IMC/FM/EM Cards Flashcards
? is the MC type of cardiomyopathy
Half of these cases are idiopathic and MC cause of ? and the other half are d/t ?
? type of dysfunction is this MC
Dilated
Primary indication for transplant;
ETOH
Systolic- dec contractility and EF w/out abnormal loading conditions
What type of heart sound is heard w/ Dilated Cardiomyopathy
What would be seen on PE
What would be seen if severe HF was present
S3 gallop w/ low EF
Inc JVP Rales Edema Ascites MR/TR
Pallor/cyanosis
Cheyne stoke- fast/shallow then slow/heavy w/ apnea
Pulsus alternans
How is Dilated Cardiomyopathy Dx
What would be seen on EKG
What is seen on CXR
Echo showing EF <50%
LBBB
Arrhythmias
Tachy w/ non-specific ST-T-wave
Balloon heart- megaly w/ pulm congestion (R>L)
Pts w/ Dilated Cardiomyopathy and dyspnea need ? lab drawn and why
? is the imaging modality of choice for RV dysplasia
A biopsy in Dilated Cardiomyopathy is only useful for ?
BNP- establish prognosis/severity
Cardiac MRI
Transplant rejection
All PTs w/ Dilated Cardiomyopathy, regardless of etiology, need to be Tx w/ ?
If still symptomatic, how is Tx adjusted
? class drug needs to be avoided unless ? is present
ACEI, BB
Add aldosterone antagonist- Spironolactone, Eplerone
Switch ACEI/ARB for ARNI- Sacubitril/Valsartan
CCBs; Afib/flutter ventricular control
All diabetics w/ Dilated Cardiomyopathy need ? drug added if LVEF is lower than ?
What are the 3 indications to use Ivabradine to slow HR in this population
What drug is used second line but is preferred d/t?
Mineralcorticoid antagonist- Spironolactone, Eplerone;
<40%
Resting HR >70
LVEF <35%
Chronic and stable
Digoxin; Dec hospitalization
? drug combo is recommended for use in AfAm w/ Dilated Cardiomyopathy
When are Pts w/ Dilated Cardiomyopathy w/ Afib candidates for biventricular pacing
When is an ICD implant a reasonable option
Hydralazine-Nitrate
Significant MR and,
QRS >150msec
ASx ischemic cardiomyopathy w/ LVEF <35% on appropriate medical therapy and >40d post-MI
? complication is more common in Dilated Cardiomyopathy compared to Ischemic Cardiomyopathy
Dilated Cardiomyopathy w/ Afib should be anticoagulated w/ ? unless ?
What are four reversible causes of Dilated Cardiomyopathy
Emobli
DOAC; Mitral stenosis
Hypothyroid
Alcohol
Toxins
Sarcoidosis
How is Dilated Cardiomyopathy Tx
What med is added to increase cardiac contractility
Define HOCM
Loop ACEI BB
Digitalis
LV wall >1.5cm thick causing diastolic dysfunction
When is the obstruction of HOCM increased
What type of murmur is present
How is the murmur increased
Systole w/ anterior motion of MVs anterior leaflet
Medium, mid-systolic cresc-decresc
Dec ventricular volume- valsalva, stand, tachy
What is the end consequence of HOCMs hypertrophy
How is this condition inherited
How is this condition differed from athletic heart
Inc LV diastolic pressure
Autosomal dominant sarcomere defect: myosin heavy chains/Ca regulating proteins
Athletes- no diastolic dysfunction
HOCM in Asians is commonly ? type compared to the other MC
HOCM in older adults is d/t ? and differed how
HOCM can present mimicking ? but is differed by ?
