Cardio Block 2 Flashcards

1
Q

What is the most important and weakest part of the visit when assessing heart valves?

A

PE- weakest

Hx/Diagnostic study- strongest

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2
Q

What are the common causes of aortic valve diseases?

A

Congenital bi/unicuspid- most common congenital heart Dz, seen in PTs <70y/o

Degenerative Ca+- wear/tear from atherosclerosis/CAD, seen in PTs +65/yo

Worldwide- RF, usually mitral valve involvement then aortic valve

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3
Q

How much of an AS occlusion is needed for Sxs?

What is the bodies remodeling response to AS/inc AL and what other issue can be forced to develop?

A

90% for Sxs to appear

Concentric hypertrophy, can lead to MR

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4
Q

What is the sequence of pathophysiologic changes seen in AS?

A

AS, Outflow obstruction, Inc EDP, Concentric* LVH, LVF, CHF, Subendocardial ischemia

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5
Q

Why does exertion syncope occur with AS during exercise?

Why does CHF occur?

A

LV can’t increase CO, dilation causes decreased cerebral perfusion pressure

Inc AL causes contractile dysfunction and inc LV diastolic volume/press, pressure backs into pulmonary vessels, inc alveoli congestion

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6
Q

What are the S/Sxs of AS

How are AS seen on PE?

A

Prolonged ASx period:
Exertion induced dyspnea, angina, dizziness

Harsh Cresc/Decresc at RUSB w/ bell/diaphragm, radiates to carotid
Narrow pulse pressure
Displaces PMI

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7
Q

Define Pulsus Parvus et Tardus

How does AS cause angina?

A

Weak and late/slow rising best appreciated at carotid/PMI and carotid at same time

Imbalance between supply/demand
Inc LVDP reduces coronary perfusion pressure gradient

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8
Q

How does AS present on ECG?

What Sx is seen in PTs w/ severe form?

A

LVH, LAE, possible A-Fib

A-Fib leading to HF/Stroke

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9
Q

Where is A-Fib seen on an EKG?

How does AS appear on CXR?

A

Bi-phasic in V1 or Lead 2

LVH, Calcified leaflets, CHF if advanced

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10
Q

How does Echo appear on Echo?

Bicuspid aortic valves are associated w/ increased risks for ?

A

TTE shows inc wall thickness and determines severity

Aneurysm and Dissections

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11
Q

If AS can’t be seen w/ Echo, what test is ordered?

Who else receives this test?

A

CT or MRI

Candidates for Transcatheter Aortic Valve Replacement (TAVR)

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12
Q

When do AS PTs get an Exercise Test?

How are AS PTs treated?

A

Asx severe AS to confirm absence of Sxs

Limit activity
No optimal pharm Tx
Caution w/ anti-hypertensive meds
NO diuretics

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13
Q

How often do AS PTs receive Echos?

A
At Dx
Mild= Q3-5yrs
Mod= Q1-2yrs
Sev= Q6-12mon
Any time Sxs change
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14
Q

What is the only true effective Tx for PTs w/ severe AS?

What is the alternate procedure for kids and young adults w/ congenital AS?

A

Valve replacement- preferred method is transcatheter aortic valve replacement

Balloon aortic valvuloplasty

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15
Q

What type of PT gets a mechanical valve and what prophylaxis do they get?

Who gets a bioprosthetic valves?

A

Younger PTs, Coumadin

PTs that won’t live more than 10yrs, no coumadin

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16
Q

What is the prognosis of AS?

What AS PTs do we screen for unnoticed Sxs?

A
ASx- near normal survival
Angina= <5yrs
Syncope= <3yrs
Dyspnea= <2yrs
A-Fib precipitates overt HF and increases mortality rates

ASx PTs

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17
Q

What is the normal cross sectional area of the aortic valve?

What is the most common etiology of AI in developed countries?

A

3-4cm^2

Congential bicuspid
Dilation of aortic root- Marfans/Ehlers-Danlos

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18
Q

Acute AI is a medical emergency if it appears in ? situations?

A
Native valve
Endocarditis
Aortic dissection
Traumatic rupture of leaflets
Iatrogenic- failed valvotomy/valve repair
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19
Q

What is the sequence of pathophysiology events that occur in AI?

