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Pance Re-Up > Cardiology #3 Murmurs, Hyperlipidemia, & Atrial Myxoma > Flashcards

Cardiology #3 Murmurs, Hyperlipidemia, & Atrial Myxoma Flashcards

1
Q

Explain the pathophysiology of aortic regurgitation.

What does this murmur sound like?

A

Incomplete aortic valve closure –> LV overload –> Heart failure

Diastolic blowing decrescendo murmur at LUSB

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2
Q

What are some symptoms of aortic regurgitation?

A

-Austin Flint Murmur: retrograde regurgitant jet competing with integrate flow from LA –> LV
-Bounding Pulses
-De Musset Sign: head bob with heartbeat
-Quincke Pulses: fingernail bed pulsations
-Water Hammer Pulse: swift increase and decrease of pulse with wrist elevation

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3
Q

What are the diagnostics done for aortic regurgitation?

A

Echo: shows dilated LV (thick)
Catheter: definitive

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4
Q

Treatment for aortic regurgitation

A

-Afterload reduction improves flow: ACE, ARBs, CCB

-Surgery: definitive

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5
Q

Explain the pathophysiology of aortic stenosis

How about some etiologies?

A

-LV outflow obstruction leads to a fixed CO, LVH, and LV failure eventually

-Degenerative: calcifications, wear and tear
-Congenital: Bicuspid valve (MC if < 70 years old)
-History of rheumatic heart disease

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6
Q

What does the murmur of aortic stenosis sound like?

A

Systolic crescendo/decrescendo murmur at RUSB radiating to the carotid

-Also has a weak, delayed carotid pulse

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7
Q

Diagnostics for aortic stenosis

A

-Echo: LVH, thick aortic valve
-EKG: LVH, A-fib
-Catheter is definitive

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8
Q

Treatment for aortic stenosis

A

-Surgical treatment (AV replacement)
–Mechnical: thrombogenic (needs long term anticoagulant)
–Bioprosthetic: less durable but minimally thrombogenic
–Intraaortic balloon pump: bridge before valve replacement

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9
Q

What are some things that the patient should avoid before valve replacement if they have aortic stenosis?

A

Physical exertion, venodilators (nitrates), negative inotropes (BB, CCB)

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10
Q

What is mitral stenosis? Where does the blood back up into in this condition?

Explain the pathophysiology.

A

Obstruction of flow from the LA–>LV due to narrowed mitral orifice.

blood backs up into the LA. LA pressure increases –> pulmonary congestion –> pulmonary hypertension

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11
Q

What is the MC etiology of mitral stenosis?

Symptoms of mitral stenosis.

A

Rheumatic heart disease

-Dyspnea, hemoptysis, pulmonary hypertension, cough
-A-fib due to LA enlargement
-RHF due to pulmonary congestion
-Mitral facies = flushed cheeks with facial pallor

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12
Q

What does the murmur of mitral stenosis sound like?

What increases the intensity?

A

Prominent S1, opening snap
Low pitched, mid diastolic rumbling murmur heard best at apex

Increases intensity with left lateral decubitus position

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13
Q

Diagnostics for mitral stenosis

ECG: ______
Echo
CXR: ______
(Definitive):________

A

ECG: LA enlargement, A-fib, pulmonary hypertension

CXR: LA enlargement

Definitive: catheterization

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14
Q

Treatment for mitral stenosis

A

-Percutaneous balloon valvuloplasty
-Valve replacement if unable to do balloon

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15
Q

What is mitral regurgitation?

What is the MCC?

A

Retrograde blood flow from LV–> LA leading to LA dilation and increased pulmonary pressure

MCC: MVP (leaflet etiology)

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16
Q

What does the murmur of mitral regurgitation sound like?

What also increases the intensity?

A

Blowing holosystolic murmur at apex with radiation to axilla

Increased intensity with left lateral decubitus position

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17
Q

Treatment for mitral regurgitation

A

-Symptom control (ACE, ARBs) or diuretics
-Surgical repair of valve

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18
Q

What is the pathophysiology of mitral valve prolapse?

Who is this MC in?

A

Leaflets bulge (prolapse) into the LA

MC in young women

19
Q

Although most patients are asymptomatic, what symptoms CAN they have with mitral valve prolapse?

A

Autonomic dysfunction: atypical chest pain, panic attacks, palpitations

20
Q

What does the murmur for MVP sound like?

A

Mid-late systolic ejection click at apex

21
Q

Pulmonic stenosis is _____________ and is almost always _____ as a cause.

