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Clinical Medicine 2 > Exam 1 - Valve dz > Flashcards

Exam 1 - Valve dz Flashcards

1
Q

What happens during S1? Sound?

A

Beginning of systole. CLosure of AV valves “Lub”.

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2
Q

What sound when AV valves close? What’s happening?

A

S1 “lub”. Closure of AV valves=beginning of systole

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3
Q

What happens during S2? Sound?

A

Closure of semilunar valves. End of systole. “Dub”.

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4
Q

When does ventricular filling occur?

A

After S2

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5
Q

When does ventricular ejection occur?

A

Between S1 and S2

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6
Q

During which phase are the coronary arteries perfused?

A

Diastole

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7
Q

What do open valves allow blood to do?

A

Blood to move forward

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8
Q

What do closed valves allow blood to do?

A

Keep blood in chamber and prevent backflow

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9
Q

What is definition of valvular disease?

A

Abnormal function of any one or more cardiac valves

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10
Q

What sound is the hallmark of valve dz?

A

Murmur

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11
Q

What is the etiolgoy of valvular heart dz in developing countries?

A

Rheumatic fever (strep)

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12
Q

What is the etiolgoy of valvular heart dz in developed countries?

A

Degenerative or inflammatory processes

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13
Q

What is ventricular remodeling?

A

Compensatory mechanism to increase load. Happens in LV more than RV.

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14
Q

Aortic Sclerosis is long marker for what?

A

Long marker for further events

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15
Q

What is the most common congenital heart dz?

A

Bicuspid aortic valve

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16
Q

When to intervene with valve dz?

A

Based on symptom severity

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17
Q

General tx for valve dz?

A

Repair or replace valve. Medical tx doesn’t really help.

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18
Q

What is the #1 symptom of valve dz?

A

Dyspnea with exertion

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19
Q

What test needed to diagnose regurg?

A

Doppler Echo

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20
Q

What is “gold standard” for imaging valve morphology and motion?

A

2D Echo

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21
Q

Valve stenosis is reliably diagnosed by which looking at what two things?

A

Increased valve thickness and decreased valve mobility

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22
Q

Describe a stenotic valve and leaflets

A

Valve fails to completely open. Leaflets have decreased mobility, increased thickness, stiff, and fused

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23
Q

What does a stenotic valve impede and cause?

A

Impeded forward flow of blood. Causes pressure overload!

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24
Q

Pressure overload is found in which type of valve dz?

A

Stenotic.

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25
Q

What does pressure overload due to the left ventricle?

A

Causes concentric LV hypertrophy. Ventricle becomes thikc and stiff which reduces complaince and impedes filling.

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26
Q

What happens to valves during regurgitation?

A

Valves fail to completely close.

Incompetent, insufficient, leaking valves.

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27
Q

What happens to blood flow in regurgitation?

A

Back flow of blood as closing or leaking through after close.

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28
Q

What is overloaded in regurgitation?

A

Volume overload!

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29
Q

What causes volume overload in regurgitation? What does it result in?

A

Caused by flow reversal/backflow of blood. Results in eccentric hypertrophy.

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30
Q

What is the ventricular compensatory mechanism in regurgitation?

A

Comp mechanism maintains ventricular complaince as heart muscle wall thickens

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31
Q

What happens to ventricle area in regurgitation?

A

Dilation

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32
Q

Which test for regurgitation?

A

Doppler Echo

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33
Q

Concentric hypertrophy is consistent with which valve dz type?

A

Stenosis

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34
Q

Eccentric hypertrophy is consistent with which valve dz type?

A

Regurg

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35
Q

Rheumatic fever is associated with which two stenosic valves?

A

Tricuspid stenosis

Mitral/Bicuspid stenosis

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36
Q

What is the etiology of Mitral Valve Stenosis?

A

Hx of rhematic fever. Thickening of leaflets, fusion of commisures, and fused chordae. Calcium deposits in valves.

