Cards Test 4 Flashcards
What is the second most common cause of valvular heart disease?
Aortic Stenosis
What is the most common congenital cardiac abnormality?
Bicuspid Aortic Valve
What are the 3 major manifestations of AS?
Angina, Exertional Syncope, and Heart Failure
T/F: Aortic Stenosis is atrial kick dependent
True; Atrial kick contributes more than 25% of the stroke volume in AS
Valsalva will increase/decrease the intensity of an AS murmur?
Valsalva decreases intensity of murmur in AS But increases intensity of murmur in HOCM
Fixed splitting of S2 corresponds to what?
ASD
Paradoxical splitting corresponds to what?
AS or LBBB
What diagnostic study confirms AS?
Echo
What is the ONLY effective treatment for AS?
Surgical Replacement
What are the indications for AVR in AS?
Symptoms develop or Evidence of progressive LV dysfunction (loss of contractility, low EF), in absence of symptoms
A widened pulse pressure is associated with acute/chronic AR?
hallmark of chronic AR; the combo of high LV stroke volume (and therefore high systolic arterial pressure) with a reduced aortic diastolic pressure produces a widened pulse pressure
How does aR clinically present?
• Patients with chronic AR remain asymptomatic for a long time.
• When symptoms do develop they are from decreased CO and development of HF
• Patients with chronic AR remain asymptomatic for a long time.
• When symptoms do develop they are from decreased CO and development of HF
Other sx: DOE, Fatigue, Decreased exercise tolerance, palpitations, and angina (failure to perfuse the coronaries)
Bisferiens Pulse
Double systolic impulse in carotid or brachial artery
Corrigan Pulse
“Water-hammer” pulses with marked distention and collapse
De Musset Sign
Head-bobbing with each systole
Duroziez Sign
To-and-fro murmur heard over femoral artery with light compression
Hill Sign
Popliteal systolic pressure more than 60 mm Hg greater than brachial systolic pressure
Muller sign
Systolic pulsations of the uvula
Quincke Sign
Capillary pulsations visible at lip or proximal nail bed
Traube Sign
“Pistol-shot” sound auscultated over femoral artery
Describe the Austin Flint murmur and what valvular disorder is it associated with?
– Low-frequency mid-diastolic rumbling at apex. It reflects turbulence across MV during diastole. It is associated with AR.
What is the diagnostic study that confirms AR?
Echo
What is the Tx for Acute AR?
- Emergent Surgical Replacement
- IV vasodilator: Sodium Nitroprusside: reduces both afterload and preload;
- IV Dobutamine: positive inotropic agent
What is the Tx for Chronic AR?
- Afterload reduction-vasodilators
- Nifedipine (Procardia XL) (CCB)
- Symptomatic patients, or asymptomatic patients with severe AR and impaired LV will require SURGICAL CORRECTION.