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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
how are preload and afterload affected in mitral regurg
increased preload | decreased afterload
26
what occurs long term with increased preload
enlarged LV, increased EF but eventually LV fails and EF drops= increased ESV
27
What is EKG look like with mitral regurg
LVH, LAH or AF
28
how is BNP affected by mitral regurg
increased
29
how does squatting or handgrip change mitral regurg murmur
increases
30
describe valsalva on mitral regurg
squatting increases murmur | standing decreases murmur
31
how does amyl nitrate affect afterload and mitral regurg
decreases afterload, so decreases mitral regurg murmur
32
what occurs with chronic mitral regurg
atrial stretches to extreme amount-- leads to a fib | straight line border on L side heart in CXR
33
how does mitral valve regurg affect venous jugular tracing read from pulm capillary wedge tracing
cV wave enlargement
34
cV enlargement measured in neck veins is what
tricuspid regurg
35
in mitral regurg what percent EF is time to replace valve? | amount of ESV?
40
36
What is ERO
effective regurginant orifice >40 mm squared
37
What is Tx for mitral regurg
repair if there is no calcification in annulus or valve and chordae can be maintained
38
patient with mitral valve prosthtetic has onset dyspnea, Tx?
replace valve
39
chest pain, palpitations mid systolic click with alte systolic murmur which shortens with lying down, handgrip and squatting joint laxity and skin changes murmur?
mitral valve prolapse
40
how does standing. valsalva and nitrate affect mitral prolapse murmur
make in longer and louder
41
how come with standing prolpase mitral valve murmur decreases
decreases VR, dec amount of blood
42
what is myxomatous degeneration of mitral valve
associated with marfans, ehlers danlos | aortic regurg, skel changes
43
how do we treat mitral valve prolapse
beta blockers mitral valve repair replace if cannot repair
44
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?
aortic stenosis
45
What is gallaverdin phenomenon?
aortic stenosis that has high pitched component that refere to apex. so seems likt two murmurs, one at base and one at apex
46
What is most common cause of aortic stenosis
bicuspid valve
47
why does aortic stenosis lead to syncope
peripheral vasodilation from high ventricular pressures stimulating baroreceptros in LV reduced afterload increases SV and it rejected from stenosis so BP drops
48
What is parvus et tardus in aortic stenosis
late and slow pulse in carotids
49
how do we know how bad aortic stenosis is
measure flow across flow | flow squated x 4 m
50
What is peak valvular flow gradient of LV failure, angina and syncope? how do we measure this?
peak gradient reaches 64 mmHg mean 40mmHg measure via doppler
51
how is it possible for a patient with severe aortic stenosis to have valve fradient of <30mmHg
heart is starting to fail | low gradeint low flow aortic stenosis with reduced EF
52
What is Tx for aortic stenosis
young- percutaneous valvulopathy older- bovine valve middle- mechanical(blood thinner)
53
what must you check for in aortic stenosis before surgery
CAD
54
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
aortic regurg
55
what occurs in aortic regurg with squatting of handgrip
gets louder
56
What is pulse like in aortic stenosis
wide pulse pressure | icnreased pressure too- bounding
57
what are other causes of wide pulse pressure besides aortic insufficiency
atherosclerosis, AV fistula, anemia, thyrotoxicosis, fever and heart block
58
when do you know when to replace aortic valve replacement
EF50 | BNP>130

Year 2 CV (31 decks)

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