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SUMMED2 > CARDIO-VALVE DZ > Flashcards

CARDIO-VALVE DZ Flashcards

1
Q

How does doppler indicate hemodynamics of heart?

A

RED- shorter waver, higher pitch means coming towards transducer
BLUE- lower pitch away from transducer

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2
Q

What are the common congenital Aortic stenosis?

A

Bicuspid aortic valve. Normal valve =3, thickened
Membranous subvalvar= Peds
Fused leaflets w/doming= Peds, valves don’t separate

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3
Q

What is the common blood flow through valves?

A

Tricuspid- 3 leaflets.
Pulmonic
Mitral- 2 leaflets
Aortic- 3 leaflets

Tissue Paper My Assests

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4
Q

Which is MC types in aortic stenosis in Adults?

A

Acquired

Calcific-MC leaftlets thickened, INC turbulent flow

Hypertrophic subaortic- IV thick, during systole outflow constricted as MSK contracts. constriction not at valve

Rheumatic- strep GAS, Latino/Asia- immigrants mmigrants VC

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5
Q

What happens pathophys when aortic valve becomes narrow?

A

Aortic Stenosis
INC ventricular systolic pressure- must overcome valve to maintain CO

LVH- stiffer like a MSK during exercises.

Systole decompensation- EF DEC
LOW pulse pressure- Narrowed,

Late LV failure Overtime/severe- HYPOTENSION

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6
Q

Overtime what happens to diastole with LVH in AS?

A

Diastolic dysfunction
CV MSK thickens, requiring more work to distend
AS- rapid deteriotaion and poor prognosis

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7
Q

Pt present with angina and syncope? What is on your DDX

A

Aortic stenosis- d/t hypertrophy, INC O2 demand

Angina- Stable, Unstable-occurs w/o damage, O2 demand not met, CP inadequate BF

CHF- HFpEF (d), HFrEF (s)

Lightheadness after exertion

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8
Q

On PE you notice a soft S2, palpable murmur, and BP pulse difference <40, What do these indicated?

A

Aortic Stenosis

  1. Systolic murmur- palpable thrills
  2. Soft S2- Aortic valves not closing
  3. Delayed arterial upstroke- systole becomes gradual vs strong in 1/3 of upstroke
  4. Narrow pulse pressure- diastole rises bc Stroke vol dfx
  5. Lung rales- LA pressure rises, blood pushed to lungs if LVH
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9
Q

Pt has angina and syncope, with S2 diminished? What is next step?

A 
Aortic Stenosis
Echocardiogram KEY
Signs: INC leaflet thick, cant close
INC systole velocity- CV pumping hard to get threw thickness
DEC valve surface area- LVH**
Maybe mosaic colors
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10
Q

Flow rate is constant regardless of where on echo?

A

continuity principle
Flow in the LV outflow tract =area flow in aortic valve
If you are given LV outflow, can solve for aortic valve area

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11
Q

What is Normal aortic valve area?

A

4 cm2​ ​; anything less is severe aortic stenosis

Echo provide number-NO CATH needed

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12
Q

What is purpose of cardiac catheter?

A

Mainly for Coronaries
CAD/Unstable angina/Acute coronary syndrome/MI

Or to check if coronary are damage b4 Valve replacement w/ aortic stenosis

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13
Q

What mechanical treatment for aortic stenosis restores normal hemodynamics?

A

Valve replacement Mechanical- needs anticoagulation d/t clot risk
Heterograft- bovine pig material
Homograft- human
TAVR-transcutaneous aortic valve, metalic stent tube keep vessel open

IF Triad of CHF, angina, Stoke Adam/syncope attacks, and systolic/EF dfx, **then VALVE replace. NOT MEDS

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14
Q

What mechanical treatment ameliorates the stenosis for 6-12mo?

A

Balloon valvuloplasty-large ballon placed in valve

IDEAL for-calcific​ or ​rheumatic ​AS for tri-leaflet valves, palliative nonsurgical pts, urgent if needed prior to hip surgery, TAVR work up

Poor prognosis

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15
Q

What is condition when blood is pumped 2x as great from LV, but leaks back int LV?

A

Aortic regurgitation

Echo Doppler- uniform color of BF

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16
Q

What are result of slow LV dilation?

A

Acute decompensation
Pulmonary congestion
dec time for LV to elarge
Diastole pressure is HIGH

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17
Q

What occurs in LV systolic failure?

