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NURP 533 > Week 6 > Flashcards

Week 6 Flashcards

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

A

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

25
Q

what is standard prophylaxis abx for dental procedures for those allergic to penicillin or unable to tolerate PO anx

A

cefazolin or ceftriaxone (1g IV)
OR
clindamycin (600 mg IC)

26
Q

acyanotic congenital heart diseases

A 
"LEFT TO RIGHT"
VSD/ASD
PDA
coarctation of the aorta
aortic stenosis
pulmonic stenosis
27
Q

VSD/ASD

A

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
Q

patent ductus arteriosis (PDA)

A

usually closes within 24 to 72 hours.
pulmonary artery carries deoxygenated blood
refer pt to cardiologist

29
Q

coarctation of the aorta

A

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
Q

Aortic stenosis can cause

A

LVH

31
Q

pulmonic stenosis can cause

A

RVH

may result in re opening of the foramen ovale (can result in stroke)

32
Q

cyanotic congenital heart diseases

A 
"RIGHT TO LEFT"
tetrology of fallot
transposition of the great vessels
trucuspid atresia
truncus arteriosis
hypoplastic left heart syndrome
33
Q

tetrology of fallot

A

aorta overrides VSD. right ventricular outflow obstruction.
ventricular septal defect can occur. RVH can occur.
not dx or treated in primary care

34
Q

transposition of the great vessels

A

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
Q

tricuspid atresia

A

blood enters RA but has no way to get to the RV.
VSD compensates.

this requires surgery

36
Q

truncus arteriosis

A

single great vessel where both ventricles contribute blood. can lead to RVH

37
Q

hypoplastic left heart syndrome

A 
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
Q

p wave is absent in

A

a-fib

39
Q

PR interval is > 0.2 seconds , what is it

A

1st degree heart block

40
Q

if there are alot of p waves, it indicates what

A

3rd degree heart block

41
Q

q waves are

A

pathologic. they indicate a prior myocardial injury

42
Q

delta wave indicates

A

wolff-parkinson-white syndrome

43
Q

atrial fibrillation

A

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
Q

treatment for A-fib

A

beta blockers to control rhythm
abalation if new onset
anticoagulant
amiodarone- can increase risk for pulmonary fibrosis with longterm use.

45
Q

CHA2DS2 VASc score

A 
afib stroke risk tool
CHF
HTN
Age >75
DIABETES
STROKE
VASCULAR DISEASE
AGE 65-74
SEX (female)

each category is 1 -2 points

46
Q

CHA2DS2 VASc score of 0

A

low risk

47
Q

CHA2DS2 VASc score of 1

A

moderate risk.

male should be consider starting anticoagulants

48
Q

CHA2DS2 VASc score of 2

A

high risk. start on oral anticoagulant

49
Q

Dx test to assess for structure/ function of valves

A

echocardiogram

50
Q

LVD develops in a patient. what other valve disorder would you expect?

A

aortic stenosis

51
Q

RVH develops in a patient. what other valve disorder would you expect?

A

pulmonic stenosis

52
Q

who would get prescribed a holter monitor?

A

pt with palpitations

53
Q

biggest etiology for developing heart valve issues

A

rheumatic heart disease

54
Q

palpitations

A

most common tachyarrhythmia

causes: stress, chemicals, caffeine
dx: event monitor for 14-30 days
or holter monitor for 24 hours

55
Q

What are 3 red flag symptoms of a heart murmur?

A

Holosystolic, diastolic, >/= grade 3, increasing intensity when standing, diastolic, a/w new extra heart sound

56
Q

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?

A

Urgent referral to cardiology (ANY child < 1 year old should be referred, even if the murmur appears innocent)

57
Q

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?

A

mitral regurgitation

58
Q

How often should patients with Mitral Valve Prolapse should get an echocardiogram?

A

q 3-5 years

59
Q

Describe the classic murmur found in hypertrophic cardiomyopathy?

A

Pansystolic murmur, quieter with squatting/louder when standing

NURP 533 (7 decks)

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