Cardio1 Flashcards

Mitral valve stenosis
The high PCWP (i.e., left atrial pressure), and the large gradient between PCWP and the LVEDP, indicated a stenoic mitral valve. Also, a stenotic mitral valve would increased the resistance to flow into the left ventricle, which would cause blood to back up in the circuit. We see this manifested in the high pulmonary artery pressure
What is the cause of this woman’s shortness of breath?
Pulmonary congestion.
The stenotic valve is increasing the resistance to flow from the left atrium to the ventricle, which is causing blood to back up in the circuit. This will lead to pulmonary congestion and increased pulmonary capillary pressure, leading to pulmonary edema and difficulty breathing.
We can also tell that pulmonary capillary wedge pressure is elevated because the pressures are elevated at the arterial and venous ends of the pulmonary circulation.
Diastolic murmur best heard at the 5th left intercostal space at the midaxillary line
mitral valve stenosis
What is the pulmonary capillary wedge pressure an estimate of?
left atrial pressure
When would you hear a murmur due to mitral regurgitation?
during diastole
What is the normal range for pulmonary capillary wedge pressure (PCWP)?
4-12 mmHg
What is indicated by a PCWP that is significantly greater than the LVEDP?
This means that there is a pressure gradient across the mitral valve, which indicates stenosis
What pressure changes would you see in someone with aortic stenosis?
Because the resistance to ejection of blood into the aorta is increased, you would see greatly increased left vantricular pressure. The systolic pressure in the aorta, however, would be normal
What type of murmur is produced by aortic regurgitation? Where can it best be heard?
Blowing, high-pitched, decrescendo diastolic murmur, best heard along the lower left sternal border
What is aortic regurgitation? How does this manifest clinically?
When blood flows back through the aortic valve into the left ventricle during diastole. This results in a blowing diastolic murmur, and a widening pulse pressure, sometimes greater than 100 mmHg
Why is the systolic pressure increased in someone with aortic regurgitation?
The systolic pressure is increased because of an increased stroke volume, which is secondary to an increased LVEDV, all due to the aortic regurgitation.
A 67 yo man comes to the physician for a physical exam required for insurance. During blood pressure measurement, systolic sounds are heard in the brachial artery with the cuff completely deflated. His BP is 170/80 mmHg. What is the most likely diagnosis? Why can these sounds be heard when the cuff is deflated?
This man likely has aortic regurgitation, evidenced by the large pulse pressure, and the systolic sounds heard with a deflated cuff.
In aortic regurg., the systolic pressure increases (the pulse pressure widens) because of increased SV. This very high volume and pressure results in turbulent flow through the brachial artery that can be heard even when the cuff pressure is zero.
Where can aortic stenosis best be auscultated?
upper right sternal border
What are the classic blood pressure findings in someone with aortic stenosis?
elevated LV peak systolic pressure, normal aortic systolic pressure = pressure gradient across aortic valve.
In aortic stenosis, there is increased resistance to blood flow through the aortic valve. In this case, the left ventricle must generate greater than normal pressure to push blood into the aorta (increased peak systolic pressure in th eleft ventricle), while the aortic systolic pressure will be normal.
A 42 yo woman comes to the ED b/c of a 1-hr hx of crushing substernal chest pain. An EKG shows critical stenosis of a cardiac valve. It is determined the stenotic valve is the aortic valve. what will be heard on auscultation?
A crescendo, decrescendo systolic murmur with an ejection click
Decrescendo diastolic murmur best heard at the lower left sternal border
aortic regurgitation
Diastolic rumble best heard in the left lateral decubitus position.
Mitral stenosis
Holosystolic murmur radiating to the apex
mitral regurgitation
What might you hear on auscultation of a pericardial effusion? Why?
Muffled heart sounds, as the fluid surrounding the heart blocks the conduction of the heart sounds.
A 70 yo man is brought to the ED b/c of a 1-month hx of worsening SOB. Auscultation shows a systolic murmur best heard at the upper right sternal border. CXR shows enlargement of the left vetnricle. Which of the following additional pathologic changes would most likely be associated with this condition?
(a) calcification of the aortic valve
(b) dilatation of ascending aorta
(c) dissection of ascending aorta
(d) rupture of aortic valve leaflets
(e) vegetations on the aortic valve
calcification of the aortic valve.
This is the most common cause of aortic stenosis in the elderly
A 70 yo man is brought to the ED b/c of a 1-month hx of worsening SOB. Auscultation shows a systolic murmur best heard at the upper right sternal border. CXR shows enlargement of the left vetnricle. What is the diagnosis? What is the relevance/connection of the enlargement of the left ventricle.
This patient has aortic valve stenosis.
Aortic stenosis –> increased afterload –> ventricular hypertrophy –> subsequent dilatation of the left ventricle
What is coarctation of the aorta?
A narrowing (stenosis) of the aorta, which increases the vessel resistance, and forces the heart to pump against a higher pressure.
What is the difference in location of the coarctation of the aorta between the infant and adult forms?
In the infant form, the coarctation lies distal to the aortic arch, but before (proximal to) the PDA
In the adult form, the coarctation lies distal to (after) the aortic arch (distal to the left subclavian artery), and is not associated with the PDA
With what genetic disorder is the infantile form of coarctatin of the aorta associated?
Turner Syndrome