Acute AR is usually associated with rapid decompensation due to ?

A

AR, Vol overload, LV dilation, Wide Pulse Pressure, Inc wall tension, Pressure overlaod, LVH

Inability to accomodate inc end DBP

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20
Q

How is Chronic AR different than Acute?

How does this compensation cause a widened pulse pressure and what is unique about this change?

A

Dilation w/ less hypertrophy
Drop in aortic diastolic pressure

High LVSV, reduced DBP= Wide pulse pressure, HALLMARK of AR**

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21
Q

How does acute AI present?

How does chronic AI present?

A

Acute Pulmonary Edema

Wide pulse pressure, CHF Sxs, Angina, Atypical chest pain

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22
Q

What are 5 Signs associated w/ AI and what are they all indicative of an increased risk for?

A
De Musset- head bobbing w/ systole
Corrigans- water hammer
Quincke- nail bed pulsations
Traube- pistol shot heard over radial/femoral
Duroziez- to and fro heard over femoral

Inc stroke volume and widened pulse pressure

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23
Q

What type of murmur is AI?

AI valve etiology is best hear at ? while root etiology is best hear at ?

A

High pitched, blowing diastolic murmur at Erb’s point w/ PT leaning fwd and exhaling

Valve= LSB 2/4ICS
Root= RSB and apex
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24
Q

Define Austin Flint murmur

A

Low rumble during mid systolic sound from normal diastolic flow from LA hitting anterior leaflet of MV, which is partially closed due to inc force of AR

