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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
Q

Common etiologies of MR

A

Mitral valve leaflet abnormality
Mitral annulus dilatation of any cause
Ruptured chordae tendinae
Papillary muscle disorder

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26
Q

Medical tx for MR

A 
Restrict physical activities
Reduce sodium intake and enhance sodium exertion
Increase forward CO
Anticoagulants and leg binders
Endocarditis prophylaxis
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27
Q

Indication for sugery among MR patients

A

When LV dysfunction is progressive (<60) and/or LV end-systolic diameter on echo is >45 mm

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28
Q

Surgical tx for markedly shrunken, deformed, calcified leaflets

A

MV replacement

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29
Q

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

A

MR repair with annuloplasty

30
Q

Barlow’s syndrome, floppy-valve syndrome, systolic click-murmur syndrome, billowing mitral leaflet syndrome
Excessive or redundant mitral leaflet tissue
Ventricular arrhythmias

A

Mitral valve prolapse

31
Q

Females
Most common cause of isolated severe MR requiring surgical treatment in North America
Arrhythmias
Chest pain substernal, prolonged, unrelated to exertion

A

MVP

32
Q

In echo, systolic displacement of MVL and quantifies mitral regurgitation and LV function

A

MVP

33
Q

Medical treatment for mvp

A

IE prophylaxis
Beta-blockers
Antiplatelet for patients with transient ischemic attack
Anticoagulation if recurrent TIAs

34
Q

Surgical treatment for MVP

A

For severe asymptomatic MR, MV repair or rarely replacement is indicated

35
Q

Most common cause of AS in adults

A

Age-related degenerative calcific AS

36
Q

Most common etiology of AS

A

Valvular (RHD, degenerative calcification, bicuspid AV stenosis)

37
Q

Subvalvular etiology of AS

A

Hypertrophic obstructive CM

38
Q

Cardinal manifestations of acquired AS

A

Syncope
Heart Failure
Exertional dyspnea
Angina

39
Q

LV diastolic dysfunction, with an excessive rise in end-diastolic pressure leading to ____

A

Pulmonary congestion

40
Q

In patients without CAD, angina results from the combination of

A

Increased O2 needs of hypertrophied myocardium

Reduction of O2 delivery secondary to the excessvie comression of coronary vessels

41
Q

Syncope is most commonly caused by the ____

A

Reduced cerebral perfusion that occurs during exertion

42
Q

Key features of the PE in patients with AS

A

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
Q

Findings in carotid upstroke

A

Slow rising, late-peaking, low-amplitude carotid pulse, the parvus and tardus carotid impulse

44
Q

Ejection systolic murmur of AS

A

Late-peaking
Heard best at the base of the heart
Radiation to the carotids

45
Q

Murmur that comes from the vibration of the valve and subvalvular structures which can be heard in the LV cavity

A

Gallavardin phenomenon

46
Q

Key finding in AS

A

LV hypertrophy

47
Q

Medical treatment for AS

A 
Avoid strenuous physcial activity
Sodium restriction
Cautious admin of diuretics and digitalis in CHF
Nitroglycerins to relieve angina
Statins
48
Q

Severe AS

A

<0.5 cm2/m2

49
Q

Indication for surgery in AS

A

Severe AS
Symptomatic with LV dysfunction
Expanding poststenotic aortic root
Those who undergo CABG even if asymptomatic

50
Q

Preferred in children and young adults with congenital noncalcific AS
High re-stenosis rate in calcific AS
Bridge to operation

A

Percutaenous Balloon Aortic Valvuloplasty

51
Q

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

A

AR

52
Q

Soft, low pitched rumbling mid-diastolic bruit at the apex

A

Austin Flint murmur

53
Q

Primary valve diseases that can cause AR

A

Rheumatic
Infective endocarditis
Trauma
Bicuspid valve

54
Q

Primary aortic root diseases that can cause AR

A 
Degenerataive heart disease
Syphilis
Marfan's syndrome
Ankylosing spondyitis
Aortic aneurysm with dissection
Systemic hypertension
Giant cell arteritis
55
Q

Pulses with abrupt distension and quick collapse of peripheral pulse

A

Corrigan’s pulse (Water hammer pulse)

56
Q

Head bobbing

A

De Mussets sign

57
Q

Pistol shot sound on the femoral artery

A

Traube’s sign

58
Q

Systolic murmur heard over the femoral artery when compressed proximally

A

Duroziez’s sign

59
Q

Systolic pulsations of the uvula

A

Muller’s sign

60
Q

Capillary pulsation

Blanching and flashing of the nail bed on light compression

A

Quincke’s sign

61
Q

Popliteal cuff BP> bracial cuff SBP by 60mmHg

A

Hill’s sign

62
Q

Peripheral signs of chronic AR

A 
Corrigan's pulse
De Musset's sign
Traube's sign
Duroziez's sign
Muller's sign
Quincke's sign
Hill's sign
63
Q

Lab exam for AR

A

LV hypertrophy
2D echo + myocaridal contractility and function
Cardiac catherization and angiography

64
Q

Medical tx of AR

A 
Same as HF
Salt restriction
Diuretics
Vasodilators
Penicillin
65
Q

Definitive tx for AR

A

Surgery

66
Q

Occurs when the septal leaflet is lower than the lateral leaflet which causes severe tricuspid regurgitation

A

Ebstein anomaly

67
Q

Medical tx of TS

A

Intensive salt restriction

Diuretics

68
Q

For surgery among px with TS, diastolic pressure gradient _____, tricuspid orifice ____

A

> 4mmHg

<1.5 to 2.0 cm

69
Q

Most common abnormality of the PV secondary to dilatation of PV ring as a consequence of PHPN

A

Pulmonic regurgitation

70
Q

High pitched decrescendo, diastolic blowing murmur along the left sternal border

A

Graham Steell murmur

Cardiology (13 decks)

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