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37
Q

What happens to bloof flow and chambers Mitral Valve Stenosis? Pressure?

A

Obstructed flow between Left Atrium and Left Ventricle. Causes LA hypertrophy. Pressure overload!

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38
Q

Describe the murmur in Mitral Valve Stenosis (Hint: rumble and snap?)

A

Diastolic rumble at apex in left lateral position. Opening snap following S2.

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39
Q

Which valve dz do you hear a diastolic rumble at apex in left lateral position and opening snap following S2?

A

Mitral valve stenosis

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40
Q

Which valve dz is pathoneumonic for an opening snap following S2?

A

Mitral valve stenosis

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41
Q

What is the #1 PE finding in Mitral Valve Stenosis?

A

Irregular pulse due to afib.

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42
Q

Sx in Mitral Valve Stenosis?

A

Insiduous onset of cough, orthopnea, fatigue, palpitations.

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43
Q

EKG findings in Mitral Valve Stenosis?

A

Afib, RVH, LA enlarged

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44
Q

Pulmonary sx in Mitral Valve Stenosis?

A

Pulm edema, pulm HTN, decreased exercise intolerance

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45
Q

What atrial arrythmia can Mitral Valve Stenosis induce?

A

Afib

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46
Q

How can preggers increase Mitral Valve Stenosis risk?

A

Increased CO

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47
Q

Tx of Afib in Mitral Valve Stenosis?

A

Convert to NSR, rate control, long-term anticoagulation

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48
Q

What do you need to control in order to reduce pulm edema?

A

Control HR

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49
Q

When to do surgery in Mitral Valve Stenosis?

A

When symptoms are bad

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50
Q

TOC in Mitral Valve Stenosis?

A

PMBV

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51
Q

When to replace mitral valve instead of PMBV in Mitral Valve Stenosis?

A

If combo stenosis and regurgitation present

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53
Q

Two types of Mitral Valve Regurg?

A

Organic=primary abnormality in 1+ valve apparatus from degeneration. #1 in developed countries.

Functional=2nd causes CAD #1->Ischemia or Infarct->LV dilation

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54
Q

What are etiologies of Mitral Valve Regurg?

A

Mitral valve propalse is #1. S/P MI, ruptured chordae.

55
Q

Backflow in Mitral Valve Regurg affects which cambers and output?

A

Backflow from LV to LA. Causes LV volume overload and LV hypertrophy. Reduces CO.

56
Q

What is overloaded in Mitral Valve Regurg?

A

Volume overload!

57
Q

Pulm HTN means what in Mitral Valve Regurg?

A

Severe Mitral Valve Regurg

58
Q

Murmur in Mitral Valve Regurg?

A

Systolic murmur. Holosystolic/pansystolic at apex and radiation to axilla. S3 heard on ascultation

59
Q

Which valve dz is a Holosystolic/pansystolic murmur heard at apex and radiation to axilla?

A

Mitral Valve Regurg

60
Q

What happens to LV in Mitral Valve Regurg? (Hint: not just LVH)

A

LV hypertrophies and dilates

61
Q

Chronic signs/sx in Mitral Valve Regurg?

A

Dyspnea, SOB, pulm edema, orthopnea, progressive LVD within 6-10 years

62
Q

Acute signs/sx in Mitral Valve Regurg?

A

Heart failure, cardiogenic shock, severe pulm edema

63
Q

PE for Mitral Valve Regurg?

A

S3 heart sound, JVD, ronchi, rales wheezes

64
Q

EKG in Mitral Valve Regurg?

A

Double hump P-wave in II, V4, V5, V6. Left atrial abnormality (enlarged).

65
Q

Double-hump P-wave in II, V4-V6 from which valve dz?

A

Mitral Valve Regurg, d/t left atrial abnormality

66
Q

CXR in Mitral Valve Regurg shows?

A

Increased LA, LV, and Pulm Edema

67
Q

Mitral Valve Regurg LV enlargement reflects what?

