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STEP 2 Cardio + Renal > Cardio. Valves (08-12) (1) > Flashcards

Cardio. Valves (08-12) (1) Flashcards

1
Q

Bicuspid aortic valve. 2 reasons to develop?

A

sporadically or through autosomal dominant with incomplete penetrance pattern

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1
Q

Most common type of congenital heart disease in adults?

A

Bicuspid aortic valve

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2
Q

Bicuspid aortic valve. inheritance pattern?

A

autosomal dominant with incomplete penetrance pattern

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3
Q

Bicuspid aortic valve. presentation depends on what?

A

on patients age

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4
Q

Bicuspid aortic valve. pathophysiology in younger patients? 2

A

Valvular leaflet abnormalities or aortic root dilation

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5
Q

Bicuspid aortic valve. in youger, feature and auscultation

A

This results in isolated aortic regurgitation (this leads to early decrescendo diastolic murmur which begins immediately after A2 which is best heard with the diaphragm of the stethoscope along the left sternal border at the 3rd and 4th intercostal spaces while the patient is sitting up, leaning forward, and holding a breath in full expiration)

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6
Q

Bicuspid aortic valve. pathophysiology in older patients?

A

calcification of aortic valves due to excessive wear-and-tear

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7
Q

Bicuspid aortic valve. in elderly. feature as a result of pathophysiology?

A

This leads to aortic stenosis

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8
Q

Bicuspid aortic valve. complications?2

A

a. Dilation of aortic root or ascending aorta.
–> Leads to aortic aneurysm and dissection.
–> Causes sudden death.

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9
Q

CHRONIC aortic regurgitation.
etiologies? 3

A

Congenital bicuspid aortic valve
Postinflammatory (eg, rheumatic heart disease, endocarditis)
Aortic root dilation (eg, Marfan syndrome, syphilis)

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10
Q

CHRONIC aortic regurgitation. pathophysiology?
Backflow from aorta into LV –> incr. in what?

A

incr. LV end-diastolic volume

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11
Q

CHRONIC aortic regurgitation. pathophysiology?
LV initially compensates with eccentric hypertrophy –> incr. in what?

A

incr. SV&CO

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12
Q

CHRONIC aortic regurgitation. pathophysiology?
Eventual LV dysfunction –> decr in what?

A

Eventual LV dysfunction –> decr. SV & CO –> heart failure

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13
Q

CHRONIC aortic regurgitation.
what murmur?

A

Diastolic decrescendo murmur

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14
Q

CHRONIC aortic regurgitation. what pulse findings? 2

A

Widened pulse pressure (incr. SBP & decr. DBP) findings

Rapid rise-rapid fall (“water-hammer’’) pulsation

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15
Q

CHRONIC aortic regurgitation. what femoral/carotid pulse finding?

A

Abrupt carotid distension & collapse, “pistol-shot” femoral pulses

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16
Q

CHRONIC aortic regurgitation. murmur kreive?

A

S1 - S2 decrendo - S1

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17
Q

What pulsus in Ao regurgitation (vs Ao stenosis)?

A

Pulsus bisferiens

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18
Q

What pulsus in Ao stenosis (vs Ao regurgitation)?

A

pulsus parvus et tardus

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19
Q

pulsus parvus et tardus in what?

A

Ao stenosis

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20
Q

Pulsus bisferiens in what?

A

Ao regurgitation

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20
Q

Pulsus bisferiens. Biphasic pulse. why?

A

It refers to 2 systolic peaks of the aortic pulse from left ventricular ejection separated by midsystolic dip

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21
Q

Pulsus bisferiens. in what 3 pathologies?

A

a. Aortic regurgitation
b. Hypertrophic cardiomyopathy
c. Large PDA

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22
Q

Aortic stenosis. what size area?

A

<3 cm2

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23
Q

Aortic stenosis. what size when become symptomatic?

A

Aortic stenosis becomes symptomatic when valve area <1 cm2

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24
Q

Aortic stenosis. common cause?

A

Age-related sclerocalcific changes in the aortic valves

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25
Q

Aortic stenosis. symtoms?

A

Chest pain, Dyspnea, Dizziness, Syncope

26
Q

Aortic stenosis. carotid pulse?

A

Delayed and diminished carotid pulse (pulsus parvus et tardus)

27
Q

Aortic stenosis. murmurs? 3

A
  • Single and soft S2
  • Audible S4
  • Crescendo-decrescendo systolic murmur in the 2nd right ICS with radiation to carotids
28
Q

Aortic stenosis. when manifests LVH?

A

LVH (does not occur until valve area <1 cm2)

29
Q

Aortic stenosis. what pulse pressure?

A

narrow

30
Q

Aortic stenosis. where intense pulse?

A

Incr. intensity of apical impulse

31
Q

Aortic stenosis. murmur name and in what phase?

