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Cardiology > 02.17 Valvular Heart Disease > Flashcards

02.17 Valvular Heart Disease Flashcards

1
Q

The abnormal narrowing of the mitral valve causes the dilation of the _____, and this can lead to ____

A

Left atrium

Atrial fibillation

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2
Q

2/3 Female

Hx: exertional dyspnea, paroxysmal norturnal dyspnea, orthopnea, hemoptysis

A

Mitral stenosis

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3
Q

Opening snap
Loud S1
Diastolic rumble at the apex

A

MS

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4
Q

ECG and CXR: left atrial enlargement with normal left ventricular size
2D echo

A

MS

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5
Q

Most common etiology of MS

A

Rheumatic heart disease

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6
Q

Congenital MS

A

Lutembachers syndrome (+ ASD)

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7
Q

Etiology of MS among elderlies

A

Mitral annular calcification

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8
Q

Fibrous thickening of alveolar and pulmonary capillary walls

A

Pulmonary hypertension

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9
Q

Natural hx of MS

A

Pulmonary HPN
Thrombi and emboli
Pulmonary infections, infective endocarditis

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10
Q

D/Dx of MS

A

Atrial septal defect
Left atrial myxom
Mitral regurgitation
Aortic regurgictation

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11
Q

RVE and accentuated pulmonary markings
Widely split S2 fixed vs opening snap
No LAE

A

ASD

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12
Q

Obstructing left atrium emptying
Tumor-plop
No diastolikc murmur

A

Left atrial myxoma

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13
Q

Systolic murmur

Left ventricular hypertrophy

A

Mitral regurgitation

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14
Q

Apical mid-diastolic murmur

A

Aortic regurgitation

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15
Q

Murmur of AR

Becomes louder on handgrip and decreases with amyl nitrate

A

Austin Flint murmur

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16
Q

Prophylaxix of B-hemolytic Streptococcal infections to prevent Rheumatic fever and infective endocarditis

A

Penicillin

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17
Q

To lengthen diastolic LV filling

A

Heart rate controlling drugs

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18
Q

Treatment regimen for MS

A

Sodium restriction, oral diuretics
Heart rate controlling drugs
Oral anticoagulation
Penicillin

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19
Q

For severe cases of MS
Indicated in symtomatic patients with isolated MS
Ideal for mobile thin leaflets with no or little calcium without extensive subvavular thickening and with no or mild mr

A

MItral valvotomy

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20
Q

Used to assess if the patient is a candidate for valvotomy (score is at 8)

A

Wilkins score

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21
Q

For MS with significant MR

Distorted valves from previous transcatheter or operative manipulative

A

Mitral valve replacement

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22
Q

Frequent in males
Easy fatigue then exertional dyspnea
Characteristic holosystolic murmur at the apex with radiation to the axilla

