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NURP 533 > Week 6 > Flashcards

Week 6 Flashcards

(59 cards)

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1
Q

What are the systolic murmurs

A 
aortic stenosis
pulmonic stenosis
mitral regurgitation
tricuspid regurgitation
mitral valve prolapse
ventricular septal defect
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2
Q

Aortic Stenosis

A

The valve doesn’t open properly.
characteristics include crescendo/decrescendo, mid systolic harsh sound.
located at right sternal border. may radiate to neck and carotids.
sound exacerbates with activity.
Causes LVH (treat with ACE inhibitor)
occurs late in life

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3
Q

what do you treat LVH with?

A

ACE inhibitors because it remodels

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4
Q

pulmonic stenosis

A

crescendo/ decrescendo, hard medium pitch,

3rd left intercostal space down the left sternal border to the apex

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5
Q

mitral regurgitation

A

blowing, pansystolic, heart at the apex, radiating to the axilla.
often seen with a-fib.
causes right sided heart failure

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6
Q

tricuspid regurgitation

A

in systole, high pitched, heard at left sternal border, may radiate to the right sternal border.

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7
Q

mitral valve prolapese

A

way more common in young women (15-30) than men.
mid to late systole, honking noise. may have systolic click. sounds can be intermittent.
heard at left lower sternal border

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8
Q

ventricular septal defect (VSD)

A

pansystolic, loudest in mid systole. heard at left sternal border radiating to the right sternal border. pressure higher on L side of heart. shunting to the right side

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9
Q

diastolic murmurs

A

aortic regurgitation
pulmonic regurgitation
mitral stenosis
tricuspid stenosis

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10
Q

aortic regurgitation

A

decrescendo. high pitched, loud “lowing” sound. best heard at Erb’s point, or slightly lower.

may be without symptoms for years.
or could have palpitations, heightened awareness of heartbeat, head pounding.

LVH leads to decreased LVEF. eventually may lead to right sided HF

HF is a late sign of AF and is associated with poor prognosis.

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11
Q

symptoms of right sided heart failure

A

fatigue, cough, progressive dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea

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12
Q

pulmonic regurgitation

A

decrescendo, high pitched soft sound. heard best at left upper sternal border. intensity increases with inspiration(have pt take a deep breath).
most common cause is congenital.

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13
Q

mitral stenosis

A

low pitched, may be observed a-fib.

best heard with the patient lying in the left lateral recumbent position.

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14
Q

tricuspid stenosis

A

decrescendo, low pitched. heard at left upper sternal border, may be heard down to xiphoid process.
may be seen where there is mitral stenosis.

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15
Q

who should get prophylactic antibiotics?

A

prosthetic heart valve, past valve repair, hx of infectious endocarditis, congenital heart disease, hx of surgery or procedures affecting the heart.

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16
Q

grade I heart murmur

A

very faint, heart with intent listening. may not be heard in all position

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17
Q

grade II heart murmur

A

quiet. heard immediately after placing the stethoscope on the chest

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18
Q

grade III heart murmur

A

moderately loud

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19
Q

grade IV heart murmur

A

loud. palpable thrill

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20
Q

grade V heart murmur

A

very loud with thrill.may be heard when stethoscope is partly off the chest

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21
Q

grade VI heart murmur

A

very loud with thrill. may be heard with stethoscope entirely off the chest

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22
Q

What time frame does the patient start taking abx before procedure

A

30-60 minutes before dental, oral, respiratory tract procedures

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23
Q

what is standard prophylaxis abx for dental procedures

A

amoxicillin (2g PO) for adult
ampicillin (2g PO) for adult
OR
cefazolin or ceftriaxone 1g IV

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24
Q

what is standard prophylaxis abx for dental procedures for those allergic to penicillin

Study These Flashcards
A

cephalexin (2g PO)
cindamycin (600 mg PO)
azithromycin / clarithromycin (500 mg PO)

