Cardio part 1

Question 1

How can severe cases of pulmonary valve stenosis present?

Answer 1

Right-sided heart failure

Question 2

How does P2 present in pulmonic stenosis?

Answer 2

Delayed and soft and absent

Question 3

Presentation of heart sounds in pulmonic stenosis

Answer 3

Ejection click often present and decreases with inspiration

The only right heart sound that decreases with inspiration; all other right heart sounds increase

Question 4

What is diagnostic for pulmonic stenosis?

Answer 4

Echocardography/Doppler

Question 5

Who should undergo intervention for pulmonic stenosis regardless of sx? (Otherwise, operate for sx)

Answer 5

Pts with peak pulmonic valve gradients >60 mm Hg or a mean of 40 mm Hg by echocardiography/Doppler

Question 6

Pathophys of pulmonic stenosis

Answer 6

Increases the resistance to RV outflow
Raises the RV pressure
Limits pulmonary blood flow
Pulmonary blood flow preferentially goes to the left lung in valvular pulmonic stenosis

Question 7

S/sx of pulmonic stenosis- mild

Answer 7

Asymptomatic

Question 8

S/sx of moderate to severe pulmonic stenosis

Answer 8

DOE
Syncope
CP
Eventually RV failure

Question 9

Examination of pulmonic stenosis

Answer 9

Palpable parasternal lift
Loud, harsh systolic murmur
Occasionally, prominent thrill in left 2nd and 3rd interspaces parasternally
In mild to moderate, loud ejection click can be heard to precede the murmur

Question 10

Exam of pulmonic stenosis- severe

Answer 10

Pulmonary component of S2 may be diminished, delayed, or absent
Right-sided S4 and a prominent a wave in the venous pulse

Question 11

Findings on EKG- pulmonic stenosis

Answer 11

Right-axis deviation or RVH

Peaked P waves

Question 12

Radiographic findings of pulmonic stenosis

Answer 12

Heart size may be nl, or there may be a prominent RV and RA or gross cardiac enlargement

Question 13

Criteria for mild pulmonic stenosis

Answer 13

If the peak gradient by echo/Doppler is <30 mm Hg

Question 14

Criteria for moderate pulmonic stenosis

Answer 14

If the peak gradient by echo/Doppler is between 30 mm Hg and 60 mm Hg

Question 15

Criteria for severe pulmonic stenosis

Answer 15

If the peak gradient by echo/Doppler is >60 mm Hg or the mean gradient is >40 mm Hg

Question 16

What is the tx of choice for pulmonic stenosis?

Answer 16

Percutaneous balloon valvuloplasty

Question 17

How is PDA best visualized?

Answer 17

MRI
CT
Contrast angiography

Question 18

What is the purpose of the ductus arteriosus?

Answer 18

Allows shunting of blood from the PA to the aorta in utero (thus bypassing the lungs)

Question 19

When should the ductus arteriosus close?

Answer 19

Immediately after birth

Question 20

What does failure of the ductus arteriosus to close cause?

Answer 20

Left-to-right shunt

Question 21

How can a PDA be closed in a neonate?

Answer 21

Administration of a prostaglandin inhibitor, such as indomethacin

Question 22

S/sx of PDA

Answer 22

No sx unless LV failure or pulmonary HTN develops
Pulse pressure wide
Diastolic pressure low
Continuous machine-like murmur
Thrills are common
Toes are cyanotic and clubbed if shunt is reversed

Question 23

Where can the PDA murmur be best heard?

Answer 23

Left first and second interspaces at the left sternal border

Question 24

EKG findings of PDA

Answer 24

Normal tracing or LVH is found

Question 25

CXR findings on PDA

Answer 25

Heart is nl in size and contour, or there may be LV and LV enlargement
PA, aorta, and LA are prominent

Question 26

What does cardiac catheterization do for PDA?

Answer 26

Can establish the shunt size and direction

Defines the size and anatomic features of the ductus

Question 27

What is recommended prophylaxis for dental procedures in someone with PDA?

Answer 27

Antibiotic prophylaxis for infective endocarditis or endarteritis

Question 28

When is closure of a PDA in an adult either percutaneously or surgically indicated?

Answer 28

Presence of left atrial or left ventricular enlargement, pulmonary artery HTN, or net left-to-right shunting
Prior endarteritis

Question 29

When is surgical repair of a PDA indicated?

Answer 29

The PDA is too large for device closure

Distorted ductal anatomy precludes device closure

Question 30

How should a small PDA be closed?

Answer 30

By catheter device

Question 31

What are the categories of valvular heart disease?

Answer 31

Stage A: Pts at risk for valvular heart disease
Stage B: Pts with progressive VHD (mild to moderate severity) and asymptomatic
Stage C: Asymptomatic pts who have reached criteria for severe VHD
-C1: Nl LV function
-C2: Abnormal LV function
Stage D: Symptomatic pts as a result of VHD

Question 32

What sx present when mitral stenosis becomes severe?

Answer 32

Fatigue
Exertional dyspnea
Orthopnea

Question 33

What are sx of mitral stenosis often precipitated by?

Answer 33

Onset of atrial fibrillation or pregnancy

Question 34

What is diagnostic for mitral stenosis?

Answer 34

Echo/Doppler

Question 35

When is intervention for mitral stenosis indicated?

Answer 35

Sx
Atrial fibrillation
Evidence of pulmonary HTN

Question 36

Pathophys of mitral stenosis due to rheumatic mitral stenosis

Answer 36

Thickening of the leaflets
Fusion of the mitral commissures
Retraction
Thickening and fusion of the chordae
Calcium deposition in the valve

Question 37

Pathophys of mitral stenosis due to congenital disease

Answer 37

Chordal fusion

Papillary muscle malposition

Question 38

S/sx of mild to moderate mitral stenosis

Answer 38

Either asymptomatic or symptomatic only with extreme exertion

Question 39

PE of mitral stenosis

Answer 39

Tapping sensation over PMI
Right ventricular pulsation in left third to fifth ICS parasternally when pulmonary HTN is present
P2 may be palpable
Opening snap following A2

Question 40

Where is the mitral stenosis murmur best heard?

Answer 40

At the apex when a pt is in the left lateral position

Question 41

S/sx of severe mitral stenosis

Answer 41

Severe pulmonary HTN

Sx of low cardiac output and right heart failure