A

Severity and chronicity of regurg

68
Q

Severe LV volume overload leads to what?

A

LV failure and reduced CO

69
Q

Tx Mitral Valve Regurg based on what?

A

Based on symptoms, Pulm HTN, LV dilation w/reduced contractility, or LV dysfunction (EJ less than 60%)

70
Q

What is most common congenital valve lesion?

A

Mitral Valve Prolapse

71
Q

Mitral Valve Prolapse is #1 cause of what?

A

Mitral Valve Regurg

72
Q

Mitral Valve Prolapse often in what population?

A

Young women

73
Q

Murder heard with Mitral Valve Prolapse?

A

One or many mid-systolic click.

Worse w/valsalva. Better w/leg elevation.

74
Q

One or more mid-systolic clicks better with leg elevation and worse with valsalva is which dz?

A

Mitral Valve Prolapse

75
Q

Test to dx of Mitral Valve Prolapse?

A

Echo. TTE is fine.

76
Q

Sx of Mitral Valve Prolapse?

A

Usually asymptomatic. Sometimes CP, palpitations, fatigue, and panic.

77
Q

Tx of Mitral Valve Prolapse?

A

Beta-blockers for CP, palpitations, or panic

Mitral valve repair/replacement if progress into severe mitral regurg.

78
Q

Who gets Aortic Stenosis most often?

A

When parent has had it. Congenital defect.

79
Q

Aortic Stenosis does what with blood?

A

Obstructs blood flow from LV to aorta

80
Q

What type of overload in Aortic Stenosis?

A

Pressure overload!

81
Q

Congenital Aortic Stenosis leaflets look like?

A

1 or 2 leaflets. Normal is 3.

82
Q

Pathological Aortic Stenosis leaflets look like?

A

Valves degenerated or calcified

83
Q

Which other dz often happens with Aortic Stenosis?

A

Coartation of aorta

84
Q

Describe Murmur in Aortic Stenosis?

A

Systolic ejection murmur. Paradoxical S2 split. LV heave or thrill if severe.

85
Q

Systolic ejection murmur and paradoxical S2 split heard in which dz?

A

Aortic stenosis

86
Q

LV heave or thrill in which dz?

A

Severe aortic stenosis

87
Q

Sx in Aortic Stenosis?

A

CHF-like sx. Dyspnea, fatigue, orthopnea. Worse with exertion.

88
Q

Is Aotric Stenosis symptomatic in younger years?

A

No. Can be asymptomatic until mid or old age.

89
Q

How to dx Aortic Stenosis?

A

Echo

90
Q

When and how to tx Aortic Stenosis?

A

Surgery, if sx severe

91
Q

Etiology of Aortic Regurg?

A

Aortic root dz from Marfan or EDS, Congenital bicuspid valves, IE, HTN, CAD

92
Q

What are happening to valves and blood in Aortic Regurg?

A

Floppy valves. Blood backflow to LV.

93
Q

What is overloaded in Aortic Regurg?

A

LV volume overload!

94
Q

What happens to LV in Aortic Regurg?

A

LVH, LV dysfunction

95
Q

Describe murmur in Aortic Regurg?

A

Diastolic Decrescents at right sternal border. Rumble at apex +/- Austin Flint maneuver.

96
Q

Which dz do you hear a Diastolic-Decrescendo at right sternal border and rumbe at apex?

A

Aortic Regurg

97
Q

Most common PE in Aortic Regurg?

A

SOB + Dyspnea

98
Q

What does chronically high LV preload cause in Aortic Regurg?

A

Increased LVEDP causes LVH and LV dysfunction resulting in CHF

99
Q

Aortic Regurg causes heart failure on which side?

A

Left sided heart failure

100
Q

Pulse pressure and Aortic Regurg?

A

Widened pulse pressure on BP

101
Q

Widended pulse pressure on BP in which dz?

A

Aortic Regurg

102
Q

Chronic Aortic Regurg sx?