Apical; MC- septal
HTN;
Sigmoid interventricular septum w/ cardiac knob below AV
AS- provoking maneuvers are opposite;
HOCM inc w/ stand/valsalva
Dec- squat, grip. leg raise
What are the three most frequent presenting Sxs of HOCM
What will be seen on PE of HOCM
? is a poor prognostic sign and what causes this to develop
Post-exertion syncope
Angina
Dysnpnea
Triple apical pulse
Bisferiens carotid pulse
JVP w/ a-wave
S4 gallop w/ lift
Afib d/t chronically elevated LA pressures
What valvular d/o is commonly seen in HOCM
What EKG finding is nearly universal in all symptomatic Pts
What else would be seen on EKG
MR
LVH
Septal Q-wave (2, 3, aVF)
High voltage precordium
What is the next step for Pts w/ HOCM identified on TTEcho
Echos must be done to r/o ? other congenital d/o
What is the initial medical management used for Tx
Ambulatory EKG
Exercise stress test
Ventricular noncompaction- trabeculation causing incomplete ventricular filling
Metoprolol; Verapamil
How can the progression of HOCM be stopped/slowed
When are Pts best managed by ICD
When is an ICD considerable
Dual biventricular pacing
Malignat ventricular arrhythmia
Unexplained syncope w/ +FamHx sudden death
LV thickness 30mm
1* relative sudden death
Unexplained syncope <6mon
How can HOCM be surgically Tx
How can HOCM non-surgically be Tx
Pregnant Pts w/ HOCM are at greater risk w/ ? measurement and are best managed w/ ?
Myotomy myomectomy w/ Alfieri
Alcohol ablation into LCA
Outflow gradient >50mmHg;
BBs
What med need to be avoided in the Tx of HOCM
What med is c/i
MCC of Restrictive Cardiomyopathy in US and world
Dec preload:
Diuretic ACEI Nitrate ARB
Digoxin
US- amyloidosis
World: tropical endomyocardial fibrosis
Define Restrictive Cardiomyopathy
This can present mimicking ? and is differentiated by ?
What two EKG findings are suggestive of a Dx
Stiff/rigid ventricle impairs diastolic filling w/ preserved contractility
Constrictive pericarditis; verify**
no ventricular accentuation w/ inhalation
Inc pulm artery pressure
S3, not pericardial knock
Low voltage, LVH
? test is used to look for amyloid deposition in the heart during Restrictive Cardiomyopathy
? imaging is used for screening
How can systemic disease involvement be confirmed but ? is needed to confirm cardiac involvement
Tech-pyrophosphate bone scan
Cardiac MRI
Rectal Adipose Gingival biopsies;
Endomyocardial biopsy
How is Restrictive Cardiomyopathy Dx
How is this Tx
What needs to be avoided
Echo w/ cath to measure atrial pressure
Loop: Furosemide
ACEI- Enalapril
CCB- Verapamil
Digoxin- precipitates arrhythmia
? medication is useful in sarcoidosis induced Restrictive Cardiomyopathy w/ conduction abnormalities
? population is more susceptible to this Dx
? are the MC forms of ASD in order
CCS
Northern European men
Ostium Secundum, mid-septum
Ostium Primum- low septum
Sinus Venosus- hole in upper atrial septum
Pulsus Bisferien seen in HOCM can also exist in ? other cardiac d/o
What would be seen on HOCM PE if there is also associated MR
What PE finding can be seen on PE of Restrictive Cardiomyopathy
Aortic regurg
Apical lift
Kussmaul Sign- JVD increases w/ inspiration
What lab result can help aid differentiating Perciarditis and Restrictive Cardiomyopathy
? is the MC arrhythmia seen in Dilated Cardiomyopathy
? chemotherapeutic medication has cardiotoxic effects and can lead to Dilated Cardiomyopathy
BNP >400: restrictive
Afib
Doxorubicin
Pts w/ Ostium Primum ASD also usually have ? other two defects
What causes a Sinus Venosus ASD to develop
What is the end results in all forms of ASD
MV/TV clefts
VSD
SVC/IVC don’t merge w/ atria properly
LA shunts blood to RV causing volume overload
? is the determining factor in the direction of shunted blood during an ASD
What is an unusual but potential cyanotic issue that can develop from ASDs
ASDs predispose the Pts to ? vascular risk
Atrial compliance
PHTN+cyanosis- Eisenmenger physiology
Paradoxic emboli
Pts w/ Patent Foramen Ovale are at increased risk for ? breathing dysfunction
? is the MC presenting Sx of ASDs
What will be heard on PE
Platypnea orthodeoxia- orthostatic hypoxemia
Afib*/flutter
Wide, Fixed, Split S2 (lub dub-dub)
Pts w/ ASDs are c/i from ? hobby
PDAs are MC in ? population
PDAs can also be d/t ? maternal infection
Diving
Premature births, more likely to spontaneously close
Rubella
ASDs can remain ASx until 30y/o but then ? presents
How are small, centrally located ASDs Tx
How are mod/large ASDs Tx
> 30: dyspnea, angina
50: Afib, RVF
<3mm close spontaneously
8mm/> or RV overload- closure at 2-6y/o w/ Pericardial/Dacron patch
? type of murmur is associated w/ PDAs
How are these Tx
How long are Pts left on endocarditis prophylaxis
Constant machinery (patent your machine)
Indomethacin/Ibuprofen w/ fluid restriction
6mon after closure
What causes PDAs
What can be the reporting c/c of PDAs
? is the MC congenital heart defect in Peds
Connection between ductus arteriosus and pulmonary artery
LE cyanosis
FTT
Tachy/Tachy
VSD- membranous
The direction of a VSD shunt depends on ?
