cardio exam unit 9 Flashcards
what is stenosis vs regurgitation?
stenosis is obstruction to FORWARD FLOW, it leads to pressure overload in the RV LV
regurgitation is backward flow. it leads to volume overload in the heart
what happens to valvuvlar diease as preload increases?
valvular diease sound gets LOUDER
how many leafleft does mitral and tricuspid have? and where are they
mitral has 2 - LA and LV
tricuspid has 3 - RA and RV
what is mitral stenosis and what is it due to M/C?
mitral stenosis is a progressive narrowing of the mitral valuve orfice –> casue increase RESISTANCE to FLOW
it is normally 5cm2 durting diastole but can reach to 1.5cm2
M/C due to rheumatic heart diease or rare congential defects
explain how mitral stenosis is casues? what casues it and explain it
Rheumatic Carditis casues inflammation of the mitral valuve with intiail mitral regurigation
mitral valuve overtime undergoes progessive REPAIR with fusion of the commisures fibrosis of the cusps –> stenosis (narrowing)
pt dont have sx until theres sig stenosis
what happens when it reaches 1.5cm2 for mtiral stenosis ?
once it reaches 1.5cm, there is sig obstruction to blood flow form LA to LV
it leads to increasd atrial pressure, enlargment, pulmonary congestion, pul HTN RIGHT side HF, venous engorgement, perpheral edema
what happens if the LA gets large enough in mitral stenosis? Think of the nerve
it can lead to pressure on the reccurent laryngeal nerve which can lead to hoareness
what is the SX and examination for mitral stenosis? M/c in F or M and what age group?
M/C in females ages 40-50 years
SX: LF HF sxs, figue, dyspnea, PND, JVD, papitations
exam: opening snap with LOW pitched DIASTOLIC rumble - heard best at the apex of the heart
- mumur louder with handgrips
explain where/when the murmur is best heard in mitral stenosis
diastolic rumble murmur!
where: best heard at the APEX OF THE HEART (at the left lateral decubitus position)
murmur increases w increased preload/venous return
best heard with tubulant spalshing of blood agasint the valvu –> louder mumurs are heard w increased preload/venous return
when do you hear an increases preload/venous return? what body postion
squatting, laying down, leg rasies
DX for mitral stenosis?
ECHO: you will see diminished mitral valuve orifice (MVO < 1.5cm2)
rheumatic mitral stenosis: commissural fusion and diastolic doming of mitral valve
EKG: LA englargement: Wide P waves and Afib
whats the tx for mitral stenosis?
there is no rx to tx mitral stenosis only tx the complication that comes from it
- HR contraol mainstay:
BB,CCB,diruetics
if its AFIB: anticoagualtion and rate control w BB CCB
if its Right HF: ACE/BB, BB, duirtetics
how do you monitor mitral stenosis?
most pt are AXS until it gets to < 1.5cm2 thats when surgety is perfomed so its imp to get ECHO 3-5 years until surgury is needed
explain the surgery mangamenet of mitral stenosis?
surgery is perfomred once mitral valve is < 1.5cm2 and pt is SX
- percutanous mitral balloon valvotomy (perfered, LESS RATE OF re-stenosis)
- mitral valuve replacement/repair: must be on warfarin/coumadin to prevent valve thrombosis (INR 2.5-3.5)
explain mtral valvle prolapse MVP
M/C VALVULAR HEART DISEASE
MC IN YOUNG WOMEN
-Idiopathic myxomatous degeneration of the mitral value causing:
- Redundant mitral value tissue with poor apposition of mitral value leaflets
- Elongated/thin/weak chordae tendinae
-ALL OF THIS CASUES MITRAL VALUVE TO FREELY OPEN/PROLAPSE
-prolapse can cause backflow of blood INTO LA during systole mitral regurgh
what is the M/C valvular disease?
MVP
what is the presentation/examination of MVP?
MOST CASES AXS
But with SX: palpitation, non-exertional CP, fatigue, dyspnea, syncope, anxiety
EXAM:
- Midsystolic click (from snapping of mitral chordae tenidnae during systole-contraction)
- LATE systolic blowing murmur (from regurg)
which dx would you hear a midsystolic click or/and late systolic blowing murmur?
MVP
which dx would you hear a LOW pitched diastolic rumble?
mitral stenosis
how would you dx / tx MVP
ECHO
Not needed but BB can be used to relive SXS
what is mitral regurgitation? whats its many etilogy and explain 5
Progressive dysfunction of the mitral apparatus allowing BACKFLOW of the blood into LEFT ATRIUM during systole (contraction)
Etiology:
-MVP (M/C/C) – due to flopping redundant values
-left ventricular dilation (dilated cardiomyopathy)
-Ischemic HD – chronic ischemia of endo tissues ischemic weak mitral apparatus
-MI w papillary rupture – acute infarction of mitral apparatus causes weak mitral apparatus heart does not get time to compensate to thelowered CO
-Infective endocarditis/early rheumatic carditis – inflammation and destruction of mitral apparatus leads to reflux of systolic blood in LA
whats the SX for mitral regurg? for AFIB and acute mitral regug due to MI papillary rupture
Progressive SOB – due to HF, pul HTN, SOB, PND, pul congestion, shock)
AFIB – due to LA stretching; irregularly irregular heart rate
Acute mitral regurg due to MI with papillary rupture: acute pul edema due to acute backflow of blood
what sound would you hear for mitral regurg and where?
Holosystolic blowing murmur – heard best at the APEX
-Radiates to axilla
-Murmur intensity increased w increased venous return
-murmur heard best in LEFT LATERAL decubitus position
-lateral displacement of PMI
main EX and suporting DX for mitral regugr?
ECHO: left atrium enlargement, LV hypertrophy, r/o pul HTN
Supporting tests:
CXR: pleural effusion, pul edema(crackle sounds) , cardiomegaly
EKG: AFIB, LA enlargement (wide P waves)