A

RV outflow obstruction

Almost always congenital, disease of the young

22
Q

What does the murmur for pulmonic stenosis sound like?

A

Harsh mid-systolic ejection crescendo-decrescendo murmur at the LUSB that radiates to the neck and increases with inspiration

23
Q

What is the preferred treatment for pulmonic stenosis?

A

Balloon valvulopalsty

24
Q

Pulmonic regurgitation is retrograde blood flow that leads to _________.

The murmur with this condition is called a Graham-Steele Murmur. Explain this.

A

RV overload

brief decrescendo early diastolic murmur at LSUB with full inspiration. Increases with inspiration and decreases with expiration.

25
Q

Is there any treatment needed for pulmonic regurgitation?

A

No treatment is needed

26
Q

With tricuspid stenosis, what happens?

What does this murmur sound like?

A

Blood backs up into the RA –> RA enlargement –> RHF

Mid diastolic murmur at LLSB that increases with inspiration, opening snap

27
Q

Treatment for tricuspid stenosis

A

-Diuretics, Na+ restriction to decrease RA overload
-Replacement of valve if RHF or decreased CO

28
Q

What does the murmur for tricuspid regurgitation sound like?

A

Holosystolic, harsh blowing high pitched murmur at LLSB with NO radiation

29
Q

With tricuspid regurgitation, Carvallo’s Sign is present. What is this?

A

Increase in intensity with inspiration

30
Q

What is the acronym used for diastolic murmurs?

Systolic murmurs?

A

Diastolic: MS PRARTS

Systolic: MR TRASPS

31
Q

What are two specific symptoms of hyperlipidemia?

A

Xanthomas (Achilles Tendon)
Xanthelasma (plaques on eyelids)

32
Q

What are the following defintions?

-Hypercholesterolemia:
-Dyslipidemia:

A

Hypercholesterolemia: Total > 200
Dyslipidemia: LDL >130 and/or HDL <40

33
Q

When should you initiate a statin therapy? There are 5 reasons why you would. Name them.

A

-DM aged 40-75
-w/o CVD 40-75 w/ > 7.5% HA or stroke risk w/in 10 yrs
- 21 or older with LDL > 190
-Anyone with atherosclerotic disease
-< 19 y/o with familial hypercholesterolemia

34
Q

What are the best medications for the following actions:

-Lower LDL
-Lower TG’s
-Increase HDL
-Type II DM

A

Statins are best to lower LDL

Fibrates are best to lower TG’s

Niacin is best to raise HDL

Statins, Fibrates are best for DM Type II

35
Q

Statins

-Drug names
-MOA
-Best to….
-Adverse Effects

A

Simvastatin, Rosuvastatin

Inhibit hepatic cholesterol synthesis

Best to lower LDL

Adverse: Myositis, Rhabdomyolysis, Increased LFT’s

36
Q

Niacin (Nicotinic Acid)

-MOA
-Adverse Effects

A

Delays HDL clearance

Adverse: flushing, pruritus, dry skin, hyperglycemia, GI symptoms

37
Q

With Niacin, what should you give beforehand to help with pruritus?

A

NSAIDs or Aspirin beforehand

38
Q

Fibrates

Drug Names
MOA
Best to…
Adverse Effects

A

-Fenofibrate, Gemfibrozil

-Inhibit TG synthesis and increase activity of lipoprotein lipase

-Best to lower TG’s

-Adverse: myalgias, gallstones

DO NOT USE IF CKD OR BREASTFEEDING

39
Q

Bile Acid Sequestrants

-Drug name
-What it does
-Is it Safe in Pregnancy?
-Often paired with?
-Adverse Effects:

A

Cholestyramine

Lower LDL, mildly raise HDL

Yes safe in pregnancy

Paired with statin

Adverse: GI, Increased TG’s

40
Q

, Ezetemibe

-What it does
-Used in combination with…

A

Lowers LDL

Pair with a statin

41
Q

An atrial myxoma is the MC primary cardiac tumor, however, it is rare. 80% of these occur in which chamber of the heart?

For this reason, it causes an obstruction of the mitral orifice, mimicking what condition?

A

80% left atrium

Mimicks Mitral stenosis

42
Q

Symptoms of an atrial myxoma (much like mitral stenosis)

A

-Dyspnea, syncope, weight loss
-Flu like symptoms
-MS like murmur: prominent S1, low pitched diastolic murmur

43
Q

Best test for an atrial myxoma and what do you see?

A

TEE: pedunculate mass in mitral orifice

44
Q

Treatment for an atrial myxoma

A

Surgical removal

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