VSD sizes are defined when compared to ? structure
? PE finding suggests increased R to L shunting in VSDs
RV pressure; smaller defect= inc gradient, louder murmur
Aortic root
Diastolic murmur
? is the classic clinical presentation of Aortic Coarctations
Half of the Pts will have ? valve defect that puts them at risk for ?
What causes these Pts to develop LV failure
Arm BP > leg BP
Bicuspid AV; Berry aneurysm
HTN
? can cause a Pt w/ VSD to present w/ acute AR and acute HF
? medication is used to reduce pulmonary pressure if Eisenmenger syndrome develops in VSDs
All VSDs w/ R-L shunts need ? intervention when in hospitals
High VSD= R-aortic cusp prolapses, reduces VSD
Bosentan- endothelial receptor blocker
IV line filters to prevent bubbles/debris from becoming systemic
? is the classic clinical presentation of Aortic Coarctations
Half of the Pts will have ? valve defect that puts them at risk for ?
What causes these Pts to develop LV failure
Arm BP > leg BP
Bicuspid AV;
Berry aneurysm
HTN
? type of aortic coarctation is associated w/ a genetic defect
What is seen on CXR
How is this Dx
Preductal- Turners, XO
Rib scalloping
Figure-3 sign
Echo w/ cath: >20mm gradient= intervention
What types of altered JVP waves may be seen in Tetrology of Fallot
What EKG finding is common in surgically repaired Tetrologies
Why do Pts need annually EKGs
Inc a-wave
C-V wave: d/t TR
RBBB
Measure QRS; >180msec d/t RVF= risk sudden death
Primary HTN is defined by ? readings
When do USPSTF screening begin and when are f/u needed
When does the AAP suggest screening Peds for HTN
SBP 130/>
DBP 80/>
2 readings, 2 visits
18y/o-
Normal: q12mon
SBP 120-129: q6mon
3/>y/o w/ RF: Q-visit
What types of altered JVP waves may be seen in Tetrology of Fallot
What EKG finding is common in surgically repaired Tetrologies
Why do Pts need annually EKGs
Inc a-wave
C-V wave: d/t TR
RBBB
Measure QRS; >180msec= risk sudden death
Primary HTN is defined by ? readings
When do USPSTF screening begin and when are f/u needed
When does the AAp suggest screening Peds for HTN
SBP 130/>
DBP 80/>
2 readings, 2 visits
18y/o-
Normal: q12mon
SBP 120-129: q6mon
3/>y/o w/ RF: Q-visit
Ranges for Normal, Elevated, Stage 1 and Stage 2 HTN
BP discrepancy of ? between arms needs further work up
Why are fundoscopic exams indicated
N: <120/880 and <80
E: 120-129 and <80
1: 130-39 or 80-89
2: 140/> or 90/>
> 15mmHg- higher mortality risk
AV nicking- arteriole crosses venule causing venous compression
When does ACC/AHA suggest starting Rx management for HTN
What are the ACC/AHA HTN targets
What are the JNC-8 HTN targets
All Stage 2 Stage 1 w/: DMT2 ASCVDz CKDz ASCVD risk 10%/>
<130/80
<60y/o/CKDz/DM: <140/90
60/>y/o: <150/90
For HTN Tx, how much sodium intake is recommended
How many alcoholic drinks can wo/men have
What are the aerobic exercise goals
<2.3g/day
Men: 2/day
Women: 1/day
Moderate x 150min (30min/day x 5d)
Vigorous x 75min (30min/day x 3d)
How are non-black/DM Pts w/ HTN Tx
How is Stage 2 HTN Tx
One of:
ACEI/ARB
CCB
Thiazide like
Two meds of different classes w/ lifestyle
How are AfAm w/ HTN Tx
When are BBx c/i for HTN Tx
What class of med is particularly indicated for angina pectoris
Two or more meds:
CCB/Thzd-like
Asthma
CCBs
S/e of using Spironolactone for HTN Tx
S/e of using BB for HTN Tx
Two s/e of using hydralazine for HTN Tx
HyperK
Impotence
Lupus-like syndrome
Pericarditis
When Tx HTN, If Pts can’t tolerate Thzd diuretic, switch for ?
