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Flashcards in Valvular Heart Disease Deck (57)
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1
Q
S1
A
closure of AV valves at start of ventricular systole
2
Q
S2
A
closure of semilunar valves at start of ventricular diastole
3
Q
S3
A
sound of rapid filling of ventricles during early diastole
4
Q
S4
A
sound of late filling from atrial kick in late diastole
5
Q
Cause of Aortic Stenosis (AS)
A
Senile calcific, bicuspid, rheumatic, congenital, Paget’s, ESRD
6
Q
Medical history of pt with AS
A
*Angina, *Syncope (fixed obstruction and cannot augment CO under conditions of low SVR; ie: meds, vasovagal), *CHF

SAD- syncope, angina, dyspnea (CHF)
7
Q
Cardiac exam with AS
A
***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
Q
EKF with AS shows
A
-LVH (left vent hypertrophy)
-LBBB
9
Q
CXR with AS shows
A
AV calcification, LV prominent without dilation
10
Q
Valsava maneuver is a provocative maneuver for hypertrophic cardiomyopathy and works by
A
makes L vent smaller, makes murmur LOUDER, less blood in L ventricle,decreasing venous return to R and L heart
11
Q
Squatting is a provocative maneuver for hypertrophic cardiomyopathy and works by
A
SOFTER WITH SQUATING, more blood is being pushing into heart, more venous return, L vent gets bigger, more turbulence, SOFTER murmur
12
Q
Pulse pressure gets ______ with HCOM (hypertrophic cardiomyopathy); AS pulse pressure is _________
A
smaller/lower

the same or HIGHER peak (brown heart phenomenon)
13
Q
What indicates a berry aneurysm?
A
Coarctation of the aorta, headaches, *bicuspid valve stenosis*
14
Q
50% mortality for angina, syncope and CHF?
A
angina (5 yrs)
syncope (3 yrs)
CHF (2 yrs)
15
Q
Surgery for AS
A
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
Q
**When EF falls below ____, need surgery, even with NO symptoms**
A
50
17
Q
In valvular aortic stenosis there is an obstruction between ________, causing excessive muscle growth from septum with turbulent blood
A
LV and blood leaving aorta
18
Q
Supravalvular aortic stenosis is caused by a syndrome called
A
Williams Syndrome
-congenital
-Murmur may radiate to subclavian artery (instead of carotid)
19
Q
Shone's syndrome
A
-Subvalvular membrane
-congenital flap of tissue (membrane from atrium), causes Subvalvular aortic stenosis- needs surgery, obstructs flow, congenital abnormality, associated with coarctation
20
Q
With severe aortic stenosis, may need to use Bernouli formula to calculate
A
can convert velocity into pressure and can calculate the valve area- USE ECHO!
21
Q
Aortic Regurgitation (Chronic)
A
Aortic root dilation from HTN, CMN, bicuspid, ankylosing spondylitis, RA
22
Q
Pt with Aortic Regurgitation will have history of
A
Dyspnea, Angina, Fatigue, CHF
23
Q
Cardiac exam with Aortic Regurgitation will show
A
-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
Q
Another murmur that may be heard with aortic regurg
A
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
Q
Other cardiac signs with aortic regurg
A
-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
Q
CXR with aortic regurg shows
A
*Cardiomegaly, boot-shaped heart, LV enlargement (dilated LV)
27
Q
Chronic Aortic insufficiency
A
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
Q
Aortic Regurgitation (acute) can be from
A
Endocarditis, Aortic dissection, ruptured sinus of Valsalva aneurysm
29
Q
Aortic Regurgitation (acute), patient usually has history of
A
Acute pulmonary edema
30
Q
Cardiac exam with acute aortic regurg
A
-Short diastolic murmur
-Faint S1
31
Q
CXR
A
Normal heart size, pulmonary congestion
32
Q
*Acute* AI, surgery or no?
A
Surgical emergency!!
33
Q
For chronic AI pt, don't use
A
Don’t use beta blocker, more regurgitation (prolongs diastole)
34
Q
Mitral Regurgitation (Chronic), causes are
A
-MVP (valve prolapse)
-**Rheumatic fever (more likely MS)
-secondary (ischemic, cardiomyopathy)
-usually seen post MI
-LV dilatation
35
Q
Mitral Regurgitation (Chronic) shows history of
A
Late-onset of CHF, later R-heart failure
36
Q
Cardiac exam of chronic MR shows
A
-holosystolic, high pitched "blowing murmur" murmur
-loudest at apex, radiates to axilla
-S3 gallop and wide-split S2
37
Q
CXR of chronic MR shows
A
Cardiomegaly, LV/LA enlargement
38
Q
Mitral Regurgitation ACUTE causes
A
Endocarditis, papillary muscle rupture in setting of MI
39
Q
Mitral Regurgitation ACUTE, patient shows hx of
A
Acute pulmonary edema
40
Q
Mitral Regurgitation ACUTE cardiac exam shows
A
-Decrescendo systolic murmur radiates to neck if posterior leaflet and back if anterior leaflet, loud P2, widely split S2
41
Q
CXR for Mitral Regurgitation ACUTE shows
A
Pulmonary edema, normal heart size
42
Q
Echo for Mitral Regurgitation ACUTE shows
A
flail leaflet (if papillary muscle was ruptured)
**WILL SEE LARGE V WAVES** (test)
43
Q
Mitral Regurgitation ACUTE, surgery or no?
A
URGENT, can temporize with vasodilators
44
Q
MVP (Mitral Valve Prolapse) Squatting vs standing?

