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Year 2 CV > Exam 3, valvular heart disease > Flashcards

Exam 3, valvular heart disease Flashcards

1
Q

1/6 blowing murmur and Lower L sternal border
3/6 diastolic rumble
both increased with inspiration
wha type of murmur is systolic one and how would it appear on jugular venous tracing

A

tricuspid stenosis

large cannon a wave

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2
Q

what is the normal values for mean Right atrial P and right ventricular pressure

A

mean right atrial pressure is 0-5 mmHg

right ventricular pressure is 25/5

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3
Q

what medications do you give for tricuspid stenosis?

types of surgeries?

A

diuretics (torsemide because better absorbed form gut)
spironolactone for ascites
balloon, valvotomy, open commissurotomy, biprosthetic valve

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4
Q

55 y.o female with history of previous Right MI has fatigue and abdominal fullness
peripheral edema ans ascites
3/6 systolic blowing murmur at left lower sternal border with audible S3
increased with inspiration
what would venous tracing look like

A

prominent cV wave

tricuspid regurg

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5
Q

what can cause cV wave enlargement on jugular venous tracing

A

RV dilation: pulm HTN, pulmonic regurg, LV failure where PA or RV systolic pressure is above 40 mmHg

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6
Q

What is Tx for tricuspid regurg

A

treat primary issue LV failure or pulm HTN

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7
Q

why do you not use mechanical valves for tricuspid

A

will clot with low flow state

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8
Q

male with COPD and pulm HTN presents with split S2 and diastolic 2/6 murmur at L 2nd ICS that increases with a deep breath
what type of murmur

A

graham steell

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9
Q

describe what can cause low pressure Pulm insufficiency-

A

pulm regurg: little murmur from trauma with dilated pulmonary annulus, carcinoid plaque, bicuspid valve or repaired tetralogy

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10
Q

what is high pressure Pulm insufficiency, pulmonic regurg

A

prolonged RV systole with split S2 from pulm HTN (mitral stenosis Graham Steell murmur)
COPD

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11
Q

how do you Tx high pressure pulmonic regurg? low pressure?

A

high- treat pulm HTN

low- watchful expectancy

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12
Q

what is the a wave in venous tracing

A

atrial contraction

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13
Q

what is the x in jugular venous tracing

A

atrial relaxation

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14
Q

what is the v wave in jugular venous tracing

A

atrial filling

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15
Q

35 y.o female has exertional dyspnea, orthopnea
prominant p wave, tall R waves in inferior wall, large negative p wave in V1
what is murmur type

A

left atrial enlargement
right ventricular enlargement
right atrial enlargement
backpressure- mitral setenosis

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16
Q

which murmur has hockey stick sign of leaflet

A

mitral stenosis

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17
Q

What are sounds heard from mitral stenosis

A

loud M1
opening snap- earlier after S2 with worsening LA pressure
rumbling diastolic murmur
presystolic accentuation of diastolic rumble

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18
Q

if mitral valve stenosis is mild, acute what are other Sx

A

pulmonary edema

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19
Q

if mitral valve stenosis is chronic, what are other Sx

A

pulmonary HTN leading to R sided CHF, AF and low CO

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20
Q

What is graham steell murmur

A

left sternal border pulm insufficiency with mitral valve stenosis

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21
Q

what is typical EKG of mitral stenosis

A

nep P wave in V1, RAD

sometimes R ventricular or right atrial hypertrophy

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22
Q

high pitch pan systolic murmur with S3 at apex

murmur?

