CV 1 Flashcards
Abx ppx to prevent Bacterial Endocarditis is currently recommended only for HIGH RISK GROUPS during DENTAL manipulations …
What are the 4 High risk groups?
What abx is used?
In this high risk group, you also need ppx for GU/GI procedures, Infected Skin surgery, Respiratory tract procedure and surgical placement of prosthetic valves.
What Abx do you use in each scenario?
- Prosthetic valve
- Prior Infective Endocarditis
- Valvulopathy after cardiac transplant
- Congenital heart defect.
Amoxicillin
Resp tract –> Amoxicillin
GU/GI –> Ampicillin
Infected SKIN and prosthetic valve –> Vancomycin
What is the most common cause of Mitral Stenosis?
What does the murmur sound like? Location?
Rheumatic Fever (90% etiology, usually 10-20 years after RF)
Murmur:
- Diastolic
- Loud S1, Opening snap, low pitched mid-diastolic rumbling
- Fifth intercostal, mid-clavicular (cardiac apex)
Mitral Stenosis typically presents with what symptoms?
- Afib (atrial dilation)
- CHF symptoms (LA dilation, fluid backs up in lungs, causing RH failure…)
- Hoarseness (compression of recurrent laryngeal N)
- Dysphagia (compression of esophagus)
What is the best initial test for Mitral Stenosis?
What is the most accurate test for DX?
Best initial TRX?
Definitive TRX?
Best initial test = TTE
Most accurate test = L heart Catheterization
Initial TRX = Diuretics
Definitive TRX = Balloon Valvuloplasty (preferred over Surgical)
What is the etiology of most Mitral Regurgitation?
Acute MR, is a medical emergency, that presents with acutely severe symptoms. What two situations do you get this?
What symptoms do you see in acute MR?
Etiology = Any condition that causes dilation of the heart (HTN, ischemic heart disease, infection)
Acute MR:
1) Ruptured Chordea Tendineae (infective endocarditis, RF, trauma, MVP)
2) Ruptured papillary muscle (2/2 MI, typically 2-5 day post MI)
Symptoms = Pulmonary edema, HF, +/- Cardiogenic shock.
What does the murmur of Mitral Regurgitation sound like? Location?
What maneuvers Decrease or Increase the Murmur?
- Systolic
- Holosystolic “blowing” murmur, can obscure S1/S2.
- Best heard 5th intercostal, mid-clavicular, apex.
INCREASED: Maneuvers that increased venous return to heart (leg raise, squat) and increase Afterload (hand grip)
DECREASED: Maneuvers that decrease venous return (Stand, Valsalva) or Decrease Afterload (AmylNitrate).
For Mitral Regurgitation, what is the medications you can use to help decrease rate of progression?
What is the indication for surgery/valve replacement?
ACEI, ARBS, Nifedipine, loops
Symptoms and Surgery if EF < 60% (normal EF is >50, but in MR threshold is higher @ 60 to say low EF)
What are the two main causes of Aortic Stenosis?
What is the typical symptoms AS presents with?
What are classic PE findings?
- Age related calcium deposits
- Congenital Bicuspid valve
Presentation = Usually asymptomatic for a long time…then Chest pain, syncope, CHF symptoms.
PE:
- ->DELAYED AND DIMINISHED CAROTID PULSE (Parvus et tardus)
- ->NO PHYSIOLOGIC SPLITTING OF S2 (normally you get splitting of S2 during inspiration because increased blood in the R heart causes delay in pulmonic valve closure, but in AS you have delayed Aortic valve closure so…no splitting)
What does the murmur of Aortic Stenosis sound like? Location?
What maneuvers INCREASE and DECREASE the MURMUR?
- Systolic
- Crescendo, Decrescendo
- Radiates to carotids
- R sternal boarder, 2nd intercostal
INCREASE: Maneuvers that increased venous return to heart (leg raise, squat) and Decreased Afterload (Amyl nitrate)
DECREASE: Maneuvers that decrease venous return (Stand, Valsalva) and Increase Afterload (hand grip)
What is the criteria for “severe” AS?
What is the indication for Valve replacement?
SEVERE AS =
1) Aortic jet velocity 4 or greater.
2) Mean transvalvular pressure 40mmhg or greater.
Severe AS with one of the following
- Symptoms
- LVEF < 50%
- Undergoing another heart procedure like CABG.
What is the classic murmur of Aortic Regurgitation?
- Diastolic
- R Sternal Border, 2nd intercostal
- Decrescendo Rumbling
What is are medications that can help for symptoms of Aortic Regurg (CHF symptoms)?
What is the surgical indication?
ACEI, ARBs, Nifedipine, loops
Surgical Valve replacement if symptomatic OR asymptomatic and EF < 55
What is the difference between Bovine vs Mechanical heart valve?
Bovine:
- 10 years
- No AC required, though some will do for 3 months. ASA 75-100 for all though.
Mechanical:
- Do not need replacement
- AC needed for life (INR 2-3)
Maneuvers that INCREASE venous return to heart (squat, leg raise) INCREASE ALL MURMURS except what two?
Maneuvers that DECREASE venous return to heart (standing, valsalva) DECREASES ALL MUMERS except what two?
HOCM
MVP
(these murmurs decrease with increased venous return to heart)
HOCM
MVP
(they increase with decreased venous return to heart)
Mitral Valve Prolapse murmur sounds like?
How does squatting/leg raise affect the murmur and click?
How does standing or valsalva affect the murmur and click?
Non ejection Click, followed by a systolic murmur.
Squat/leg raise DECREASES murmur and CLICK is later in systole.
Standing/Valsalva INCREASES murmur CLICK is earlier
