Cardiology: Valvular Heart Disease Flashcards
name leading cause of valvular heart disease? what used to be the leading cause?
mechanical degeneration
used to be rheumatic fever (affecting mitral valve more than aortic valve)
how is aortic aneurysm defined?
associated with?
most are located where?
what percentage below renal arteries?
defined as >50% dilation of all 3 layers of aortic wall
associated with atherosclerosis
abdominal
>90% below renal arteries
name signs and symptoms of aortic aneurysm
usually asymptomatic
pulsatile abdominal mass of abdominal bruits
name risk factors of aortic aneurysm
HTN, high cholesterol, other vascular disease, + family history, smoking, gender (male>female) and age
how does ruptured aneurysm present
hypotension, severe tearing abdominal pain that radiates to back
when should men be screened for aortic aneurysm
all men 65-75yrs with history of smoking should be screened once by ultrasound for AAA
70 year old male with HTN presents for routine appointment. He quit smoking 20 yrs ago but has a 20 pack yr history. What screening if any is indicated?
the US Preventative Services Task Force (USPSTIF) guidelines recommend one-time screening for AA by ultrasound in males ages 65-75 who have ever smoked
how should pts with aortic aneurysm be treated?
asymptomatic pts monitor for lesions 5cm
when should aortic aneurysm be surgically repaired?
- surgical repair if >5.5 (abdominal), >6 cm (thoracic), or smaller but rapidly enlarging
- emergent surgery for symptomatic or ruptured aneurysm
how is aortic dissection defined
transverse tear in the intima of a vessel that results in blood entering the media creating a false lumen and leading to a hematoma that propagates longitudinally
what is most common cause of aortic dissection?
the most common sites (2)?
most common age?
gender?
- HTN
- mc sites above the aortic valve and distal to left subclavian artery
- 40-60yrs
- females more than males
how does aortic dissection present?
sudden tearing/ripping pain in anterior chest (ascending) or back (descending)
what is BP of pts with aortic dissection?
usually HTN
if hypotensive consider tamponade, blood loss, or other cardiopulmonary etiologies
what may be found on PE in pt with aortic dissection?
asymmetric pulses
murmur of aortic regurgitation if aortic valve is invovled
neurologic deficits may be seen if aortic arch or spinal arteries are involved
name gold standard of imaging for aortic dissection? if contraindicated what is indicated
CT angiography
use MRA if CT is contraindicated
how can TEE be helpful in aortic dissection
can provide details of thoracic aorta, the proximal coronary arteries, the origins of arch vessels, presence of pericardial effusion, and aortic valve ingetrity
what system is used to classify aortic dissection? which should be treated surgically?
Stanford system is used to classify dissection
type A:proximal to left subclavian artery (proximal or ascending)
type B: all others (descending)
treat all ascending aortic dissections with surgery
how should aortic dissection be treated? what should be avoided? what should be given to avoid reflex tachy?
- monitor and medically manage BP and HR
- avoid thrombolytics
- begin beta-blockers before starting vasodilators to prevent reflex tachy
how is deep venous thrombosis (DVT) defined?
clot formation in large veins of the extremities or pelvis
what is triad of DVT?
venous stasis (plane flights, bed rest, incompetent venous valves in lower extremities), endothelial trauma (surgery, injury to lower extremities) and hypercoagulable states (malignancy, pregnancy, OCP use)
how does DVT present
-unilateral extremity pain and swelling
what is Homans’ sign
calf tenderness with passive foort dorsiflexion (poor sensitivity and specificity for DVT)
how is DVT diagnosed? PE?
DVT: doppler US,
PE: a spiral CT or V/Q scan
how is DVT treated?
- anticoagulation (IV unfractionated heparin, or SQ low molecular weight heparin (LMWH)
- follow this by PO for a total of 3-6 months