A

mitral regurg

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23
Q

S3 in tricuspid or mitral regurg means what

A

severe

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24
Q

What can cause mitral regurg

A

defective papillary muscles
defective chordae tendinae
defective leaflets
defective annulus

25
Q

how are preload and afterload affected in mitral regurg

A

increased preload

decreased afterload

26
Q

what occurs long term with increased preload

A

enlarged LV, increased EF but eventually LV fails and EF drops= increased ESV

27
Q

What is EKG look like with mitral regurg

A

LVH, LAH or AF

28
Q

how is BNP affected by mitral regurg

A

increased

29
Q

how does squatting or handgrip change mitral regurg murmur

A

increases

30
Q

describe valsalva on mitral regurg

A

squatting increases murmur

standing decreases murmur

31
Q

how does amyl nitrate affect afterload and mitral regurg

A

decreases afterload, so decreases mitral regurg murmur

32
Q

what occurs with chronic mitral regurg

A

atrial stretches to extreme amount– leads to a fib

straight line border on L side heart in CXR

33
Q

how does mitral valve regurg affect venous jugular tracing read from pulm capillary wedge tracing

A

cV wave enlargement

34
Q

cV enlargement measured in neck veins is what

A

tricuspid regurg

35
Q

in mitral regurg what percent EF is time to replace valve?

amount of ESV?

A

40

36
Q

What is ERO

A

effective regurginant orifice >40 mm squared

37
Q

What is Tx for mitral regurg

A

repair if there is no calcification in annulus or valve and chordae can be maintained

38
Q

patient with mitral valve prosthtetic has onset dyspnea, Tx?

A

replace valve

39
Q

chest pain, palpitations
mid systolic click with alte systolic murmur which shortens with lying down, handgrip and squatting
joint laxity and skin changes
murmur?

A

mitral valve prolapse

40
Q

how does standing. valsalva and nitrate affect mitral prolapse murmur

A

make in longer and louder

41
Q

how come with standing prolpase mitral valve murmur decreases

A

decreases VR, dec amount of blood

42
Q

what is myxomatous degeneration of mitral valve

A

associated with marfans, ehlers danlos

aortic regurg, skel changes

43
Q

how do we treat mitral valve prolapse

A

beta blockers
mitral valve repair
replace if cannot repair

44
Q

syncope with murmur since childhood. now has ejection sound with diamond shaped harsh systolic murmur at base and high pithced systolic murmur at apex
former murmur increases afer ectopic beat and decreases with squatting
most likleymurmur?

A

aortic stenosis

45
Q

What is gallaverdin phenomenon?

A

aortic stenosis that has high pitched component that refere to apex. so seems likt two murmurs, one at base and one at apex

46
Q

What is most common cause of aortic stenosis

A

bicuspid valve

47
Q

why does aortic stenosis lead to syncope

A

peripheral vasodilation from high ventricular pressures stimulating baroreceptros in LV
reduced afterload increases SV and it rejected from stenosis so BP drops

48
Q

What is parvus et tardus in aortic stenosis

A

late and slow pulse in carotids

49
Q

how do we know how bad aortic stenosis is

A

measure flow across flow

flow squated x 4 m

50
Q

What is peak valvular flow gradient of LV failure, angina and syncope?
how do we measure this?

A

peak gradient reaches 64 mmHg
mean 40mmHg
measure via doppler

51
Q

how is it possible for a patient with severe aortic stenosis to have valve fradient of <30mmHg

A

heart is starting to fail

low gradeint low flow aortic stenosis with reduced EF

52
Q

What is Tx for aortic stenosis

A

young- percutaneous valvulopathy
older- bovine valve
middle- mechanical(blood thinner)

53
Q

what must you check for in aortic stenosis before surgery

A

CAD

54
Q

bicuspid aortic valve and HTN with new onset PND
2/6 systolic murmur at base
3/6 decresencdo diastolic murmur at base
1/6 late diastolic low pitched murmur at apex

A

aortic regurg

55
Q

what occurs in aortic regurg with squatting of handgrip

A

gets louder

56
Q

What is pulse like in aortic stenosis

A

wide pulse pressure

icnreased pressure too- bounding

57
Q

what are other causes of wide pulse pressure besides aortic insufficiency

A

atherosclerosis, AV fistula, anemia, thyrotoxicosis, fever and heart block

58
Q

when do you know when to replace aortic valve replacement

A

EF50

BNP>130

Year 2 CV (31 decks)

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