A

Systolic murmur (crescendo-decrescendo)

32
Q

Aortic stenosis. what murmur in mild-moderate stenosis?

A

Early-peaking systolic murmur suggests mild to moderate aortic stenosis;

33
Q

Aortic stenosis.what murmur in severe stenosis?

A

Late-peaking systolic murmur suggests severe aortic stenosis.

34
Q

Aortic stenosis. diagnostic method?

A

cardioecho

35
Q

Aortic stenosis. differential? 1

A

Hypertrophic cardiomyopathy: No radiation to carotids, murmur heard best at left lower sternal border.

36
Q

what is second most common type of aortic stenosis?

A

SUPRAVALVULAR AORTIC STENOSIS

37
Q

SUPRAVALVULAR AORTIC STENOSIS. definition?

A

It usually refers to congenital left ventricular outflow tract obstruction due to discrete or diffuse narrowing of the ascending aorta

38
Q

SUPRAVALVULAR AORTIC STENOSIS. what murmur and where?

A

Midsystolic murmur best heard at 1st right intercostal space

39
Q

SUPRAVALVULAR AORTIC STENOSIS. what pulse changes? Blood pressure?

A

Unequal carotid pulses
Differential blood pressure in the upper extremities

40
Q

SUPRAVALVULAR AORTIC STENOSIS. what one more feature palpated?

A

Palpable thrill in the suprasternal notch

41
Q

SUPRAVALVULAR AORTIC STENOSIS. complications?

A

a. Left ventricular hypertrophy (high-voltage QRS complexes, lateral ST segment depression, lateral T wave inversion)
b. Coronary artery stenosis

42
Q

Pulmonic valve stenosis. etiology? 2

A

Congenital (usually isolated defect)
Rarely acquired (eg. carcinoid)

43
Q

Pulmonic valve stenosis. clinical presentation. severe?

A

Right-sided HF in childhood

44
Q

Pulmonic valve stenosis. clinical presentation. mild-moderate?

A

symptoms (eg dyspnea) in early adulthood

45
Q

Pulmonic valve stenosis. murmur? 2

A

Crescendo-decrescendo murmur (incr. on inspiration)

Systolic ejection click and widened split of S2

46
Q

Pulmonic valve stenosis. diagnosis?

A

cardioecho

47
Q

Pulmonic valve stenosis. treatment 2

A

Percutaneous balloon valvulotomy (preffered) * balloon just dilates
Surgical repair in some cases

48
Q

Pulmonic valve stenosis. ejection click. where heard and when?

A

high-pitched sound after S1 best heard during expiration

49
Q

Pulmonic valve stenosis. where best heard murmur and when?

A

Crescendo-decrescendo systolic murmur best heard over the left 2nd ICS. It increases with inspiration (due to increased preload)

50
Q

Pulmonic valve stenosis. widened split. when best heard?

A

Widened splitting (which is further increased during inspiration)

51
Q

MITRAL STENOSIS. clinical features - on respiratory

A

Dyspnea, orthopnea, PND (parox. nocturnal dyspnea), hemoptysis

52
Q

MITRAL STENOSIS. thromboembolic feature?

A

Afib, systemic thromboembolism

53
Q

MITRAL STENOSIS. voice symptoms?

A

Voice hoarseness from recurrent laryngeal nerve compression due to LAE (Ortner syndrome)

54
Q

MITRAL STENOSIS. what is Ortner syndrome?

A

Voice hoarseness from recurrent laryngeal nerve compression due to LAE (Ortner syndrome)

55
Q

MITRAL STENOSIS. clinical feature - face?

A

Mitral facies (pinkish-purple patches on cheeks)

56
Q

MITRAL STENOSIS. S1 and S2?

A

Loud S1, loud P2 if pulmonary hypertension

57
Q

MITRAL STENOSIS. what specific murmur?

A

Opening snap (high-frequency early diastolic sound)

58
Q

MITRAL STENOSIS. what rumble, where heard?

A

Mid-diastolic rumble (best heard at cardiac apex

59
Q

MITRAL STENOSIS. diagnostics? 3

A

xray, TTE, ECG

60
Q

MITRAL STENOSIS. whats on xray? 4

A

Pulmonary blood flow redistribution to upper lobes,
dilated pulmonary vessels,
LAE,
flattened left heart border

61
Q

MITRAL STENOSIS. whats on ecg?

A

,,P mitrale” (broad and notched P waves), atrial tachyarrhythmias, RVH (tall R waves in V1 and V2)

62
Q

MITRAL STENOSIS. whats on TTE?

A

MV thickening/calcification/ decr. mobility, coexisting MR

63
Q

MITRAL STENOSIS. complications?

A

Afib.

64
Q

MITRAL STENOSIS. murmur schema?

A

S1-S2 short break OS decreascendo -> crescendo - S1

65
Q
A

STEP 2 Cardio + Renal (26 decks)

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