A

Chronic decompensation

EF- ejection fraction DEC

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18
Q

Pt c/c weakness, palpitations, CP, orthopnea, wide pulse pressure? What other findings on exam?

A

AORTIC REGURGITATION

HIGH PITCHED early **diastolic decresendo murmur -Blood falling back after systole.
HEARD at LSB and apex - Heard at Mitral and Aortic

Systolic flow murmur-Aortic, turbulent has valve closes

CHF- EF <40, CP, edema, orthopnea ascites, fatigue, SOB, weak

Palpitations TYPEs

  1. INC SV- valve is loose, so can pump out alot, felt LLD
  2. Atrial Fibrillation- arrhythmia, people feel irregular rapid beats

Large upstroke volume

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19
Q

PT has history of Marfans in Family? What other cause of Chronic aortic regurgitation?

A

Hypertension

Aortic root dilatation

Arteriosclerosis-valve vessels stiffened

Aortic stenosis-

VRProsthesis: leaflet vs. perivalvular d/t difficult sewing or stent around valve

Endocarditis​- infection of the aortic valve; common in IVDU
RA, SLE-rare

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20
Q

Baby Joe was born with bicuspid aortic valve? What are risk of his conditions?

A

Aortic Regurgitation Chronic II

Other etiology
○ VSD ​(ventricular septal defects)
● Sinus of Valsalva aneurysm​ (rare)-MC graudal distended
● Aortitis
● Rheumatic Fever rare 
● Syphilis - rare
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21
Q

Pt was in a car accident and hit his steering wheel. c/o fatigue, SOB, CP, and palpitation. PE- you hear a absent S1 CXR- Normal heart size? What could be a complication?

A 
ACUTE-Aortic Regurgitation
● Aortic Dissection
● Endocarditis
● Valve prosthesis - clot formation
● Rupture of sinus of Valsalva aneurysm
● Rheumatic fever-rare
22
Q

What is natural progression of Aortic REgurg?

A

Long period w/o symptoms
Blood falls back to LV in diastole
Gradual LVH w/ normal stroke volume via dilation
Symptoms mean rapid deterioration- LVSEF very symptomatic
ACUTE decomp- pulmonary congestion
CHRONIC decomp- LV systolic failure, EF DEC

23
Q

What encourages forward ejection rather than backward flow?

A 
Treatment of AR
Afterload reduction
None very helpful
CHF-diuretics
Antibiotics needed preop some cases, Dirty surgery
24
Q

When is surgery beneficial for Aortic regurgitation?

A

ACUTE OR SEVERE AR EMERGENCY
Endocarditis
Chronic AR- based on: 1. SX 2. Sys dFX/EF 3. Inc LV dilation

25
Q

What is sound defect in S1 at Mitral valve, which Rheumatic and fibrocalcific changes may damage this valve?

A

Mitral Stenosis-RARE

Mitral and Tricuspid 1st- Mitral most bc LV bigger/louder

26
Q

What leads to RHF and LA enlargement?

A 
MITRAL STENOSIS
Blood backs up into LA due to narrow mitral valve
LA pressure rises
Lungs back flow/congested
2nd Pulmonary HTN
27
Q

Pt c/c CP, edema, SOB, sx fo CHF w/ palpitations
PE CV *Loud S1, narrow pulse pressure
Lung- Rales
What are DDX?

A

MITRAL STENOSIS

KEY * LOUD S1 at Mital

28
Q

Pt c/c CP, edema, SOB, sx fo CHF w/ palpitations
PE CV *Loud S1, narrow pulse pressure
Lung- Rales
What are other findings

A

LOUD S1
Opening snap
Diastolic murmur- blood still in chamber
Narrow pulse pressure
Rales- Pulmonary HTN: RV lift, LOUD P2, JVPressure INC, v waves**

29
Q

Pt has LOUD S1 with pulmonary rales. What is next step?

A

ECG
Signs: LA abnormal, RVH, Atrial Fib

CXR
Echo w/Doppler

30
Q

What are hallmarks of Mitral stenosis on CXR

A

Large L pushes L bronchus
Large Pulmonary artery in RV
Small LV

31
Q

Echo shows leaflets fused tips, thick, and shorten chords. What is DX and what other findings?

A 
MITRAL STENOSIS
Leaflets flexible, still domes
Leaflets calcified
Pressure half-time in doppler
Pulmonary HTN
32
Q

?Is catherization diagnosis needed for all Mitral Stenois?