AR + physiological MS w/out opening snap

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25
How does AI look on EKG? How does it look on CXR?
LVH, LAE, LAD Strain pattern LBBB A-Fib ``` Acute= pulmonary edema/congestion Chronic= cardiomegaly, dilated ascending aorta ```
26
Why do PTs w/ AI get a radionuclide angiography/MRI? What two tests can be ordered as follow up tests?
Initial and Serila assessment of LV volume and function at rest Root angiography- hymodynamic measurements Cardiac cath- when non-invasive tests are inconclusive/discrepant results
27
How are AI PTs managed with pharmaceuticals?
Nothing in ASx ACEI, D-CCB or Hydralazine in severe cases w/ preserved LV function BBs in PTs w/ Sxs or reduced LV function who are not surgical candidates
28
When do AI PTs get surgery?
Sxs and NYHA >2 EF <50% ASx severe AI while undergoing CABG or surgery
29
What are the 3 ways to classify infective endocarditis? What heart valve d/o is commonly affected by infective endocarditis?
Clinical- sub/acute Host substrate- native, prosthetic, IVDA Microbe- Staph, Strep AS
30
Majority of US infective endocarditis PT are ? old and w/ ? issues What valves are usually infected?
+60 Pre-existing structural heart Dz AV > TV > PV Drug abuse= TV
31
?? is the most common underlying cardiac condition in PTs w/ infective endocarditis What PT population is at an increased risk of infective endocarditis?
MVP Hypertrophic cardiomyopathy, especially w/ outflow obstructions
32
What risk factor is among the highest risk factors for subsequent infective endocarditis cases? Nonbacterial thrombotic endocarditis can occur spontaneously in PTs w/ ? systemic illnesses?
Previous endocarditis Marantic endocarditis of malignancy Libman-Sacks endocarditis in Lupus Eryth.
33
What are the most common microbes in endocarditis on native valves? What microbes are most common in IVDU PTs?
Strep, mainly Viridans Staph A Staph A Strep
34
What are the most common microbes in prosthetic valve endocarditis when PT has had surgery within the past year? What two microbes are the most common in PTs w/ prosthetic valves and surgery was more than 1yr ago?
Staph Epidermis Staph A Strep Staph A
35
What are the risk factors for endocarditis
``` Age >60 Male Structural heart Dz Prosthetic valves Congenital heart Dz ```
36
Define Pentology of Fallot
``` VSD PS Misplaced aorta Thickened RV wall ASD ```
37
What are the non-heart Dz risk factors for endocarditis
``` Indwelling catheter (chronic hemodyalisis) IV drugs Hx of endocarditis infection Poor dental hygiene HIV ```
38
What conditions are needed inside of the body for endocarditis to start an infection process? What is the most common cause of endocarditis adherence?
Endocardial surface injury Platelet/fibrin thrombus formation Bacteria enters circulation Bacteria adherence to injured sites Turbulent blood flow
39
Sterile vegetation is able to adhere to surfaces due to ? What additional issue does this adherence material offer than promotes infections?
Fibrin deposits Covers and protects vegetation from host defenses
40
Acute endocarditis usually presents with ? 2 Sxs and is due to ? microbe Subacute endocarditis is usually due to ?
Rapid/high fever, New murmur Staph Low fever, non constitutional Sxs
41
50% of endocarditis PTs complain of ? issue In 5-10% of cases, what is the chief complaint?
MSK Sxs- flank arthritis to diffuse myalgias Low back pain/low grade fever w/ no osteomyeltitis or epidural abscess
42
What are the primary cardiac Dzs of endocarditis? What are the secondary phenomena?
CHF signs from valve insufficiency Focal neural from embolic stroke Back pain w/ vertebral osteomyelitis
43
What are the common complaints of endocarditis PTs who abuse IV drugs? How are acute and subacute infectious endocarditis Dxs differentiated?
Dyspnea, Cough, Angina Due to TV involvement and secondary embolus in pulmonary vasculature Subacute (Strep)= fever, fatigue, anorexia, back pain and weight loss Less common Sxs= CVA or CHF
44
What are the 4 symptoms and 4 signs that appear in high frequency (>40%) of endocarditis?
``` S= Fever, Chills, Weakness, Dyspnea Sxs= Fever, Murmur, Skin lesion/emboli, Petechia ```
45
What are the S/Sxs of moderate frequency (10-40%) of endocarditis?
S: Olser nodes(painful)/Janeway lesion (painless), Splinter hemorrhages, Splenomegaly, Stroke, HF, Pneumonia, Meningitis Sxs= Sweat, Anorexia, Cough, Stroke, Rash, N/V, HA, Myalgias/Arthralgias
46