25
what is standard prophylaxis abx for dental procedures for those allergic to penicillin or unable to tolerate PO anx
cefazolin or ceftriaxone (1g IV) OR clindamycin (600 mg IC)
26
acyanotic congenital heart diseases
``` "LEFT TO RIGHT" VSD/ASD PDA coarctation of the aorta aortic stenosis pulmonic stenosis ```
27
VSD/ASD
mixing of the oxygenated blood (from the left ) and unoxygenated blood (from the right). left to right shunt. lungs are getting oxygenated blood. (not a bad thing) ASD- left to right atrium VSA- left to right ventricle
28
patent ductus arteriosis (PDA)
usually closes within 24 to 72 hours. pulmonary artery carries deoxygenated blood refer pt to cardiologist
29
coarctation of the aorta
results in decreased perfusion to the abdominal organs and lower periphery. (it is like a kink in a hose. The kink is below the 3 great vessels on aorta).
30
Aortic stenosis can cause
LVH
31
pulmonic stenosis can cause
RVH | may result in re opening of the foramen ovale (can result in stroke)
32
cyanotic congenital heart diseases
``` "RIGHT TO LEFT" tetrology of fallot transposition of the great vessels trucuspid atresia truncus arteriosis hypoplastic left heart syndrome ```
33
tetrology of fallot
aorta overrides VSD. right ventricular outflow obstruction. ventricular septal defect can occur. RVH can occur. not dx or treated in primary care
34
transposition of the great vessels
aorta rises from the right ventricle. pulmonary artery arises from the left ventricle. (flipped from normal) VSD is compensatory, Patent foramen ovale or PDA will be managed by cardiac surgery
35
tricuspid atresia
blood enters RA but has no way to get to the RV. VSD compensates. this requires surgery
36
truncus arteriosis
single great vessel where both ventricles contribute blood. can lead to RVH
37
hypoplastic left heart syndrome
``` short survival rate. found in utero 5 year survival rate. Left ventricle is small. aorta is small. unable to push out alot of blood to the body RV is extremely large ```
38
p wave is absent in
a-fib
39
PR interval is > 0.2 seconds , what is it
1st degree heart block
40
if there are alot of p waves, it indicates what
3rd degree heart block
41
q waves are
pathologic. they indicate a prior myocardial injury
42
delta wave indicates
wolff-parkinson-white syndrome
43
atrial fibrillation
most common dysrhythmia . quivering atrium, not contracting. pt loses 20% cardiac output. at increased risk for clot/stroke due to stagnant/pooling blood. RVR is heart rate >110. (can cause troubled hemodynamics) there is a relationship with hyperthyroidism that causes it. perform CHA2DS2 VASc score to determine risk for strroke
44
treatment for A-fib
beta blockers to control rhythm abalation if new onset anticoagulant amiodarone- can increase risk for pulmonary fibrosis with longterm use.
45
CHA2DS2 VASc score
``` afib stroke risk tool CHF HTN Age >75 DIABETES STROKE VASCULAR DISEASE AGE 65-74 SEX (female) ``` each category is 1 -2 points
46
CHA2DS2 VASc score of 0
low risk
47
CHA2DS2 VASc score of 1
moderate risk. | male should be consider starting anticoagulants
48
CHA2DS2 VASc score of 2
high risk. start on oral anticoagulant
49
Dx test to assess for structure/ function of valves
echocardiogram
50
LVD develops in a patient. what other valve disorder would you expect?
aortic stenosis
51
RVH develops in a patient. what other valve disorder would you expect?
pulmonic stenosis
52
who would get prescribed a holter monitor?
pt with palpitations
53
biggest etiology for developing heart valve issues
rheumatic heart disease
54
palpitations
most common tachyarrhythmia causes: stress, chemicals, caffeine dx: event monitor for 14-30 days or holter monitor for 24 hours
55
What are 3 red flag symptoms of a heart murmur?
Holosystolic, diastolic, >/= grade 3, increasing intensity when standing, diastolic, a/w new extra heart sound
56
A 10 month old patient present to the clinic for a potential ear infection. During exam, the provider notes a new onset short, musical, systolic murmur. What should the provider do next?
Urgent referral to cardiology (ANY child < 1 year old should be referred, even if the murmur appears innocent)
57
Your patient presents with a harsh, holosystolic, murmur that is best heard at the apex and radiates to the axilla. This is most likely what?
mitral regurgitation
58
How often should patients with Mitral Valve Prolapse should get an echocardiogram?
q 3-5 years
59
Describe the classic murmur found in hypertrophic cardiomyopathy?
Pansystolic murmur, quieter with squatting/louder when standing

NURP 533 (7 decks)

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