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Bloc C - Circulation > Clinical Cardiology > Flashcards

Clinical Cardiology Flashcards

1
Q

What kind of murmurs can you hear in the aortic area of auscultation?

A

Ejection type murmurs:

  • Aortic stenosis
  • Flow murmur
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2
Q

What kind of murmur can be heard in the pulmonic area of auscultation?

A

Ejection-type murmur

  • Pulmonic stenosis
  • Flow murmur
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3
Q

What kind of murmur can be heard in the left sternal border area of auscultation?

A

Early diastolic murmur

  • Aortic regurgitation
  • Pulmonic regurgitation
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4
Q

What kind of murmur can be heard in the mitral area of auscultation?

A

Pansystolic murmur

  • Mitral regurgitation

Mid-to-late diastolic murmur

  • Mitral stenosis
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5
Q

What kind of murmur can be heard in the tricuspid area of auscultation?

A

Pansystolic murmur

  • Tricuspid regurgitation
  • VEntricular septal defect

Mid-to-late diastolic murmur

  • Tricuspid stenosis
  • Atrial septal defect
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6
Q

What are the only low-pitch sounds that we can hear with the bell of our stethoscope ?

A

S3 and S4

Heard at the left side apex

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7
Q

What murmurs/sounds increase with inspiration?

A
  • Tricuspid regurgitation
  • Pulmonic regurgitation
  • S2 differentiates into P2 and A2
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8
Q

What are the possible underlying pathologes associated with a systolic ejection sound?

A
  • Aortic stenosis
  • Pulmonic stenosis
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9
Q

What are the possible underlying pathologes associated with a pansystolic sound?

A
  • Mitral regurgitation
  • Tricuspid regurgitation
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10
Q

What are the possible underlying pathologes associated with a late systolic sound?

A

Mitral valve prolapse

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11
Q

What are the possible underlying pathologes associated with a early diasystolic sound?

A
  • Aortic regurgitation
  • Pulmonic regurgitation
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12
Q

What are the possible underlying pathologes associated with a mid-to-late diasystolic sound?

A

Mitral stenosis

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13
Q

What is the etiology of aortic stenosis?

A
  • Degenerative calcification
  • Bicuspid aortic valve
  • Rheumatic aortic valve disease
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14
Q

What are the consequences of aortic stenosis ?

A
  • LV undergoes concentric hypertrophy to compensate (stiffening)
  • Increased afterload
  • An unchanged end-diastolic volume
  • An increased end-systolic volume
  • A decreased stroke volume
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15
Q

What is the clinical presentation of aortis stenosis?

A
  • S4 present, absent/reduced S2
  • Ejection type murmur (crescendo-decrescendo between S1 and S2)
  • The carotid pulse is going to feel late and week
  • Symptoms: angina (5 years to live), syncope (3 years to live), heart failure (2 years to live)
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16
Q

What is the etiology of mitral stenosis?

A
  • Congenital MS
  • Mitral annulus calcification
  • Infective endocarditis
  • Rheumatic heart disease
17
Q

What are the consequences of mitral stenosis?

A
  • Pulmonary hypertension
  • Left atrial enlargement (may result in atrial fibrillation, stroke)
18
Q

What are the clinical manifestations of mitral stenosis ?

A
  • Early: dyspnea on exertion, fever
  • Later: dyspnea at rest, orthopnea, paroxysmal nocturnal dyspnea
  • Latest: signs of right hear failure
  • If asymptomatic (“ 80% 10 years survival), symptomatic (50-60% 10 years survival) and if pulmonary hypertension (3 years survival)
19
Q

What can you find at physical examination of a patient with mitral stenosis?

A
  • Loud S1 with disease progression (mitral valve snaps with LV pressure in systole)
  • Reduced S1 later with disease progression
  • Opening snap (OS) after S2 because the opening comes earlier thus at higher pressure
  • Decrescendo diastolic rumble with pre-systolic accentuation (mid-to-late)
  • LA enlargement, RV hypertrophy if PH present
  • Thickened MV
20
Q

How do you treat an aortic or mitral stenosis?

