE?
Dental work
80
What is the bug to cause IE from GI surgery?
Enterococcus
81
What is the bug to cause IE from colon cancer?
S. bovis and S. equinus
82
What is the bug to cause IE from pregnancy?
S. agalactiae
83
What is the most common congenital valve anomaly?
Calcific stenosis of bicuspid aortic valve.
84
Mitral calcification is common in waht types of people?
Women > 60
85
In mitral calcification, what do the nodules provide a site for?
Thrombi formation (can lead a stroke)
86
What are the main complications to MVP?
Infective endocarditis, MR, stroke, systemic infarct, arrhythmias
87
SLE can set up vavlvulitis of which valves?
Mitral and tricuspid
88
Carcinoid heart disease usually affects which side of the heart?
R
89
Which condition leads to small and warty nodules in a line along the closure? Rheumatic Heart Disease Nonbacterial Thrombotic endocarditis Endocarditis of SLE Infective endocarditis
RHD
90
Which condition leads to Large and irrgular clumped nodules, and can extend to the chordae? Rheumatic Heart Disease Nonbacterial Thrombotic endocarditis Endocarditis of SLE Infective endocarditis
IE
91
Which condition leads to small and bland nodules, along the lines of the closure? Rheumatic Heart Disease Nonbacterial Thrombotic endocarditis Endocarditis of SLE Infective endocarditis
NTE
92
Which condition leads to small to medium nodules, may be on either sides of the valve? Rheumatic Heart Disease Nonbacterial Thrombotic endocarditis Endocarditis of SLE Infective endocarditis
SLE

Cardiovascular 4 (9 decks)

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