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Flashcards in Valvular Heart Disease Deck (57)
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1

S1

closure of AV valves at start of ventricular systole

2

S2

closure of semilunar valves at start of ventricular diastole

3

S3

sound of rapid filling of ventricles during early diastole

4

S4

sound of late filling from atrial kick in late diastole

5

Cause of Aortic Stenosis (AS)

Senile calcific, bicuspid, rheumatic, congenital, Paget’s, ESRD

6

Medical history of pt with AS

*Angina, *Syncope (fixed obstruction and cannot augment CO under conditions of low SVR; ie: meds, vasovagal), *CHF

SAD- syncope, angina, dyspnea (CHF)

7

Cardiac exam with AS

***Harsh crescendo-decrescendo, late-peaking SEM (systolic ejection murmur) radiating to the neck (carotid arteries)***
-palpable systolic thrill, sustained LV impulse, pulsus parvus et tardus (pulses are weak with delayed peak)
-S2 single (A2 is absent), paradoxical split S2, S4 gallop (S4 heard during diastolic dysfunction)

8

EKF with AS shows

-LVH (left vent hypertrophy)
-LBBB

9

CXR with AS shows

AV calcification, LV prominent without dilation

10

Valsava maneuver is a provocative maneuver for hypertrophic cardiomyopathy and works by

makes L vent smaller, makes murmur LOUDER, less blood in L ventricle,decreasing venous return to R and L heart

11

Squatting is a provocative maneuver for hypertrophic cardiomyopathy and works by

SOFTER WITH SQUATING, more blood is being pushing into heart, more venous return, L vent gets bigger, more turbulence, SOFTER murmur

12

Pulse pressure gets ______ with HCOM (hypertrophic cardiomyopathy); AS pulse pressure is _________

smaller/lower

the same or HIGHER peak (brown heart phenomenon)

13

What indicates a berry aneurysm?

Coarctation of the aorta, headaches, *bicuspid valve stenosis*

14

50% mortality for angina, syncope and CHF?

angina (5 yrs)
syncope (3 yrs)
CHF (2 yrs)

15

Surgery for AS

TAVR (transaortic valve replacement)
-Put in a new valve (bioprosthetic or mechanical)
-Elderly need valve for 10-15 yrs, use bioprosthetic
-50 year old or younger pt- use mechanical (only need 1 operation vs multiple replacements with bioprosthetic), need to take coumadin with this

16

**When EF falls below ____, need surgery, even with NO symptoms**

50

17

In valvular aortic stenosis there is an obstruction between ________, causing excessive muscle growth from septum with turbulent blood

LV and blood leaving aorta

18

Supravalvular aortic stenosis is caused by a syndrome called

Williams Syndrome
-congenital
-Murmur may radiate to subclavian artery (instead of carotid)

19

Shone's syndrome

-Subvalvular membrane
-congenital flap of tissue (membrane from atrium), causes Subvalvular aortic stenosis- needs surgery, obstructs flow, congenital abnormality, associated with coarctation

20

With severe aortic stenosis, may need to use Bernouli formula to calculate

can convert velocity into pressure and can calculate the valve area- USE ECHO!

21

Aortic Regurgitation (Chronic)

Aortic root dilation from HTN, CMN, bicuspid, ankylosing spondylitis, RA

22

Pt with Aortic Regurgitation will have history of

Dyspnea, Angina, Fatigue, CHF

23

Cardiac exam with Aortic Regurgitation will show

-High pitched blowing, early diastolic decrescendo murmur (on LSB if valvular on RSB if aortic)
-Wide pulse pressure, low diastolic pressure, bounding pulses (quick rising), laterally displaced PMI
-S3 gallop

24

Another murmur that may be heard with aortic regurg

Austin-flint murmur at apex (diastolic MR; MV struck by regurgitant jet, you will not hear loud S1 or OS which is common w/ mitral stenosis)

25

Other cardiac signs with aortic regurg

-Quinckes pulse: capillary pulsation
-DeMusset’s sign (head bobbing)
-Corrigan's sign: water hammer pulse
-Durosier's sign: femoral retrograde bruits
-Bisferiens pulse
-Mueller's sign: systolic pulsation of uvula
-Traube's sign: pistol shot femorals
-Hill's sign- BP lower ext > BP upper ext

26

CXR with aortic regurg shows

*Cardiomegaly, boot-shaped heart, LV enlargement (dilated LV)

27

Chronic Aortic insufficiency

Start with ace inhibitor or calcium channel blocker

-Chronic AI, LV has lots of time to adapt to increased flow volume (hypertrophies eccentrically, keeps forward output okay), eventually lose compensatory, eventually flow forward flow decreases and this mechanism fails

28

Aortic Regurgitation (acute) can be from

Endocarditis, Aortic dissection, ruptured sinus of Valsalva aneurysm

29

Aortic Regurgitation (acute), patient usually has history of

Acute pulmonary edema

30

Cardiac exam with acute aortic regurg

-Short diastolic murmur
-Faint S1