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CPR 2 Exam 1 > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

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1
Q

What does valvular heart disease most commonly arise from?

A

Degenerative senile calcification
Myxomatous degeneration
Congenital bicuspid aortic valve

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2
Q

What is myomatous degeneration?

A

Remodeling of collagen and ECM
Thinning if fibrin
Thickening of valve leaflets

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3
Q

What do murmurs result from?

A

Turbulence across valves and or increase blood flow (anemia, pregnancy)

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4
Q

What is stenosis?

A

Sclerosis, fibrous, calcification

Impedes forward flow

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5
Q

What does stenosis create?

A

Pressure overload

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6
Q

What does regurgitation create?

A

Volume overload

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7
Q

What is regurgitation?

A

Insufficiency, incompetence

Reversal of flow, valve leaks, fails to close

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8
Q

What are the systolic murmurs?

A 
Mitral regurgitation
Tricuspid regurgitation
Aortic stenosis
Pulmonic stenosis
VSD
ASD
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9
Q

What are diastolic murmurs?

A 
Aortic regurgitation
Pulmonic regurgitation
Mitral stenosis
Tricuspid stenosis
Atrial myxoma
PA
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10
Q

What is grade 1 on the murmur scale?

A

Barely audible

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11
Q

What is grade 2 on the murmur scale?

A

Faint, soft

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12
Q

What is grade 3 on the murmur scale?

A

Louder, easily heard

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13
Q

What is grade 4 on the murmur scale?

A

Very loud with palpable thrill

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14
Q

What is grade 5 on the murmur scale?

A

Heard with the stethoscope barely touching the chest with thrill

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15
Q

What is grade 6 on the murmur scale?

A

Can hear without the stethoscope or can hear with stethoscope close to chest: palpable thrill

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16
Q

Which murmur grades do not have a palpable thrill?

A

1-3

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17
Q

What are causes of acute mitral regurgitation?

A 
Ischemic papillary muscle dysfunction
Rupture chordal tendinaeae
Infective endocarditis
Volume overload (LA pressure, pulmonary edema, RVF/LVF cardiogenic shock)
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18
Q

What are the causes of chronic mitral regurgitation?

A

Mitral valve prolapse
Myxomatous degeneration
Mitral annular calcification

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19
Q

Where is mitral regurgitation heard?

A

5th ICS at midclavicular line

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20
Q

What is heard on PE with mitral regurgitation?

A

Systolic murmur
Blowing at apex
Radiates to left axilla
Reduced S1 use diaphragm

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21
Q

What is mitral valve prolapse?

A

One or both leaflets prolapse into the left atrium

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22
Q

Which gender is mitral valve prolapse most common in?

A

Female

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23
Q

What is heard on auscultation with mitral valve prolapse?

A

Systolic murmur at apex

Click/murmur increase with valsalva and standing

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24
Q

What are symptoms of mitral valve prolapse?