What are the low frequency (<10%) S/Sxs of endocarditis? How is steps are taken and labs ordered to help Dx endocarditis?
S: New murmur, Retinal lesion, RF Sx: Ab pain, Delerium/coma, Hemoptysis, Back pain Hx, PT, Blood culture, Echo, EKG, CXR
47
What murmur presents w/ hemoptysis? What criteria is used to diagnose definite or possible endocarditis?
MS Modified Duke criteria Definitive= 2 major, 1 major 3 minor, 5 minor Possible= 1 major 1 minor, 3 minor
48
What is unique about the presence of Strep Bovis/Strep Gallolyticus Major criteria for Duke criteria include ?
Colorectal cancer 1) Typical microbes= Two +Blood cultures drawn 12hrs apart 2) Skin microbes= 3 or 4 or more blood cultures w/ first and last drawn at least 1hr apart 3) Single +Blood culture for Cox Burnetii (Q Fever) or Phase 1 IgG Ab titer >1:800
49
What are the 5 minor criteria of Duke Criteria?
``` IV drug use/Prosthetic heart valve Fever + 100.4/38*C or higher Vascular phenomenon Immunologic phenomenon Microbe evidence- only one positive ```
50
What labs are ordered for PTs w/ suspected endocarditis? What are the major criteria for Echo?
Chem 7, CBC, UA, Blood cultures Vegetation, New regurgitation, Abscess, TTE- initial TOC (large vegetations, quantifies dysfunction, non-invasive and easy) TEE- >90% specific and more sensitive (small vegetation, prosthetic valves, prior valve abnormality, bad windows/deformity)
51
What type of EKG changes can indicate endocarditis? What is the most common risk factor for enteric gram-negative endocarditis?
Conduction d/o, blocks- indicate peri-valvular involvement Health care contact, not IV drug use
52
What is the diagnostic procedure of choice for suspected atrial myxomas? If the search continues to be negative, what two microbes are considered last?
2D echo Marantic/Libman-Sacks (Lupus and Myxoma)
53
HACEK spp microbes are mostly ? Coxiella Burnetti
Oral flora, often w/ Hx of peridontal Dz Exposure to raw milk, farms or rural areas
54
Brucella spp Bartonella spp
Ingestion of contaminated milk/milk products Henslae- Cat Quintana- human body lice; homeless, alcohol abuse
55
Chlamydia psittaci Nutritionally variant streptococci
Bird exposure Slow/indolent course, MOST common
56
Legionella spp Aspergillus and non-candidal fungus
Contaminated water, often nosocomial outbreaks, usually prosthetic valves Prosthetic valves
57
Initial labs for endocarditis include ? and usually reveal ? results
CBC w/ Diff, Serum E+, Renal function, UA Subacute= Fe like anemia, WBC normal Acute= Inc WBC especially if Staph A is the cause Proteinuria and hematuria are common
58
What test is King for endocarditis? What if this initial test is negative?
TEE Repeat Q3-5 days
59
If PT is unstable and must be given ABX prior to culture draw, when is the preferred time to draw blood? How long does ABX Tx last?
Give ABX after all 3 cultures are drawn, minimum of 2 4-6wks
60
What ABX is used for empiric Tx of endocarditis? What is used for Strep, Staph or PCN allergy?
IV vancomycin- covers Staph (methicillin susceptible and resistant), Strep and Enterococci Strep- IV Penicillin G 12-18M units Staph (Oxacillin susceptible)- IV Nafcillin + Gentamicin or Cefazolin + Gentamicin Staph (Oxacillin resistant)- IV vancomycin PCN allergy- Ceftriaxone + Gentamycin or Vancomycin (Dont give Gentamycin alone)
61
What are the potential complications of endocarditis Tx?
``` Emboli CHF Abscess- seen w/ TEE Intracranial hemorrhage Immune complex glomerulonephritis ```
62
What endocarditis PTs get surgery?
``` Refractory pulmonary edema Severe valve regurgitation Obstruction w/ cardiogenic shock HF of any degree Local infection complications Relapsing/refractory bacteremia despite ABX therapy ```
63
What is the Tx step for infective endocarditis that has no available effective anti-microbial therapy What are the relapse chances?
Fungi, Brucella, Pseudomonas aerugiosa (DM), L sided Staph Usually w/in 2mon Inc w/ prosthetic valves Continued IV drug use
64
What are the mortality chances of infective endocarditis? When is it recommended to give PTs prophylaxis?
In hospital- 23% or less 6mon- 27% or less 50% if infected w/ fungus or P. aeruginosa Prostetic valves/materials Prior Hx of IE Unrepaired cyanotic congenital heart Dz
65
What PTs are at highest risk for IE and need prophylaxis?
Repaired congenital heart dz w/ residual shunts/regurgitation at/near site of repair First 6mon after congenital dz repair w/ catheter/occlusion device Valve regurgitation due to structurally abnormal valve in transplanted heart