3 s/e of using ACEIs
They are c/i when?
Mineralcorticoid antagonist- Spironolactone
HyperK Angioedema Cough
Pregnancy
S/e of using Spironolactone for HTN Tx
S/e of using BB for HTN Tx
Two s/e of using hydralazine for HTN Tx
HyperK
Impotence
Lupus-like syndrome
Pericarditis
? trifecta makes up the Metabolic Syndrome
? is thought to be the MCC of Secondary HTN
If Secondary HTN is thought to be d/t Pheo, the MCC or Cushings, how are these tested
3 of the 5: Obesity (M: 40", W: 35") Insulin resistance HyperTG >150 or on drug Tx HDL M: <40, W: <50 BP >130/85 or on drug Tx Fasting glucose >100 or on drug Tx
Primary Aldosteronism
Pheo: 24hr urine metanephrine and catecholamine
PA: 24hr urine aldosterone/HypoK
Cusing: dexamethasone suppression test
? lab result after starting ACEI for HTN Tx signal possible renal stenosis
Secondary HTN cause by a Pheo present w/ ? triad
Pheos are associated w/ ? FamHx
Inc creatinine
Sweating
Episodic HA
Tachycardia
MEN 2A/2B-
Medullary thyroid carcinoma, Hyperparathyroid,
What are the two different types of Hyperaldosteronism that can cause HTN
What urine lab result is Dx and
How is the Dx then confirmed
Conn Syndrome- adrenal adenoma, majority
Bilateral hyperplasia- primary hyperaldosteronism
Ald/Renin ratio >25:1
Aldosterone suppression test- PO sodium, measure urine aldosterone
Once confirmed, adrenal CT
Three meds used for HTN in pregnancy
? two meds are reserved for Pts taht fail all other medical therapy
Name of renin blocker medication
Labetalol
Methyldopa
Nifedipine
Hydralazine
Minoxidil
Aliskiren
What non-pharm methods can be used to Tx HTN and how much reduction can be expected
What needs to be monitored for when using Thzds, Loops, ACEI, ARBs and Aldosterone antagonists
Diet: 8-14 Weight: 5-20 Exercise: 4-9 Na restriction: 2-8 Alcohol: 2-4
Chem-7 (CMP): T: Hypo-K/Mg L: Hypo-K/Mg AC: Hyper-K AR: Hyper-K AA: Hyper-K
Three meds used for HTN in pregnancy
? two meds are reserved for Pts taht fail all other medical therapy
Name of renin blocker medication
Labetalol
Methyldopa
Nifedipine
Hydralazine
Minoxidil
Aliskiren
What VS readings suggest OHTON etiology was hypovolemia
What VS readings suggest a Dx of POTS
How is OHOTN Tx
HR >100bpm
Inc x 30bpm
Sxs w/out HOTN
+Sxs, no HOTN
Inc Na/Fluids
Fludrocortisone
Midodrine
? sign is seen on PE w/ TR
? is the MC systemic vasculitis
What causes the vessel occlusion during this MC
Carvalio- pansystolic increased w/ inspiration
GCA
Intimal hyperplasia remodeling
? is the greatest RF for developing GCA
? other condition is closely related to GCA’s prevalence
All Pts w/ GCA need ? PE test conducted
Age, Scandanavian women
Polymyalgia rheumatica- stiff shoulder/pelvic in AM
Fundoscopic- cotton wool spots (retinal ischemia)
What artery is involved in an anteriolateral MI
What artery is involved in a posterior MI
What artery is involved in a inferior MI
V4-6: Left main
ST depress V1-2: RCA
2, 3, aVF: RCA
MCC of Cardiogenic shock
What Sxs are present
What is seen on PE
Acute MI
Pulm congestion AMS Tachy Clammy HOTN <90
JVD
UOP <20mL
How is Cardiogenic Shock Dx
How is this Tx
Cardiogenic shock d/t free wall ruptures is MC seen after ? type of MI
Inc pulmonary capillary wedge pressure >15mmHg