A

Chest pain
ST
PVCs
Dyspnea

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25
When does the murmur increase with mitral valve prolapse?
Decrease of ventricular volume and chamber size
26
When does the murmur with mitral valve prolapse decrease?
Squatting | Hand grip
27
How do you treat mitral valve prolapse?
Reassure | Symptomatic give beta blocker
28
Is tricuspid regurgitation symptomatic?
No
29
What is tricuspid regurgitation associated with?
``` Pulmonary HTN Lung disease RV infarction Inferior wall MI IE Pacemaker ```
30
What is heard with tricuspid regurgitation?
Blowing systolic murmur | 4th ICS LSB
31
When does the tricuspid regurgitation murmur increase?
Inspiration
32
What murmur is the Carvallo sign associated with?
Tricuspid regurgitaion
33
What is seen on jugular venous pulse with tricuspid regurgitation?
Prominent V wave
34
What is the etiology of aortic stenosis?
Age related degenerative calcification Bicuspid aortic valve Rheumatic heart disease
35
What is the pathology associated with aortic stenosis?
Pressure overload | Right ventricular hypertrophy
36
The more severe the aortic stenosis the more narrow the what?
Outflow
37
The higher the gradient across the aortic valve the lower the what?
Area
38
What are the symptoms of aortic stenosis?
Dyspnea Angina Syncope
39
What is heard on PE with aortic stenosis?
``` Systolic murmur Crescendo-decrescendo Harsh 2nd ICS RSB Radiates into sternal notch/cardotids ```
40
What heart sound is diminished with aortic stenosis?
S2
41
What are the pulses in aortic stenosis?
Parvus (weak/small) | Tardus (slow rising, late pulse)
42
Is the pulse pressure wide or narrow with aortic stenosis?
Narrow
43
What is seen on the EKG with aortic stenosis?
``` Left ventricular hypertrophy Strain pattern (down sloping ST segment-T wave) ```
44
What is associated with aortic root dilation?
Bicuspid aortic valves
45
What do people with bicuspid aortic valves have a predisposition to?
Infective endocarditis
46
Where is bicuspid aortic valve most commonly heard?
LSB or apex
47
75% of bicuspid aortic valves turn into what?
Aortic stenosis
48
What connective tissue disorders is bicuspid aortic valve associated with?
Marfans | Turner's syndrome
49
What is heard with pulmonic stenosis?
``` Systolic murmur Crescendo-decrescendo 2-3 ICS LSB Radiates to left shoulder-clavicle ```
50
What conditions is pulmonic stenosis associated wtih?
``` Tetralogy of Fallot PS VSD RVH Overriding aorta ```
51
What is heard with VSD?
Holosystolic murmur Left lower sternal border with thrill Left-to-right shunt/murmur Increases with handgrip
52
What is heard with ASD?
Systolic murmur Upper LSB with fixed splitting of S2 Left-to-right shunt
53
What is the etiology of mitral stenosis?
Rheumatic heart disease Group A streptococci Congenital Mitral annular calcification
54
What does a decreased MVA area lead to?
Pulmonary HTN AVF LAE A fib.
55
What are the symptoms of mitral stenosis?
Dyspnea Orthopnea Palpitations Hoarseness (compression of left laryngeal nerve (Ortner's syndrome)
56
What is Ortner's syndrome?
Compression of left laryngeal nerve seen in mitral stenosis
57
What is heard on PE in mitral stenosis?
Diastolic murmur Low pitch (use bell) Rumbling at apex Inc. S1 and S2 followed by opening snap
58
What is seen on ECG in mitral stenosis?
``` Left atrial enlargement if in sinus rhythm A. Fib RVH RAD if associated with pul HTN Anticoagulated if in A fib ```
59
What is the etiology of tricuspid stenosis?
Rheumatic disease Carcinoid syndromes SLE Right atrial myxomas
60
What gender is tricuspid stenosis most common in?
Females
61
What is heard in tricuspid stenosis?
Diastolic murmur 4th ICS LSB Increases on inspiration
62
What is seen on jugular wave in tricuspid stenosis?
Prominent A wave
63
What is seen on ECG in tricuspid stenosis?
Right atrial enlargement (tall peaking of P waves)
64
What are the acute causes of aortic regurgitation?
Infective endocarditis Aortic dissection Chest trauma
65
What are the chronic causes of aortic regurgitation?
Calcific degeneration Bicuspid aortic root Rheumatic heart disease
66
What is the pathology associated with aortic regurgitation?
Volume overload LVH Left heart failure
67
What are the acute symptoms of aortic regurgitation?
Pulmonary edema from infective endocarditis
68
What are the chronic symptoms of aortic regurgitation?
Dyspnea Orthopnea Angina
69
What is heard with aortic regurgitation?
``` Diastolic decrescendo murmur 2rd ICS LSD Can mimic mitral stenosis (Austin Flint) Soft S2 ```
70
What is seen on PE with aortic regurgitation?
``` Wide pulse pressure DeMusset sign Quincke's sign Traube sign Duroziez's sign ```
71
What is the treatment for aortic regurgitation?
ACEi | ARB
72
What is the DeMusset sign?
Head bobs with beats
73
What is the Quincke's sign?
Capillary nail pulsation
74
What is the Traube sign?
"Pistol shot" (systolic and diastolic) sounds over femoral artery
75
What is Duroziez's sign?
Diastolic murmur over femoral artery when compressed with bell of stethoscope
76
What is heard in pulmonary regurgitation?
Diastolic Decrescendo 2nd ICS LSD (Graham Steele)
77
What is pulmonary regurgitation associated with?
Pulmonary HTN | Increased S2

CPR 2 Exam 1 (20 decks)

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