Cardio 3 - valvular and vascular diseases Flashcards
MCC mitral stenosis
rheumatic heart disease
mitral stenosis results in
elevated left atrial pressure and pulmonary venous pressure
longstanding –> Afib due to increased left atrial pressure/size
murmur for mitral stenosis
opening snap
low-pitched diastolic rumble
loud S1
tx mitral stenosis
medical - diuretics, BB (to decrease HR), anticoagulation if Afib
surgery - percutaneous balloon valvuloplasty and open mitral valve surgery
aortic stenosis results in
LV outflow obstruction –> LVH
longstanding/severe –> pulls apart mitral valve –> mitral regurgitation
Murmur of aortic stenosis
harsh crescendo-decrescendo systolic murmur
2nd ICS on the RIGHT
radiates to carotid arteries
soft S2
parvus et tarsus - diminished and delayed carotid upstrokes
tx aortic stenosis
aortic valve replacement
aortic regurgitation is also called
aortic insufficiency
murmur for aortic regurgitation
diastolic decrescendo murmur at LEFT sternal border
widened pulse pressure – markedly increased SBP and decreased DBP
corrigan pulse/water-hammer pulse
tx aortic regurgitation
if sx - salt restriction, diuretics, ACEI or ARBs for after load reduction
surgery - aortic valve replacement
murmur of mitral regurgitation
holosystolic murmur at the apex
Afib is a common finding
tx mitral regurgitation
after load reduction
anticoagulation if Afib
mitral valave repair or replacement
what is the MCC mitral regurgitation
MVP
murmur for mitral valve prolapse
mid to late systolic click
mid to late systolic murmur
tx MVP
asx = reassurance
sx = BB
sx aortic dissection
severe, tearing, stabbing pain
typically abrupt
anterior or back of the chest
(back pain for type 2)
(chest pain for type 1)
PE for aortic dissection
pulse or BP asymmetry > 20 btwn arms
HTN more common with descending
Hypotension MC with ascending
aortic regurgitation
dx aortic dissection
CXR - widened mediastinum > 8 mm on AP view
CTA or MRA (MRA takes longer) - performed if stable
TEE - can be performed at bedside; noninvasive - performed if unstable
aortic angiography was once the gold standard and has largely been replaced by CTA
tx aortic dissection
surgery - usually for type A
medical - usually for type B; IV beta blockers - can add sodium nitroprosside or nicardipine to reach target BP
target BP for aortic dissection
SBP < 120 and HR < 60 within 20 minutes
debakey vs Stanford classifications for aortic dissection
debakey:
type 1 - originates in ascending aorta, propagates at least to he aortic arch and often beyond it distally
type II - originates in and is confined to the ascending aorta
type III - originates in descending aorta, rarely extends proximally but will end distally
stanford:
A - involves ascending aorta and/or aortic arch and possibly descending aorta
B - involves the descending aorta (distal to the left subclavian artery origin), without involvement of the ascending aorta or aortic arch
sx AAA
usually asx and discovered on exam
sense of “fullness”
may have hypogastric pain and LBP – usually throbbing
pulsatile mass on exam
sx suggesting expansion and impending rupture of AAA
sudden onset of severe pain in back/lower abdomen - radiates to groin, butt, legs
grey turner sign (back/flanks) and Cullen sign (umbilicus)
triad for rupture of AAA
abdominal pain
hypotension
palpable pulsatile abdominal mass
