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Clinical Medicine 2 > Exam 1: Valvular Heart Disease > Flashcards

Exam 1: Valvular Heart Disease Flashcards

1
Q

What is likely the etiology of aortic stenosis of patients over the age of 65?

A

Degeneration and sclerosis of the valve, which accounts for most aortic stenosis

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2
Q

What is likely the etiology of aortic stenosis in patients between the ages of 30-65?

A

Congenital bicuspid valve which becomes calcified and stenotic

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3
Q

What is likely the etiology if aortic stenosis in a patient under the age of 30?

A

Congenitally stenotic unicuspid valve

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4
Q

What is the triad of symptoms of aortic stenosis?

A

Angina, syncope, and heart failure

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5
Q

What kind of murmur is heard with aortic stenosis? Where is is best heard?

A

Midsystolic murmur, grade 3-4/6, crescendo decrescendo. Best heard at the 2nd RICS

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6
Q

What kind of murmur is louder with squatting due to increased ventricular return and ventricular filling?

A

Aortic stenosis

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7
Q

What is the recommended management for asymptomatic mild aortic stenosis?

A

Educate regarding symptoms and echo every 3-5 years

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8
Q

What is the recommended management for asymptomatic moderate aortic stenosis?

A

Echo every 1-2 years

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9
Q

What is the recommended management for asymptomatic moderate-severe aortic stenosis?

A

Echo every 6-12 months and cardiology evaluation and close follow up

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10
Q

What is the patient education you should give with asymptomatic aortic stenosis?

A

Avoid strenuous physical activity, avoid dehydration, and monitor for worsening signs/symptoms

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11
Q

What is the management for symptomatic aortic stenosis?

A

Referral to cardiothoracic surgeon or interventional cardiology (possible aortic valve replacement)
-Cardiac cath

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12
Q

What is the definitive technique for evaluating severity and site of stenosis?

A

Cardiac cath

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13
Q

What are the two types of mechanical valves?

A

Ball and cage and the tilting valve

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14
Q

What are the risks associated with prosthetic valves?

A

Increased risk of endocarditis, requires antibiotic prophylaxis

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15
Q

What kind of valve requires life long anticoagulation?

A

Mechanical valves, Should keep INR between 2.5 and 3.5

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16
Q

How does the heart sounds differ from HCM and aortic stenosis?

A

Murmur is similar, except is HCM murmur is louder with valsalva and standing due to decreased venous return and ventricular filling

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17
Q

What are both of the acute etiologies for aortic regurgitation?

A

Endocarditis and aortic dissection

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18
Q

What are the 3 etiologies for chronic aortic regurgitation?

A

1) valve disease (calcific)
2) aortic root dilation
3) both (bicuspid aortic valve)

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19
Q

How does acute aortic regurgitation occur?

A

LV pressure rises rapidly and the ventricle does not have time to dilate. There is decreased cardiac output, which results in profound hypotension, cardiogenic shock, and/or pulmonary edema

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20
Q

How does chronic aortic regurgitation occur?

A

Results from LV overload with gradual dilation and eccentric hypertrophy overtime.
Patient may be asymptomatic for 20 years, but once they do develop symptoms, deterioration is rapid

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21
Q

What kind of murmur is found is aortic regurgitation? Where is it best heard?

A

High pitched, blowing diastolic decrescendo murmur.

Best heard at the 2nd-4th LICS

22
Q

What happens to the blood pressure in aortic regurgitation?

A

There is a wide pulse pressure from increased SBP and decreased DBP, gives rise to water hammer or corrigan pulse

23
Q

What is an austin flint murmur?

A

A soft, low pitched diastolic murmur at the apex which sounds like a mitral stenosis murmur

24
Q

What might you see on EKG in a patient with chronic aortic regurgitation?

A

LVH

25
Q

What is the management of acute aortic regurgitation?

A

Emergent valve surgery and stabilization with IV vasodilators and possible inotropic agents

26
Q

What is the management for asymptomatic mild chronic aortic regurgitation?

A

Monitor for symptoms and echo every 3-5 years

27
Q

What is the management for asymptomatic moderate chronic aortic regurgitation?