66
What PTs are NOT given prophylaxis for IE?
Congenital bicuspid valve Acquired native aortic/mitral valve dz MVP w/ regurgitation HCM w/ latent/resting obstruction
67
What is the DOC for IE prophylaxis? What ABX are used for PTs that are allergic to this prophylaxis?
2g Amoxicillin Post-procedure ABX are not required Allergic to PCN= Cephalexin Clindamycin Azithromyin/Clarithromycin
68
What are the murmurs associated w/ MS, MR and MVP? What PT population tends to get it?
``` MS= opening snap MR= blowing holosystolic MVP= mid-systolic click ``` Young females w/ 2:1 W/M, younger ages in 3rd world countries, 2-3 decades post-infection
69
What is the pathophysiology of MS? How does PHTN look on EKG?
MS, Fixed CO, Inc LA Press, Inc pulm press, Inc hydrostatic press, Plasma in lungs, CHF dyspnea P wave >2.5mm in Lead 2
70
What are the two types of PHTN that develop due to MS? How do they form?
Passive- inc pressure due to backward flow from LA press (most common) Reactive- hypertrophy of pulmonary artery
71
What is the end result of MS? What are the main S/Sxs of MS?
R sided HF due to RVH, and TR Progressive dyspnea w/ exertion Hemoptysis
72
How does a MS murmur sound? What PE finding indicates the severity of MS?
Low rumbling decrescendo diastolic rumble heard w/ bell @ LLD Duration
73
How does MS look on EKG? How does it look on CXR?
LAE (P-mitrale) RVH RAD Possible A-fib LAE, Pulmonary congestion, Kerley B lines, Prominent pulmonary arteries
74
What Dx test is done for suspected MS and can confirm Dx? What can be seen on this test?
TTE Thick MV leaflets (fish mouth) Severity of mean gradient Potential LA thrombus
75
TEEs should always be performed for ? 2 reasons? How is MS treated?
ID LA thrombus Eval MV morphology and hemodynamics in PTs w/ sub-optimal TTE ``` Na restriction/Diuretics BB Non-DHP CCB Digoxin- rate control A-fib Anti-coagulants- A-fib or thrombus ACEIs can be used but have delayed benefit ```
76
Since sudden death from MS is rare, all PTs need to ? What is the best/definitive Tx for MS?
Exercise Valvotomy/replacement Percutaneous mitral balloon valvotomy is PREFERRED unless congenital MS
77
What is the f/u schedule for MS PTs after Tx? What is the normal MV size?
``` Known MS and changing Sxs Serial echo for ASx Routine TTE: Q3-5yrs MVA >1.5cm (mild) Q1-2yrs MVA 1-1.5cm (mod) Annually MVA <1cm (sev) ``` 4-6cm^2
78
MR usually effects ? PTs and involves ? leaflet? What is the most common cause of degenerative MR in the US?
F>M Posterior leaflet MVP
79
What are the etiology causes of Primary MR? What are the secondary causes?
Congenital, RH, IE, MVP, Trauma HOCM, Acute MI, Ischemic Dz, LV dysfunction, RF
80
Define Acute MR
``` Sudden usually from damage to valve: Post-MI Ruptured chordae from IE Blunt trauma to chest Deteriorated chordae from CT Dz (Marfans, Ehlers-Danlos) ```
81
Define Chronic MR
Myxomatous degeneration of valve Rheumatic deformity Congenital defect Calcification of annulus
82
Severity of MR is based on what 5 things?
``` Opening size during regurg Systolic gradient between LA/LV Systemic resistance on LV LA compliance Duration of regurg ```
83
What are the 3 direct consequences of MR One of these consequences is different than MS how?
Elevated LA volume/press Reduction of Fwd CO Diastolic volume stress on LV MS= fixed forward CO
84
What is the difference in pathophysiology between Acute and Chronic MR
Acute= Normal LA, High LA pressure, High Pulmonary venous press, Dec CO Chronic= Inc LA size, normal LA/pulmonary press, low fwd CO
85
What is the difference in Tx of Acute and Chronic MR? What are the primary Sxs of each?
``` Acute= no fluids Chronic= fluids ``` ``` Acute= pulmonary edema, needs emergent surgery Chronic= low CO ```
86
How does acute MR present on PE?
``` Apical thrill if severe Soft S1 w/ wide split S2 Loud P2 (PHTN always) Enlarged LV L displacement of PMI ```
87
How does chronic MR present on PE? Why is one of these Sxs unique and differentiating from acute?
Loud, high pitched holosystolic at apex and radiates to axilla best heard at axilla in LLD w/ diaphragm Loud S2 Intensifies w/ hand grips May radiate to back Chronic doesn't have PHTN, quiet P2
88
How does MR look on EKGs? How does it look on CXR?
A-fib, LAE, LVH Cardiomegaly LAE, LVH Annular calcification
89
What's the difference between acute/chronic MR on CXR? What Dx test can be done?
Acute= pulmonary edema TTE Echo Exercise Doppler Echo- for ASx PTs w/ severe MR
