Cardio part 1 Flashcards
How can severe cases of pulmonary valve stenosis present?
Right-sided heart failure
How does P2 present in pulmonic stenosis?
Delayed and soft and absent
Presentation of heart sounds in pulmonic stenosis
Ejection click often present and decreases with inspiration
The only right heart sound that decreases with inspiration; all other right heart sounds increase
What is diagnostic for pulmonic stenosis?
Echocardography/Doppler
Who should undergo intervention for pulmonic stenosis regardless of sx? (Otherwise, operate for sx)
Pts with peak pulmonic valve gradients >60 mm Hg or a mean of 40 mm Hg by echocardiography/Doppler
Pathophys of pulmonic stenosis
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
S/sx of pulmonic stenosis- mild
Asymptomatic
S/sx of moderate to severe pulmonic stenosis
DOE
Syncope
CP
Eventually RV failure
Examination of pulmonic stenosis
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
Exam of pulmonic stenosis- severe
Pulmonary component of S2 may be diminished, delayed, or absent
Right-sided S4 and a prominent a wave in the venous pulse
Findings on EKG- pulmonic stenosis
Right-axis deviation or RVH
Peaked P waves
Radiographic findings of pulmonic stenosis
Heart size may be nl, or there may be a prominent RV and RA or gross cardiac enlargement
Criteria for mild pulmonic stenosis
If the peak gradient by echo/Doppler is <30 mm Hg
Criteria for moderate pulmonic stenosis
If the peak gradient by echo/Doppler is between 30 mm Hg and 60 mm Hg
Criteria for severe pulmonic stenosis
If the peak gradient by echo/Doppler is >60 mm Hg or the mean gradient is >40 mm Hg
What is the tx of choice for pulmonic stenosis?
Percutaneous balloon valvuloplasty
How is PDA best visualized?
MRI
CT
Contrast angiography
What is the purpose of the ductus arteriosus?
Allows shunting of blood from the PA to the aorta in utero (thus bypassing the lungs)
When should the ductus arteriosus close?
Immediately after birth
What does failure of the ductus arteriosus to close cause?
Left-to-right shunt
How can a PDA be closed in a neonate?
Administration of a prostaglandin inhibitor, such as indomethacin
S/sx of PDA
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
Where can the PDA murmur be best heard?
Left first and second interspaces at the left sternal border
EKG findings of PDA
Normal tracing or LVH is found
CXR findings on PDA
Heart is nl in size and contour, or there may be LV and LV enlargement
PA, aorta, and LA are prominent
What does cardiac catheterization do for PDA?
Can establish the shunt size and direction
Defines the size and anatomic features of the ductus
What is recommended prophylaxis for dental procedures in someone with PDA?
Antibiotic prophylaxis for infective endocarditis or endarteritis
When is closure of a PDA in an adult either percutaneously or surgically indicated?
Presence of left atrial or left ventricular enlargement, pulmonary artery HTN, or net left-to-right shunting
Prior endarteritis
When is surgical repair of a PDA indicated?
The PDA is too large for device closure
Distorted ductal anatomy precludes device closure
How should a small PDA be closed?
By catheter device
What are the categories of valvular heart disease?
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
What sx present when mitral stenosis becomes severe?
Fatigue
Exertional dyspnea
Orthopnea
What are sx of mitral stenosis often precipitated by?
Onset of atrial fibrillation or pregnancy
What is diagnostic for mitral stenosis?
Echo/Doppler
When is intervention for mitral stenosis indicated?
Sx
Atrial fibrillation
Evidence of pulmonary HTN
Pathophys of mitral stenosis due to rheumatic mitral stenosis
Thickening of the leaflets Fusion of the mitral commissures Retraction Thickening and fusion of the chordae Calcium deposition in the valve
Pathophys of mitral stenosis due to congenital disease
Chordal fusion
Papillary muscle malposition
S/sx of mild to moderate mitral stenosis
Either asymptomatic or symptomatic only with extreme exertion
PE of mitral stenosis
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
Where is the mitral stenosis murmur best heard?
At the apex when a pt is in the left lateral position
S/sx of severe mitral stenosis
Severe pulmonary HTN
Sx of low cardiac output and right heart failure