Pressor: Dobutamine, NorEpi
Balloon pump
Judicious fluids
Q-wave transmural
Lateral wall
Define OHOTN
This is MCC by ? issue and MCC by ? drug
What would be seen in VS if etiology was d/t autonomic dysfunction
SBP dec x 20mm
DBP dec x 10mm
<5min repositioning
Acute MI complication;
MAOIs
HOTN w/ HR increase <10bpm
What VS readings suggest OHTON etiology was hypovolemia
What VS readings suggest a Dx of POTS
How is OHOTN Tx
HR >100bpm
Inc x 30bpm
Sxs w/out HOTN
+Sxs, no HOTN
Inc Na/Fluids
Fludrocortisone
Midodrine
Absolute c/is for fibrinolytic therapy for STEMI Tx
Suspect dissection
Active bleed/diathesis
Malignant intracranial neoplasm
Ischemic stroke <3mon
Cerebral vascular lesion
Hemorrhage, cranial
How often are cardiac markers needed during STEMI
What is the next step for all of these Pts
How is this next step different for NSTEMI/UA Pts
3 sets, q8hrs
Angiography
Delayed x 24-48hrs
Next step for all inferior wall MIs
What factors can lower the threshold for angina Sxs
How long do angina pain attacks last depending on the etiology
Right sided lead- V4R
After meals
Cold
Excitement
Exertion: <3min
Food/Emotion: <20min
What biomarkers are seen in MIs
? condition can present mimicking a STEMI but isn’t
Myoglobin
1-4h 12hr <24hrs
Troponin:
4-8hr 12-24hr 7-10d
CK-MB:
4-6hr 12-24hr 3-4d
Stress cardiomyopathy- Tako-tsubo/apical ballooning syndrome
How much stenosis is needed to cause angina Sxs w/ exercise
How much stenosis is needed to make Sxs at rest
What is the earliest stage of an atherosclerotic plaque
> 70%
> 90%
Inflammation induced foam cell (lipid laden macrophage) w/ fatty streak
HF is a syndrome of ? dysfunction
? is the dominant Sx of L-HF
? is the dominant Sxs of R-HF
Ventricular
Dyspnea
Fluid retention
What are the 4 medications withing a cardiac Vasculo-Protective Regiment
? is the only drug class proven to prevent re-infarction and increase post-MI survival
What medication is used as a last step when the preferred can ‘t be used
Antiplatelet
Statin/CSPK-9
BB
ACEI
BBs
Ranolazine- late Na channel blocker
What two meds can prevent the progression of HF for Pts in Class A and B
Define Cor Pulmonale
What are the 4 NYHA HF Classificaitons
ACEI and BB
R-HF d/t pulmonary dz
1: ASx, no limitations
2: Sx w/ mod activity
3: Sx w/ mild activity
4: Sx at rest
Absolute c/is for fibrinolytic therapy for STEMI Tx
Suspect dissection
Active bleed/diathesis
Malignant intracranial neoplasm
Ischemic stroke <3mon
Cerebral vascular lesion
HTN, cranial
How often are cardiac markers needed during STEMI
What is the next step for all of these Pts
How is this next step different for NSTEMI/UA Pts
3 sets, q8hrs
Angiography
Delayed x 24-48hrs
? is the characteristic EKG finding of anginal episodes
? is the MC used non-invasive procedure to evaluate angina pain
? is the name of the protocol used
Horizontal/down sloping ST segment, reverse when ischemia stops
Exercise stress test- unless pain at rest/minimal activity
Bruce protocol
? is a relative c/i for performing exercise stress tests to assess angina
? is the medical Tx of choice for angina pain but commonly causes ? s/e
? medication is used for chronic angina
Sx aortic stenosis
Sublingual nitro;