90
How is acute MR Tx? How is Chronic MR Tx?
Acute= dec preload w/ diuretics, vasodilators ``` Chronic= no benefit from meds Vasodilators (ACEI) to dec AL Goal is surgery Tx HTN Anti-arrhythmics MVP/Afib= anticoagulation ```
91
If MR is acute and secondary to papillary rupture, what is the Tx of choice?
Valve replacement If HOTN/cardiogenic shock is present, aortic balloon pump can be used to increase organ perfusion and decrease MR Normotensive PTs- vasodilators decrease AL
92
What is the prognosis for mild/mod/sev MR? How is MVP defined on Echo?
``` Mild= stable for yrs Mod-Sev= surgery within 10yrs or death ``` Billowing of mitral leaflets 2mm or more above annual plane
93
MR is associated w/ ? CT D/ox?
Marfann- ectopia lentis, pectus excavatum, pes planus, wrist/thumb sign Ehlers-Danlos Syndrome Osteogenesis imperfecta
94
Define Ebstein's Abnormality
Congenital malformation of TV and RV due to improper development of TV in first 8wks of gestation
95
Define MVP Syndrome
``` DEFAMED MP Dyspnea Exercise intolerance Fatigue Anxiety Mild to Stabbing chest pain Emoblic phenomena Dizziness S/Sxs of MR Palpitation ```
96
What type of murmur is MVP? What causes one of the identifying features?
Mid systolic click w/ late systolic click Snapping of chordae during systole when valve bows into atria
97
What bedside maneuver accentuates MVP? What diagnostic imaging is used?
asd Echo
98
What test is ordered for PTs w/ suspected MVP or ASx w/ MVP? How often are they followed up on to track progression?
Echo Only w/ change of Sxs
99
How is MVP managed? How is MVP syndrome managed?
ASA A-Fib= anti-coag therapy or TIA while on ASA No prophylaxis Reassurance/life style changes Avoid caffeine/ETOH Avoid stress/fatigue
100
PT w/ late systolic murmur and mids-ystolic click can move the click later into systole by ? maneuver? TS usually found with other valve lesions, especially ? but rarely ?
Squatting Common- MS from RH Rarely- congenital, carcinoid syndrome, RA/metastatic tumors
101
S/Sxs of TS? What type of murmur is it?
Abd distension Hepatomegaly JVP w/ A-waves Low pitch tumble hear on LLSB w/ bell w/ possible opening snap
102
What maneuvers make TS louder? How does it appear on EKG and CXR?
Inspire Leg raise Squat RAE w/ absence of RVH RAE
103
How is TS Dx? How is it Tx?
Echo Reduce preload w/ diuretics Surgery for other valve repair Percutaneous balloon dilation
104
What can cause/lead to TR?
RDz on MS to TR from PHTN w/ RV enlargement IE Ebstein- most common Carcinoid syndrome from Lungs or GI- rare
105
How does TR present on PE? What findings will be found on PE?
Palpitations w/ A-Fib Abd fullness Prominent V-waves RV heave Ascites Pulsatile liver edge
106
What type of murmur is TR? What makes it louder or quieter?
Blowing holosystolic heart at LLSB w/ diaphragm Iinc w/ inspiration Dec w/ valsalva/standing
107
What EKG changes are seen w/ TR? What will be seen on CXR?
RAE, RVH, A-Fib RAE, RVH
108
How is TR treated? What usually causes PS?
Diuretics for volume/congestion Severely Sxs= surgery Congenital- most common Carcinoid syndrome from Gi tumor metastasizing to liver and releasing serotonin metabolites into blood forming plaques
109
What are the S/Sxs of PS? What is seen on PE?
ASx to exertional dyspnea Exercise induced fatigue/syncope Sxs of R HF RV impulse w/ left parasternal lift S2 split and S4
110
How does PS sound? How often are these PTs f/u on?
Crescendo-decrescendo systolic murmur heard w/ bell or diaphragm at LUSB and accompanied w/ early ejection click ECG for baseline and Q5-10yrs RVH present
111
When/why would cardiac cath be done on PS PT?
R sided Swan Ganz cath to w/ Doppler PTs w/ peak gradient greater than 36mm Balloon valvotomy candidates
112
How is PS treated? How does PHTN look on EKG?
Severe w/ surgery Balloon valvotomy via cath is usually effective Peaked P-wave 4-6mm tall in Lead 2
113
What causes PR? What PTs usually get this?
PHTN Tetrology of Fallot
114
What heart dz is associated w/ rheumatic d/os? What are the S/Sxs of PR?
PI Exertional dyspnea, chest pain, syncope Fatigue Anorexia/abd pain Ortner's Syndrome- cough, hemoptysis, hoarsness (2nd one, MS)
115
What doe PR sound like? Define the Graham-Steele murmur
Early diastolic murmur w/ ejection click Result of PHTN- high pitched decrescendo diastolic murmur hear at LSB
116
How is PR treated? What is the difference between ASD murmur and PR murmur?