A

NO
Gradient between LA (PA wedge) and LV in diastole
● Not needed for evaluating presence or severity

● Performed only for:
○ Preoperative exclusion of CAD if sufficient age or risk factors

33
Q

What is common onset of Mitral stenosis?

A 
Pt doesn't recall h/o rheumatic fever 
Long latency
Insidious constriction of activity
CP- Abrupt atrial fib
○ Hemodynamic decompensation
○ Systemic emboli
34
Q

What is the ideal treatment for Mitral Stenosis?

A

Prevent recurrent rheumatic fever- PROPHAXLIS
Diuretics
Anticoagulatin-ASA d/t risk of A. Fib

35
Q

Describe surgery measure for Mitral Stenosis

A

Balloon -commissurotomy if anatomy OK
Surgical open heart surgery to repair mitral valve
Valve replacement

36
Q

What is main cause of Mitral Regurgitation?

A

1MC- CAD Dz, STEM/MI

  1. LV dialatin
  2. Endocarditis-RF rare
  3. Prolaspe
  4. Connected tissue, inflam-rare
  5. Congenital defects- rare
37
Q

What acute soft tissue ruptures cause Mitral regurgitation?

A

Chordal ruptures- endocarditis, myxomatous (prolapse)
Papillary rupture-MI, trauma
Papillary ischemia- d/t circumflex block
They shorten can close enough

38
Q

What occurs when blood regurgitates into left atrium in ​systole?

A

FROM MITRAL VALVE REGURGITATION
● LV ​enlarges- amount of blood is 2x more- flows back into LA
● Acute decompensation: ​congestion:○ INC LA pressure → acute CHF
● Chronic decompensation: ​LV systolic failure → muscle tires out → ejection fraction drops

39
Q

Pt c/c CP, weakness, SOB, w/ fever
PE- edema, s/s of Left CHF.
holosystolic murmur, PMI+ at apex? What is DX?

A

MITRAL Regurgitation
edema 2/2 RHF

Late systolic if starts mid systole d/t papillary damage, prolapse after click

40
Q

ON ECG, Pt has L atria abnormality and LVH? What is on DDX and what other findings?

A

MITRAL REGURGITATION
Findings:
***MC-A. fib

41
Q

What are findings for MR pt on CXR?

A

**LA enlargement​ ​←​ initial finding
○ LV enlargement
○ CHF

42
Q

What is workup will ROTH spots show up? What is it indicative of?

A

ECHO
Roth spots from endocarditis

Other findings
■ Quant-Volume of left atrium filled
■ Quanit- Orifice area, analogous to aortic stenosis
○ Etiology​- chronic fevers, weight loss,
○ LV function+

43
Q

What workup can you see a Large V wave indicative of MR?

A 
Cardiac catheterization- Etiology,  CAD
Large “V” wave
○ Angiographic presence of MR 
○ LV size and contractility
○ Hemodynamic effects: output, pressures
44
Q

What treatment can be used for MR due to endocarditis?

A

○ Endocarditis ​ABX ​prophylaxis, TREAT
○ Vasodilator- Afterload reduction
○ CHF TX
○ Arrhythmias TX

45
Q

What is important with surgical tx of MR?

A

Valve repair/replace- shorten/reattach chords
1. fix B4 the ejection fraction becomes abnormal
EF could gets worse post surgery d/t decompensation

Cath ring-MITRAclip

46
Q

What is the result of RV failure or dialation?

A

TRICUSPID REGURITATION

47
Q

What is MCC of RV failure?

A

LV failure

Pulmonary HTN
2/2- MC
1. lung dz
2. Mitral dz
3. Eisenmenger synddrome- ESvolume overload. EX-Atrial or ventricle defect
48
Q

What group of people are at risk of Tricuspid Regurge?

A

IV drug users- endocardiitis of tricuspid valve

COPD pts, RF- very rare

49
Q

Pt has edema, ascites, and fatige with exercises? What is ddX

A

R CHF
Tricuspid regurgitation
NO Pulmonary congestion

50
Q

What are PE finding of Tricuspid Regurgitation

A

Palpate Large V waves jugular veins during systole**
NO murmur audible***
Fever, chills, wt loss- Endo
SOB- COPD pt

51
Q

What is ideal treatment of Tricsupid REgurg?

A

Treat Endo, LVH
COPD TX
Diuretics

52
Q

What is most important in surgery for Tricuspid Regurg?

A

TX- underlying MITRAL valve condition prior-KEY
Tricuspid annuloplasty ring
Valve replacement

SUMMED2 (38 decks)

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