Block 2; Week 2

Question 1

What does it indicate when the jugular venous pressure is distended?

Answer 1

Backup of fluid.

Usu heart failure

Question 2

What do bilateral soft carotid bruits usu indicate?

Answer 2

Athersclerotic disease

Question 3

What do pulmonary crackles usu indicate?

Answer 3

Cardiac asthma

Question 4

What is one thing that can cause aortic stenosis?

Answer 4

Calcification of the aortic valve over time.

Question 5

What does PMI displaced laterally indicate?

Answer 5

Hypertrophy of the ventricle.

Aortic stenosis causes left ventricular hypertrophy. This displaces the PMI.

Question 6

What is a congential explanation for aortic stenosis?

Answer 6

They were born w/ a bicuspid valve & the two started fusing together.

Question 7

What are 5 important symptoms of aortic stenosis?

Answer 7

Ischemia-->angina
congestive heart failure
exertional syncope
dyspnea upon exertion
crescendo-decrescendo murmur radiating to the carotids.

Question 8

What aortic valve diameter qualifies as stenotic?

Answer 8

less than 1 cm.

Question 9

Where can you best hear the crescendo-decrescendo murmur indicative of aortic stenosis?

Answer 9

Right Sternal Border

2nd intercostal space

Question 10

What are some important signs of CHF?

Answer 10

S3 gallop
peripheral edema in the legs
pulmonary edema
jugular vein distention in the upright position

Question 11

What does the S2 sound mean?

Answer 11

It is a normal sound. It is the closing of the semilunar valves. The aortic valve closes before the pulmonic valve b/c of pressure differences.

Question 12

What does the S3 sound mean?

Answer 12

You shouldn’t hear this sound.
It is the sound of ventricular filling.
It is associated with heart failure.

Question 13

What does the S4 sound mean?

Answer 13

This occurs during diastole.

It is the sound of the atrial kick against a hypertrophied ventricle.

Question 14

If you suspect aortic stenosis what are the 2 most important tests & why?

Answer 14

ECG–check for ischemia & chamber enlargement

Echo–look at the heart valves, esp the aortic valve.

Question 15

What are 4 important physical exam maneuvers to identify aortic stenosis?

Answer 15

Squatting
Abrupt Standing
Valsalva maneuver
Hand Grip Test

Question 16

What is ejection fraction & what is a normal LVEF?

Answer 16

Ejection Fraction–>percentage of blood that is pumped out of the ventricle with each beat.
LVEF NORMAL: 55-70%
An LVEF that is much less than this indicates heart failure.

Question 17

Increased troponins of which type indicate heart damage?

Answer 17

Increased Troponin T & I.

Question 18

How can heart failure lead to increased levels of BNP in the blood?

Answer 18

So…the heart just can’t eject very much blood b/c it is weak…LVEF will be low.
This means that a lot of blood is just staying in the ventricle & causing overstretching.
BNP is released w/ overstretching.

Question 19

Why is a catheterization useful in aortic stenosis diagnosis?

Answer 19

This is aka angiogram.
It is the most diagnostically conclusive.
Even if the Echo assured you that there is aortic stenosis, you can do a cath to see if there are any other heart issues that should be repaired at the same time during surgery.

Question 20

What are some of the treatment options in terms of valve replacement for aortic stenosis?

Answer 20

Mechanical valve–>but you have to always take anti-coagulants…but they last forever.
Bovine or porcine valve. lasts 10-15 years.
Percutaneous Valve.

Question 21

If the patient is old & has aortic stenosis, what are his chances if he doesn’t get a valve replacement & only relies on medical treatment?

Answer 21

Not good.