A
  • Surgical valve replacement
  • Transcatheter balloon to open it
  • Reduce H20 and Na+ intake, slow HR and anticoagulant if atrial fibrillation
21
Q

Explain the 2 types of right-sided stenosis

A

Trisuspid

  • Rare
  • Most common etiology is rheumatic
  • Exam similar to MS (OS and diastolic murmur)
  • Distended neck veins with large a-wave
  • Treated with balloon dilatation or surgical correction

Pulmonary

  • Rare
  • Congenital
  • Crescendo-decrescendo murmur, possible ejection click
  • Treatable by balloon valvuloplasty
22
Q

What are the advantages and disadvantages of mechanical valves ?

A

Advantages

  • Durable

Disadvantages

  • Thrombogenic
  • High risk endocarditis
23
Q

What are the advantages and disadvantages of bioprostethic valves ?

A

Advantages

  • Less thrombogenis risk

Disadvantages

  • High risk endocarditis
  • Less durable
24
Q

What is the etiology of aortic regurgitation?

A
  • Abnormality of aortic valve
  • Dilatation of aortic root
25
Q

What are the consequences of aortic regurgitation?

A
  • Enlarged ventricular silhouette
  • Rounded isovolumetric relaxation
  • Rounded end-diastolic filing
  • Rounded isovolumetric contraction
  • Increased diastolic LV volume
26
Q

What are the Symptoms and clinical manifestation of aortic regurgitation?

A
  • Dyspnea
  • Wide pulse pressure, bounding pulse
  • Low diastolic pressure: angina
  • Leaky valve: blowing decrescendo diastolic murmur at left sternal border, possible Aunstin-Flint
  • Signs: Bisferiens pulse (double pulse) Corrignan pulse (water hammer), hill sign (popliteal), Quincke sign (lit or nail bed)
27
Q

What is the treatment of aortic regurgitation?

A
  • Surgery if symptomatic
  • 4 years if angina and 2 years with heart failure
28
Q

What is the etiology of mitral regurgitation?

A
  • Mitral annulus
  • Leaflets
  • Chordae tendineae
  • Papullary muscles
  • Left ventricle (secondary)
29
Q

What are the consequences of mitral regurgitation?

A
  • Acute: sudden damage (papillary muscle or chordae tendineae ruptured)
  • Chronic: myxomatous degeneration, rheumatic deformity, congenital valve defect, mitral annular calcification
  • Secondary: rupture by outside cause (ex: LV enlargement)
30
Q

What is the pathophysiology of mitral regurgitation?

A

LA goes up, less blood pumped, rounded isovolumetric contraction, and relaxation, decreased end-systolic volume, increased diastolic LV volume and LV stroke volume increases to compensate.

Contributing factors: mitral orifice, pressure gradient LV to LA, systemic vascular resistance, LA compliance, duration of regurgitation and regurgitant fraction (volume of MR/SV)

31
Q

What are the symptomes and clinical manifestations of mitral regurgitation?

A
  • Acute: pulmonary edema and related symptoms
  • Chronic: fatigue, weakness, dyspnea, potential right heart failure
  • Holosystolic murmur, classically radiated to axilla, possible presence of S3
  • LA enlargement, pulmonary edema
32
Q

What is the treatment of mitral regurgitation?

A
  • Acute MR need surgical emergency internveiton (20-25% 30 day mortality)
  • Chronic MR: related to cause (repair preferred over replacement)
33
Q

What is mitral prolapse?

A

“Parachuting”

Etiology: Inherited

Symptoms and clinical manifestations:

  • Mid-systolic click and mid-to-late-systolic murmur (less loud when squatting)
  • Large LV volume
  • Dx confirmed by echo
34
Q

What are the 2 right-sided valve regurgitation?

A
  1. Tricuspid: very common, typically functional and cause by something else, prominent V-wave, pulsatile liver, LLSB systolic murmur, treatment includes treating underlying condition, diuresis and sometimes surgical
  2. Pulmonary regurgitation: typically cause by pulmonary hypertension, high piteched decrescendo murmur and left sternal border

Bloc C - Circulation (10 decks)

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