Cardiology Flashcards
Mitral valve prolapse / floppy valve sydrome / barlow syndrome
Balooning of mitral valve leaflets - pushed higher. Than its normal , extra stress on chorda tendinae & pappilary muscles - resulting in subendocardial ischemia - hypoxia
Causes of mitral valve prolapse
Myxomatous degeneration of mitral valve tissue
Type 3 collagen defect
Broken myofibrils
. End result is valve bulges up causing primary mitral regurgitation
- connective tissue disorder A) marfans syndrome . Chr 15 defect . Fibrilin 1 . Arachanodactyly . Mortality d/ t aortic dessection B) ehler danlos syndrome C) osteogenisis imperfecta
-
Causes of mitral valve prolapse
Straight back syndrome
- thoracic kyphosis - antero poster diameter of chest is less
- rheumatic fever ( aschkoff body ) dilated cardiomyopathy
Pathphysiology of mitral valve prolapse ?
1 ) auscultatory findings - mid systolic click
- due to extra tension on chorda tendinae pressure develops in middle of systole
2 ) ischemic damage in subendocardial area causing ventricular arythmia complaints of chest pain
Clinical features of mitral valve prolapse ?
1) asymtomatic
2) chest pain substernal
3) palpiations due to premature ventricular contractions
4) infective endocarditis
5 ) transient ischemic attack - platelet plugs fibrin deposits
6 ) sudden cardiac death - MR , LVF
On auscultation in mvp ?
After s1 ejection click - mid systolic clicks
Chordate tendinae may be damaged & MR will be developing blood leaks from LV - LA
- sound of this blood leaking will be heard mid systolic clicks - late systolic crescendo descendo murmur
Murmur in mitral valve prolapse
Late systolic murmur
Murmur in aortic / poulmonary stenosis
Ejection systolic murmur
Murmur on squating and standing in mvp becomes
Shorter - squating
Larger - standing
Posterior leaflet defect in mvp ?
Bllod moves anteriorly murmur radiates to base
Anterior leaflet defect in mvp
Bloodmoves posteriorly murmur radiates to axilla/ back
Treatment for mvp
1 . Beta blockers
2. Profylaxis - infective endocarditis
3 . Mitral valve repair to prevent regurgitation
4 .
Golden period of MI ?
1st hour
Causes of sudden cardiac. Death in post MI. Patients. & toc. ?
1) tachyarythmia - vf
Toc - defibrillation
2) bradyarythmia - mobitz 2 heart block
Toc - atropine - to accelerate heart
Patient with st elevation MI , thrombus in right coronary artery evaluation ?
St elevation in leads 2, 3 , avf ( inferior leads ) - helps in identifying inferior wall mi , min st elevation should be
> 2mm males
> 1.5 mm females
Troponin 1 rise shows increasing trend
Troponin value usually starts doubling by ?
3 - 4 hours
Pci ( baloon angioplasty ) procedure ?
Ideally done within 90 min ,
Guidewire will be navigated from radial artery - subclavian artery - root of aorta - right coronary artery - steered tgrough thrombus - inflate - destroy the clot - revascularization obtained
To prevent development of atgerosclerosis from progressing further we have to give ?
Statins
Deployment of stent
What are drug eluting stent
They are coated with medicines that will prevent the restenosis
- it is coated with 2 medicines
Everolimus
Zoterolimus
Advantages of drug eluting stent ?
Modify atherosclerotic process
Prevent development of stenosis
Biodegradable stents ?
Get incoparated in walls of blood vessels
Rotatory atherectomy ?
For patients with chronuc stable angina
Thrombus will ne removed so stent can be deployed
To check characyer of pulse ?
Carotid artery
To check rate / rythm ?
Radial artery
In children if palpable then ?
Femaral can be used
Max pressure pulse wave form where ?
Middle of systole
Dichrotic notch present after
S2
Pulsus tardus / anachrotic pulse ?
Slow rising pulse with less amplitude ! The duchrotic notch may not be recorded thats why anachrotic pulse
Pulse in aortic regurgitation ?
Collapsing pulsr , corrigan pulse , water hammer pulse
Anachrotic pulse
Aortic stenosis
Bisfiriens pulse
Hocm
Corrigan / collapsing/ water hammer pulse
Aortic regurgitation
Dicrotic pulse
Dilated cardiomyopathy
Pulsus alterance
Lvf , alternate weak and strong pulse
Irregularly irregular pulse
Artirial fibrillation
Pulsus paradoxus
Found in hypotensive state - dissapears in inspiration Cardiac tamponade Inf wall mi Severe copd Status asthmaticus Pregnancy
Irregularly irregular breathing
Biots breathing
Irregularly irregular pulse
Artirial fibrillation
Murmur in mitral stenosis
Mid diastolic murmur
Peak at middle of diastole has small secondary spike called as
Pre systolic accentuation
Secerity of mitral stenosis decided by
Length of murmur
Contraindications of pmbv
Calcified severe ms, severe ms + mr , severe ms + left atrial appendage thrombi
Early diastolic murmur seen in
Graham steel , ar mild , pr mild
Mid diastolic murmur seen in
Ms , austin flint , flow murmur
Late diastolic murmur seen in
Rheumatic carditis , carley coomb murmur
Ejection systolic murmur seen in
As , ps , hocm
Pan systolic murmur seen in
Mr , tr , vsd
Late systolic murmur seen in
Mitral valve prolapse
All murmurs decrease in intensity with valsalva / standing / amyl nitrate inhalation due to reduction of venous return except ?
Hocm - louder
Mvp - louder
All murmurs increase in intensity with situps hand grip except
Hocm - softer
Mvp - shorter