HA
Ranolazine
HF is a syndrome of ? dysfunction
? is the dominant Sx of L-HF
? is the dominant Sxs of R-HF
Ventricular
Dyspnea
Fluid retention
? is the MCC systolic HF
What are the 4 classifications of HF
MI induced myocardium dysfunction
A: at risk to develop d/t HTN
B: structural heart Dz w/out Sxs
C: clinical HF
D: refractory to therapy
6 causes of high output HF
What will be the first Sx of this condition
What is the best test to Dx CHF
Beriberi- dec thiamine Anemia Hyperthyroid Pregnancy AV fistula Pagets
Tachy progressing to systolic failure
Echo
How is JVP measured
? finding is abnormal
Define Hepatojugular Reflex and what this correlates to
HOB at 45*
Sternal angle to height of puslation
Add 5cm
> 8cm
Liver pressure inc JVP x 1cm;
Inc Pulm Cap Wedge pressure
? lab result is a poor prognosis for Pts w/ chronic HF
Normally BNP is used for prognosis/staging but can be artificially low in ? populations
? medication can also cause artificially low levels
Anemia w/ high RDW
Older
Female
COPD
Neprilysin inhibitors- neprilysin will degrade BNP
What are two methods to define presence/extend of CADz in HF
? medication is the most effective way to relieve HF Sxs
? drug combo is the initial Tx for most HF w/ Sxs and reduced LVEF
Left sided cath
CT angiography
Diuretics
ACEI and Diuretic;
early addition of BB
How is mild fluid retention in HF Tx
These meds tend to be ineffective when GFR is below ?
? one is best for lower GFRs
Thiazdies:
Hydrochlorothiazide
Metolazone
Chlorthalidone
<30mL/min
Metolazone: 20-30mL/min
What loop diuretics can be used in the Tx of HF
? is a common s/e across the loops
What PO K-sparing agents are used w/ Loop/Thzds and how do they work
Furosemide
Bumetanide
Torsemide
Pre-renal azotemia
Triamterene, Amiloride: reduce K secretion at distal tubules
? medication is used for HF Tx if Pt is refractory to Loop/Thzds?
How is Systolic HF Tx
When is the prevalence of Diastolic Left HF more common
Metolazone- loop/thzd combo
Loop ACEI BB
> 55y/o w/ HTN
How is Diastolic Left HF Tx
What medication can never be used
Gold standard to Dx Right HF
ACEI and BB;
Don’t use diuretic
Digoxin
Right sided cath
3 causes of high output HF
What will be the first Sx of this condition
Beriberi- dec thiamine
Anemia
Hyperthyroid
Tachy progressing to systolic failure
? is normal EF
What is seen on systolic HF
What is seen in diastolic HF
55-60;
Inc mortality <35
Dec LVEF, S3
Thick walls, S4
Why do ventricles release BNP in response to inc volume
BNP levels higher than ? make CHF likely
What are the 3 beta-1 selective used to reduce mortality from HF
Dec RAAS,
Inc Na excretion
> 100
Bisprolol
Metoprolol succinate
Carvedilol
What are the 2 MCC of Aortic Stenosis
? genetic marker is most strongly associated w/ AS
AS owns ? MC fact
Uni/Bicuspid valve
Age related calcification
Notch 1
MC surgical valve lesion in developed countries
What Triad does AS present w/
How is the murmur best heard on exam
The presence of an ejection sound suggests ?
Syncope
Angina
Dyspnea- late finding
Leaning fwd w/ expiration
Congenital cause
What lab result can indicate AS is present
Define the Gallavardin Phenomenon of AS
Usually the syncope w/ this condition is d/t ?