A

MR

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23
Q

Left atrial enlargement
AFib
LVH
ECG, 2D

A

MR

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24
Q

Most accurate non invasive imaging technique

A

2D echo

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25
Common etiologies of MR
Mitral valve leaflet abnormality Mitral annulus dilatation of any cause Ruptured chordae tendinae Papillary muscle disorder
26
Medical tx for MR
``` Restrict physical activities Reduce sodium intake and enhance sodium exertion Increase forward CO Anticoagulants and leg binders Endocarditis prophylaxis ```
27
Indication for sugery among MR patients
When LV dysfunction is progressive (<60) and/or LV end-systolic diameter on echo is >45 mm
28
Surgical tx for markedly shrunken, deformed, calcified leaflets
MV replacement
29
Lessens problem on long-term anticoagulants and thromboembolism Indicated for patients with ruptured chordae, annular dilatation and IE Not suitable for MR due to myxomatous degeneration and patients with calcified annulus
MR repair with annuloplasty
30
Barlow's syndrome, floppy-valve syndrome, systolic click-murmur syndrome, billowing mitral leaflet syndrome Excessive or redundant mitral leaflet tissue Ventricular arrhythmias
Mitral valve prolapse
31
Females Most common cause of isolated severe MR requiring surgical treatment in North America Arrhythmias Chest pain substernal, prolonged, unrelated to exertion
MVP
32
In echo, systolic displacement of MVL and quantifies mitral regurgitation and LV function
MVP
33
Medical treatment for mvp
IE prophylaxis Beta-blockers Antiplatelet for patients with transient ischemic attack Anticoagulation if recurrent TIAs
34
Surgical treatment for MVP
For severe asymptomatic MR, MV repair or rarely replacement is indicated
35
Most common cause of AS in adults
Age-related degenerative calcific AS
36
Most common etiology of AS
Valvular (RHD, degenerative calcification, bicuspid AV stenosis)
37
Subvalvular etiology of AS
Hypertrophic obstructive CM
38
Cardinal manifestations of acquired AS
Syncope Heart Failure Exertional dyspnea Angina
39
LV diastolic dysfunction, with an excessive rise in end-diastolic pressure leading to ____
Pulmonary congestion
40
In patients without CAD, angina results from the combination of
Increased O2 needs of hypertrophied myocardium | Reduction of O2 delivery secondary to the excessvie comression of coronary vessels
41
Syncope is most commonly caused by the ____
Reduced cerebral perfusion that occurs during exertion
42
Key features of the PE in patients with AS
Palpation of the carotid upstroke Evaluation of systolic murmur (harsh late peaking crescendo-decresdo) Assessment of splitting of the second heart sound Examinations for signs of heart failure
43
Findings in carotid upstroke
Slow rising, late-peaking, low-amplitude carotid pulse, the parvus and tardus carotid impulse
44
Ejection systolic murmur of AS
Late-peaking Heard best at the base of the heart Radiation to the carotids
45
Murmur that comes from the vibration of the valve and subvalvular structures which can be heard in the LV cavity
Gallavardin phenomenon
46
Key finding in AS
LV hypertrophy
47
Medical treatment for AS
``` Avoid strenuous physcial activity Sodium restriction Cautious admin of diuretics and digitalis in CHF Nitroglycerins to relieve angina Statins ```
48
Severe AS
<0.5 cm2/m2
49
Indication for surgery in AS
Severe AS Symptomatic with LV dysfunction Expanding poststenotic aortic root Those who undergo CABG even if asymptomatic
50
Preferred in children and young adults with congenital noncalcific AS High re-stenosis rate in calcific AS Bridge to operation
Percutaenous Balloon Aortic Valvuloplasty
51
Easy fatigue then exertional dyspnea Wide pulse pressure with bounding pulses Diastolic decrescendo murmur at the base of the heart Midsystolic ejection murmur at the base of the heart Austin Flint murmur
AR
52
Soft, low pitched rumbling mid-diastolic bruit at the apex
Austin Flint murmur
53
Primary valve diseases that can cause AR
Rheumatic Infective endocarditis Trauma Bicuspid valve
54
Primary aortic root diseases that can cause AR
``` Degenerataive heart disease Syphilis Marfan's syndrome Ankylosing spondyitis Aortic aneurysm with dissection Systemic hypertension Giant cell arteritis ```
55
Pulses with abrupt distension and quick collapse of peripheral pulse
Corrigan's pulse (Water hammer pulse)
56
Head bobbing
De Mussets sign
57
Pistol shot sound on the femoral artery
Traube's sign
58
Systolic murmur heard over the femoral artery when compressed proximally
Duroziez's sign
59
Systolic pulsations of the uvula
Muller's sign
60
Capillary pulsation | Blanching and flashing of the nail bed on light compression
Quincke's sign
61
Popliteal cuff BP> bracial cuff SBP by 60mmHg
Hill's sign
62
Peripheral signs of chronic AR
``` Corrigan's pulse De Musset's sign Traube's sign Duroziez's sign Muller's sign Quincke's sign Hill's sign ```
63
Lab exam for AR
LV hypertrophy 2D echo + myocaridal contractility and function Cardiac catherization and angiography
64
Medical tx of AR
``` Same as HF Salt restriction Diuretics Vasodilators Penicillin ```
65
Definitive tx for AR
Surgery
66
Occurs when the septal leaflet is lower than the lateral leaflet which causes severe tricuspid regurgitation
Ebstein anomaly
67
Medical tx of TS
Intensive salt restriction | Diuretics
68
For surgery among px with TS, diastolic pressure gradient _____, tricuspid orifice ____
>4mmHg | <1.5 to 2.0 cm
69
Most common abnormality of the PV secondary to dilatation of PV ring as a consequence of PHPN
Pulmonic regurgitation
70
High pitched decrescendo, diastolic blowing murmur along the left sternal border
Graham Steell murmur

Cardiology (13 decks)

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