A

Dyspnea, CHF-like SOB, palpitations

103
Q

Acute Aortic Regurg signs/sx?

A

Sudden pulm edema, hypotension, cardiogenic shock

104
Q

Initial dx method for Aortic Regurg?

A

Doppler Echo

105
Q

When to replace valve in Aortic Regurg?

A

Before irreversible myocardial dysfunction.

If LV less than 50% or LVESD more than 55.

106
Q

Etiologies of Tricuspid Stenosis?

A

Rheumatic fever, carcinoid syndrome, IE, trauma

107
Q

What is obstructed in Tricuspid Stenosis?

A

Obstructed blood flow from RA to RV

108
Q

What is overloaded in Tricuspid Stenosis?

A

Pressure overload

109
Q

What happens to RA in Tricuspid Stenosis?

A

Right atrial dilation

110
Q

Systemic manifestations of Tricuspid Stenosis?

A

Hepatosplenomegaly, ascites, lower extremity pitting edema, peripheral edema

111
Q

Which side heart failure in Tricuspid Stenosis?

A

Right sided. Pulm HTN

112
Q

Murmur in Tricuspid Stenosis?

A

Mid-diastolic rumble at left lower sternal border (4th ICS). Open snap.

113
Q

Which valve dz has mid-diastolic rumble at left lower sternal border (4th ICS) and Open snap.

A

Tricuspid Stenosis

114
Q

Tricuspid Stenosis signs/sx?

A

Chronic pulm edema, severe COPD, right-sided HF/pulm HTN

115
Q

Tricuspid Stenosis and neck sensation?

A

Neck pulsation d/t JVD

116
Q

Tricuspid Stenosis and EKG findings?

A

Tall pointed P-waves (look like T-waves)

117
Q

Tall pointed P-waves in which valve dz?

A

Tricuspid stenosis

118
Q

Medical tx for Tricuspid Stenosis?

A

Diuretics

119
Q

Surgical tx for Tricuspid Stenosis?

A

Bioprosthetic TVR is definitive care. Don’t use mechanical valve d/t thrombosis, can’t pass cath through it, and can’t place pacemaker.

120
Q

2 causes of Pulmonic Valve Regurg?

A

High-pressure=Pulm HTN #1 cause

Low-pressure=d/t dilated pulm annulus, bicuspid/dysplasic pulm valve, or plaque on pulm valve

121
Q

What is overloaded and where in Pulmonic Valve Regurg?

A

Right sided volume overload!

122
Q

Pulmonic Valve Regurg backlow from where to where?

A

From Pulm Art to RV

123
Q

Pulmonic Valve Regurg murmur?

A

Loud P2 followed by rapidly attenuating early diastolic murmur

124
Q

Which valve dz has a loud P2 followed by rapidly attenuating early diastolic murmur?

A

Pulmonic Valve Regurg

125
Q

Sx of Pulmonic Valve Regurg?

A

Right sided HF sx. Peripheral edema, JVD, liver dz, etc

126
Q

Tx for Pulmonic Valve Regurg?

A

Tx underlying cause

127
Q

Bioprosthetic valves made of what? Last how long?

A

Porcine or bovine. Reoperation in 10-20 years.

128
Q

Anticoagulation in bioprosthetic valve?

A

No lifelong anticoagulation. 3 months ASA after implantation.

129
Q

Who best to use bioprosthetic valve?

A

Elderly. No anticoagulation and they might not outlive the valve.

130
Q

Risk and prophylaxis with bioprosthetic valve?

A

Risk of IE increased.

Prophylax w/ABX if dental procedure on gingival or periapical areas.

131
Q

Do mechanical valves degenerate?

A

No degeneration of mechical valves

132
Q

Anticoagulation and mechanical valves?

A

Lifelong anticoagulation with Warfarin. Goal INR 2-3.

133
Q

Mechanical valve better for who?

A

Better for younger PTs

Clinical Medicine 2 (14 decks)

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