Helmet/Schistocytes- RBC fragments from valve calcification
Sounds like MR w/ high pitch heard at apex
V-tach
AV blocks
What medical therapy is recommended for Pts post-AS surgery
What are the 3 MCC of AR
What is a rare seronegative cause
Clopidogrel x 6mon
ASA for life
HTN
Infective endocarditis
Congenital
Ankylosing
What are the most frequent presenting Sxs of AR
What will be seen on PE in this condition
What 4 other signs are seen
Exertional dyspnea
Fatigue
Wide pulse pressure
Water hammer/Corrigan pulse
Hill: leg BP > arm BP Musset- head bob Quinke- nail bed Duroziez- to-and-fro Traubes: pistol sound over femoral/radial pulses
What extra murmur can be present w/ AR
What is the indication after load reduction is needed
What class is preferred
Austin-Flint: diastolic murmur from blood hitting anterior mitral leaflet
SBP >140
ARBs
Native tricuspid valve stenosis and MR is usually d/t ?
In the USA, TS is MC d/t ? two etiologies
TS is characterized by ? four PE findings
Rheumatic heart dz
Prior TVR
Carcinoid syndrome
Hepatomegaly
Ascites
Right HF
Dependent edema
Tricuspid stenosis will cause ? type of JVP finding
Since this valvulopathy can mimic ?, it’s differentiated by ?
? is the mainstay of Tx, particularly ? one is considerable bowel ischemia is present
Giant a-wave
MS;
Increases w/ inhalation
Loop diuretics;
Tosemide, Bumetanide
How is TS Tx if liver is engorged/ascites is present
Preferred surgical Tx is ?
? congenital and iatrogenic etiology can cause TR
Aldosterone inhibitors
Percutaneous balloon valuloplasty
TVR
Ebstein Anomaly: septal, posterior leaflets into the RV
Pacemaker lead injury
? JVP wave is altered w/ TR
Name of surgical procedure to decrease annular diameter of TR
What are the two categories of PR etiologies
X-descent fades w/ inc regurg
Large V-wave w/ rapid descent
DeVega annuloplasty
High Pressure: P-HTN (MCC)
Low Pressure: dilated annulus, congenital
What type of PE finding is heard w/ PR
What secondary murmur is also heard w/ PR
? is a common EKG finding in these Pts
Widely split S2 w/ pulmonic ejection sound
Right sided S4
Graham Steel- diastolic pulmonary murmur d/t dilated annulus; mis-Dx as AR
RBBB
How can the direction of MR murmur indicated the cause of the murmur
? do PTs need prior to MV replacement to Tx MR
Radiates anterior- posterior leaflet
Radiates posterior- anterior leaflet
Men >40/menopausal women- angiography to determine CADz
? is heard on PE during MS
? part of the valve is MC involved in MVP
? unique presentation in females can indicate underlying MVP
Accentuated S1 w/ palpable apex and opening snap
Middle cusp of posterior leaflet- if both involved= Barlow Syndrome
POTS
AR
MS
PR
TS
AS
PS
HOCM
MVP
MR
TR
VSD
Sit, lean fwd; Diaphragm at Erbs
L lat-decubits; Bell at mitral
Sit, lean fwd: Diaphragm at Pulmonic
Supine; Bell at Tricuspid
Sit; Diaphragm at Aortic
Supine; Bell at Tricuspid
Supine; Diaphragm at Mitral
Supine, Diaphragm at Mitral
Supine, Diaphragm at Mitral apex
Supine, Diaphragm at Tricuspid
Supine; Diaphragm at Tricuspid LLSB
MC Sx of MS
MCC of TS is ? and usually is seen w/ ?
Why are TS and MS difficult to differ on exam
Dyspnea
Rheumatic heart dz;
Rheumatic MS leads to TR d/t P-HTN
Both have opening snaps
Define Ortner’s Syndrome
? leaflet is affected by age and calcification the most
Hoarse voice d/t PR
Posterior
How is MS seen on EKG
Term used to describe the Echo finding of MS leaflets
? is the preferred surgical procedure
MC- p-mitrale: P-wave >2.5cm in lead 2
Fish mouth- thickened leaflets
PMBV- percutaneos mitral balloon valvotomy
How often do ASx Mitral stenosis need to f/u w/ Echo
? mitral leaflet is MC affected in MR
Severity of MR is based on ? 5 things
3-5yrs: MVA >1.5cm2
1-2yrs: MVA 1-1.5cm2
Annual: MVA <1.0cm2
Posterior
Size Pressure gradient LA and LV Systemic pressure against LV Duration LA compliance