A

Echo every 1-2 years

28
Q

What is the management for asymptomatic moderate-severe chronic aortic regurgitation?

A

Echo every 6-12 months and cardiology evaluation and follow up

29
Q

What is the management for symptomatic chronic aortic regurgitation?

A

Referral to cardiothoracic surgery or interventional cardiology. Surgical aortic valve replacement is the treatment of choice.

30
Q

What are the two surgical options for aortic regurgitation?

A

Root replacement and pulmonary autograft

31
Q

What are the acute causes of mitral regurgitation?

A
  • ischemic: papillary muscle rupture and damage

- Nonishcemic: rupture mitral chordae tendineae from MVP, endocarditis, trauma, and ARF

32
Q

What are the chronic etiologies of mitral regurgitation?

A
  • inherited: mitral valve prolapse and mar fans
  • Rheumatic heart disease
  • Acquired connective tissue disease
  • Idiopathic valve calcification
  • Congential maldevelopment of the valve
33
Q

How does chronic mitral regurgitation progress?

A

LV adapts to larger blood volume by enlarging and increasing the stroke volume. Overtime more than half the blood volume ejects into the LA during systole.

34
Q

What often results from LAE in mitral regurgitation?

A

Atrial fibrillation

35
Q

How does mild to moderate MR often present?

A

Often asymptomatic and gradually appear over years (dyspnea and fatigue). with LAE and RVH, pulmonary HTN develops

36
Q

What kind of murmur is heard with mitral regurgitation? Where is the best heard?

A

High pitched, pansystolic murmur. Best heard at the apex and radiates tot he left axilla

37
Q

What is often seen on EKG in a patient with mitral regurgitation?

A

Usually LAE, often LVH, and atrial fibrillation is possible

38
Q

What is often seen on CXR in patient with mitral regurgitation?

A

LAE and LVH

39
Q

What is the management for acute mitral regurgitation?

A

Urgent surgical consult and stabilization with IV nitroprusside

40
Q

What is the management for chronic mitral regurgitation?

A
  • limit activities that produce symptoms
  • If HTN, reduce afterload
  • if hypervolemic, reduce preload
  • if A fib, anticoagulants (INR 2-3)
  • possible surgery for valvuloplasty or valve replacement
41
Q

What is mitral valve prolapse?

A

Ballooning of the mitral leaflets into the left atrium during systole

42
Q

What is often heard on auscultation in a patient with mitral valve prolapse?

A

Mid to late systolic clicks

43
Q

What is diagnostic for mitral valve prolapse?

A

Echo

44
Q

What is the management of mitral valve prolapse?

A
  • Most cases are mild and patient should be reassured with lifestyle changes
  • if associated palpitation, beta blockers
  • if symptomatic, follow as though MR
45
Q

What is the pathophysiology of mitral stenosis?

A

Narrowing of the mitral valve, obstructs flow of the LA to LV, increases LA pressure, increases pulmonary vascular pressure

46
Q

What is the most common cause of mitral stenosis?

A

Rheumatic heart disease

47
Q

What are the symptoms of mitral stenosis?

A

-Initially asymptomatic, but symptoms may be precipitated by sudden exertion, excitement, fever, severe angina, tachycardia, sex, pregnancy, a fib, etc

48
Q

What usually causes the symptoms of mitral stenosis?

A

Pulmonary congestion

49
Q

What other condition is seen with mitral stenosis about 50% of the time?

A

Atrial fibrillation

50
Q

What is heard on auscultation in a patient with mitral stenosis?

A

Loud S1 with opening snap followed by mid-late diastolic rumbling murmur

51
Q

What is the management for mild mitral stenosis?

A

Diuretics and sodium restriction

52
Q

What is the management of atrial fibrillation?

A
  • possible cardioversion
  • prevention of systemic embolization (warfarin recommended for mechanical heart valves and NOACs (Dabigatran, Rivaroxaban, Apixiban, and edoxaban) are recommended except in moderate to severe MS

Clinical Medicine 2 (22 decks)

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