Cardiology II Flashcards
cardiac valvular disease - causes and dx
issue with valves of heart - can either be stenosis or regurgitation (i.e. insufficiency) due to “floppy” valve
historically, rheumatic dx
now, atherosclerosis
Dx Test: ECHO!!
mitral valve prolapse - what do you hear on auscultation
midsystolic click
aortic stenosis - sxs
dyspnea, angina, syncope w/ exertion
- LV failure and hypertrophy (displaced PMI)
Murmur: systolic ejection murmur, harsh and loud
- have pt lean forward
aortic stenosis - dx
doppler ECHO (test of choice)
EKG: LVH
CXR: cardiomegaly, calcified valve
aortic stenosis - tx
valve replacement has great results
- must do if following triad of HF, angina, or syncope
aortic regurgitation - sxs and cause
dyspnea on exertion
PE: head-bobbling and pulsating nail beds
- WIDE PULSE PRESSURE (high systolic and low diastolic)
- also see LVH since blood flowing back into LV
cause: can see in Marfan’s due to aortic root problem
Murmur: high pitched, blowing diastolic murmur
aortic regurgitation - dx
ECHO - test of choice
EKG and CXR: LVH
aortic regurgitation - tx
acute regurg (following invasive endocarditis) - immediate surgery
chronic regurg:
- ARBs and ACE-I reduce sxs
- valve replacement eventually
mitral stenosis - sxs
orthopnea, proximal nocturnal dyspnea, exertion dyspnea
- initial sxs often with onset of A-fib or pregnancy
Murmur: mid-diastolic, low-pitched rumble
- OPENING SNAP (HINT-MS/OS)
- loudest in L lateral position (use bell)
mitral stenosis - dx
ECHO - see “hockey stick shape of anterior leaflet of mitral valve
EKG: atrial findings, including A-Fib
mitral stenosis - tx
often asymptomatic
- follow
if have A-Fib - treat A-Fib
- anti-coag
possibly valve repair or replacement
mitral regurgitation - progression
initially can see increased pre-load and reduced afterload
eventually, LV enlarges, weekend, and EF drops = left-sided heart failure
mitral regurgitation - sxs
gradually progressing dyspnea and fatigue over many years
Murmur: harsh, blowing, holo-systolic murmur best heard at apex radiating to left axilla
mitral regurgitation - dx
ECHO and TEE (trans-esophageal)
mitral regurgitation - tx
sxs manage: vasodilators, ACE-I
surgery for intolerable sxs or EF<60%
mitral valve prolapse (MVP) - sxs
common - found in thin, young females and goes away with age
usually, asymptomatic, but can present as young women with non-specific chest pain, dyspnea, fatigue, palpitations
Murmur:
- mid-systolic click
- murmur increases with standing or valsalva
mitral valve prolapse (MVP) - dx
clinically diagnosed; ECHO confirms
mitral valve prolapse (MVP) - tx
beta-blockers for hyperadrenergic state (young women)
SSRI
surgical repair is option, but not common
NOTE: no ABX prophylaxis needed
tricuspid stenosis - sxs
uncommon
rt-sided heart failure
- hepatomegaly, ascites, dependent edema
elevated JVP (giant a wave)
Murmur: diastolic, rumbling murmur
- best heard at left, lower sternal border
- increases with inspiration
- use bell
tricuspid stenosis - dx and tx
ECHO - best
EKG: right-sided issues (rt atrial enlargement, rt ventricular hypertrophy)
Tx:
- diuretics (tx right HF sxs)
- bioprosthetic valve is tx of choice
tricuspid regurgitation - causes and sxs
iatrogenic: pacemaker lead placement
tricuspid valve prolapse, plaque, collagen inflammatory dz, tricuspid endocarditis
sxs: right-sided sxs (high JVP
Murmur: blowing, holosystolic
- best heard at left, lower sternal border
- increases with inspiration
tricuspid regurgitation - dx and tx
Dx: ECHO
Tx:
- minor regurg = diuretics help
- valve replacement if needed
pulmonic stenosis - sxs
frequently asymptomatic
- gradual increase in dyspnea w/ exertion, CP, syncope
- right-sided sxs: JVP
Murmur: harsh, loud, systolic murmur
- best heard at 2nd/3rd left sternal border
- DECREASES w/ inspiration
pulmonic stenosis - dx and tx
Dx: ECHO
- EKG: right sided problems
Tx:
- tx predisposing conditions (rt sided HF)
- valve replacement if needed