KNOW THIS!
A
Squatting- more filling- more blood- longer time before you heart the click- its closer to S2

Standing- less blood on left side- less filling- shorter on the click- heart it closer to S1
45
Q
Mitral stenosis causes
A
-*Rheumatic fever
-calcifications
46
Q
Mitral stenosis, patient hx
A
Late-onset of CHF, later R-heart failure
47
Q
Mitral stenosis cardiac exam
A
-follows opening snap
-deceased interval between S2 and opening snap means its more severe (no snap if end state, too much stenosis)
-Diastolic rumble at apex -short S2-OS interval, loud P2, RV heave
-Anything that increases the gradient will increase the murmur intensity
-LA pressure > LV pressure during diastole
48
Q
EKG for MS will show
A
left atrial enlargement and
a fib
-GIANT P WAVES

*NOTHING HAPPENS TO L VENT
49
Q
CXR for MS will show
A
Pulmonary vein congestion, massive L atrial enlargement
50
Q
Mitral stenosis, patient will present with
A
-will have hoarseness (pressing on recurrent laryngeal nerve)
51
Q
Tricuspid Regurgitation causes
A
Rheumatic, carcinoid, functional from RV failure, Ebstein’s anomaly (congenital displacement of anterior tricuspid valve leaflet, severe TR)
-(commonly caused by RV dilation)
52
Q
TR pt history
A
R-sided CHF predominates
53
Q
Tricuspid regurgitation cardiac exam
A
-Holosystolic murmur at LLSB
-*louder with inspiration (Carvallo’s sign)
-**prominent CV waves*** and rapid y descent
-Loudest at tricuspid area, radiates to RIGHT sternal border
54
Q
Secondary (Functional)
Tri Regurg
A
Left-sided CHF, MS, MR, primary pulmonary disease, L to R shunt, pulmonic valve stenosis, PA stentosis
55
Q
PRIMARY Tri Regurg
A
Carcinoid, due to pacemaker, endocarditis, rheumatic fever, marantic, drug-induced, Ebsteins
56
Q
Other rare stenosis
A
slide 43
57
Q
Drug-induced valve disease
A
-Ergot alkaloids
-For migraines
-Fen-fen
-Pergolide (L sided valve disease)
-MDMA (ecstasy)
-IVDA-->endocarditis