Diuretic, O2, HTN treatments ASD- Fixed split S2, no inc w/ inspiration PR- wide split
117
What type of murmur does HOCM create? Which holosystolic murmur inc w/ inspiration?
High pitched cresc/decresc mid-systolic murmur heard on LLSB TR
118
What is the relation between a VSD size and its sound? HF is considered the final/most severe form of heart Dz including ? 6
Smaller= louder ``` Coronary artherosclerosis HTN MI Valve Dz Congenital HDz Cardiomyopathies ```
119
What are the 3 things that cause HF?
Inc Preload Inc Afterload Dec contractility
120
Low CO and inc AL causes decreased ? which causes what chain reaction? What is the sequence of pahtologial events leading to CHF?
RAAS, causes fluid overload ``` LV dysfuntion Dec contractility/CO Catecholamine produciton- Epi, NorEpi Inc Afterload/BP Inc wall tension ```
121
What are two meds given to reduce catecholamine production during HF? Which drug is best for HF?
BBs, ACEIs- dec PL, AL and contractility BBs
122
What is the number one Dz that increases Afterload? HF is a ? problem
HTN Diastolic
123
What are the 5 Tx goals of HF? What med can be used to decrease Preload?
Manage oxygenation/ventilation Treat unstable arrhythmia Dec PL/AL Improve contractility Nitro, BB, Loops/Thiazide
124
What meds can be used to decrease after load? What drugs can be used to inc contractility?
ACEI, BB, Hydrochlorothiazide, Chlorthaladone Dobutamine, Digoxin, NorEpi, Epi
125
What 2 meds are used last for HF and affects the pump? Pulmonary edema occurs as a secondary result to ? HF
CCB, Digoxin Only used if dec PL/AL isn't successful Backwards
126
What is the difference between Diastolic Dysfunction and Systolic Dysfunction? What is the difference between forward and backward HF?
Dys- ineffective ventricle filling (hypertrophy) Sys- ineffective ventricle emptying Fwd- can't maintain CO to meet demand Rvs- can't accommodate venous return causing congestion
127
What's the difference between Low and High output failure? What causes 70% of HFrEF?
Low- poor CO High- inc metabolic demand CAD
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Reduced ejection fraction is anything below ? What is the cellular response to the first sign of ischemia?
40% 40-50= gray area Hibernation
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What are the 3 things that cause constrictive cardiomyopathy? What causes transient and permanent Diastolic Dysfunction?
Amylodosis, Sarcoidosis, Hemachromatosis Transient- ischemia Permanent- Hypertrophy, restrictive cardiomyopathy, MIs
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Inc LV filling pressure produces ? What is the cause of R sided HF when not caused by L sided HF?
Venous congestion upstream Issue in the lungs
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What processes can cause impaired contractility? What can cause increased after load? What can cause impaired diastolic filling?
CAD (MI, transient ischemia) Chronic volume overload (MR, AR) Dilated cardiomyopathy Severe AS Uncontrolled/severe HTN ``` LVH Restrictive cardiomyopathy Myocardial fibrosis Transient ischemia Tamponade/constriction of pericardium ```
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What is the CO equation
CO= SV x HR
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What is the Preload equation What happens if AL and Contractility are the same?
Wall tension at end of diastole EDV/EDP Inc Pre-Load, Frank Starling adjusts
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What is the Afterload equation How does inc Afterload result in a dec SV?
Wall tension during contraction SBP LV pressure increases Inc SBP Less shortening of myocardial fibers Dec SV
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What is Contractility? What does this measurement reflect?
Strength of contraction Independent of AL or PL Chemical/Hormone influence of contraction Consistent AL and PL, but inc of Contractility= efficient emptying of ventricles
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S/Sxs of HFrEF? What type of dysfunction is this?
Paradoxysmal dyspnea and fatigue Primary systolic dysfunction
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Once we have cardiac remodeling, what 3 neuro-hormonal mechanisms are activated?
RAAS Adrenergic Hypothalamic Neuro Hypophyseal system
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With over stimulation of RAAS, what type of renal consequence is seen?
Renal free water absorption | Dilutional hypnatremia