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UF COM ClinDx Unit 4 > L5-6 - Stenosis & Regurg > Flashcards

L5-6 - Stenosis & Regurg Flashcards

1
Q

What is involved with examination of the CV system?

A

NOT just auscultation

History, physical, X ray, ECG & other (echo etc.)

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2
Q

Which valvular problems are mainly a pressure overload? Which is mainly a volume overload?

A

Stenosis = pressure

Regurg = volume

This is for aortic & mitral

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3
Q

What is the origin and importance of a murmur that a patient has had since childhood?

A

Congenital

Probably not relevant to current problem

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4
Q

What is endocarditis prophylaxis? What does this finding in the history mean?

A

Antibiotics during dental procedures

Probably doesn’t have endocarditis

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5
Q

What is important about a BP of 110/80?

A

Narrow pulse pressure

Suggests aortic stenosis

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6
Q

Narrow pulse pressure points towards what?

A

Aortic stenosis

Not as much blood is pumped out (low SV), so systolic is lower (while diastolic is similar). Also seen in CHF & shock

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7
Q

What is suggested with a physical finding of slow rising pulses or apex?

A

Aortic stenosis

Weak pulses because LV pressure is much higher than aortic pressure

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8
Q

What is suggested by the physical finding of flat neck veins?

A

Normal RA pressure

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9
Q

What is parasternal lift? What is suggested by this finding?

A

Palpable or visible impulse at chest wall just to the L of the sternum.

Severe = Represents RV hypertrophy due to respiratory problem or pulmonary stenosis

Mild = Aortic regurg

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10
Q

What is suggested by the the finding of crescendo decrescendo systolic ejection murmur?

A

Aortic Stenosis

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11
Q

What is suggested by a normal ECG with an elevated QRS voltage?

A

Stiff/thick ventricular wall associated with aortic stenosis or HTN

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12
Q

What diagnoses can be made with the ECG?

A

ECG findings are consistent with other findings, but it cannot diagnose anything on its own other than HR

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13
Q

When looking for calcified aortic valve, what view should be used on the X ray?

A

Lateral, on AP the spine gets in the way

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14
Q

Describe the flow of blood leaving the ventricle in a normal valve & stenotic valve?

A

nl = bolus of blood

stenotic = squirt of blood as volume is squeezed through smaller opening

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15
Q

What is suggested by a wide pulse pressure?

A

Aortic regurg

Increased SV

Also seen during exercise as more blood is in arterial system at any one moment –> higher systolic & lower dystolic

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16
Q

What is suggested by the physical finding of bounding pulse?

A

Aortic regurg

Leaping and forceful pulse that quickly disappears. Also associated with HTN & high stroke volume

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17
Q

What is suggested by bisferriens at the carotid pulse?

A

= double pulse per 1 cardiac cycle (first is systolic & second is high diastolic)

Aortic regurg

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18
Q

What is suggested by a bounding & collapsing apex impulse?

A

Aortic regurg

High pressure which rapidly drops during diastole

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19
Q

What is suggested by quincke pulsations in the nail bed?

A

red —> blanching –> red …

Aortic regurg

Not enough blood in nail beds during diastole

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20
Q

What causes muffled S1?

A

Blood coming in from mitral & aortic (regurg) so the heart fills faster & the valves doesn’t have to move as much –> muffled

Aortic regurg

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21
Q

What is suggested by systolic flow murmur?

A

Aortic regurg

cuz blood is flowing back through aortic valve, more blood must be ejected during systole –> higher SV

Flow murmur = only caused by increased blood flow

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22
Q

What is suggested by ST depression at V5 & V6?

A

Aotic regurg

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23
Q

What is suggested by tricuspid valve regurg on echo?

A

Probably trivial. A lot of people have it

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24
Q

What is the most common valvular disorder?

A

Mitral regurg

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25
Q

What is mitral valve prolapse?

A

When thick mitral valve is displaced into atrium

Some asymptomatic, but often associated with regurg

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26
Q

What is suggested by the absence of S1?

A

Mitral regurg

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27
Q

What is a holosystolic murmur?

A

starts at S1 and extends to S2. Causes by mitral regurg

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28
Q

What is suggested by an enlarged RA?

A

Mitral regurg

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29
Q

What is suggested by a double density LA on CXR?

A

Mitral regurg

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30
Q

What is a double density atria?

A

Right edge of the left atrium pushes behind the right cardiac shadow, forming its own distinct silhouette

See edge of ventricle at one location & edge of atrium at a distinctly different location

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31
Q

Why is the LV easily emptied in mitral regurg?

A

Reduction in afterload because some blood flowing back into LA which has a low pressure

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32
Q

What is suggested by a prominent V wave on ECG?

A

Mitral regurg

atrial filling is accelerated because of regurg

33
Q

What is the first heart sound?

A

Lub sound of Lub-dub. Indicates the beginning of ventricular systole & the closure of the mitral/tricuspid valve

Blood that was flowing into the ventricle is forced to change direction and sloshes around the now closed chamber

34
Q

What is the second heart sound?

A

Dub sound of Lub-dub. Indicates the end of ventricular systole & the closure of the aortic/pulmonic valve (pressure plateau)

Blood leaves ventricle –> aorta & pulmonic trunk are elastic –> Stretch –> recoil at end on ventricular contraction –> compresses blood in them –> pushed blood downstream & pushed back up stream against the valves

Has splitting due to inspiration

35
Q

What is the third heart sound?

A

Indicates near maximal ventricular dilation at the end of rapid ventricular filling –> point of initial decrease in filling speed

Early in ventricular diastole

Creates a “Ken-tucky” like cadence

36
Q

What is the fourth heart sound?

A

Indicates abnormal filling during atrial contraction. Related to the failure of the ventricle to fill –> louder atrial contraction needed to fill it. Usually the result of the ventricle not being able to stretch properly (hypertrophy)

Late in ventricular diastole

Right before S1 (sounds sort of like a split S1)

Creates a “Tenne-ssee”

37
Q

Most common cause(s) of aortic stenosis?

[From wikipedia not lecture]

A

Calcification of normal valve (present later)

Calcification of a congenital bicuspid valve (present earlier)

38
Q

What is an ejection click? When is it heard?

A

Aortic stenosis

Impact of left ventricular outflow against the partially fused aortic valve leaflets. Right after first heart sound

39
Q

A crescendo decrescendo systolic murmur is heard with what valvular problem?

A

Aortic stenosis

40
Q

What causes a decreased/soft second heart sound?

A

Aortic stenosis or aortic regurg

As gets calcified, the aortic valve doesn’t snap shut anymore –> less crisp of a sound in stenosis

41
Q

You may hear a 4th heart sound in what valvular problem?

A

Aortic stenosis

High afterload –> hypertrophy –> difficulty filling –> needs extra push from atria

42
Q

Which valvular problem(s) has/have decreased effective forward flow (flow from heart to body) when compared to SV?

A

Aortic Regurg = A fraction of blood ejected from heart is regurgitated back into heart. So only a fraction of SV actually makes it to the body

Mitral regurg = some of blood ejected is going back into atria

43
Q

Which valvular problem presents with decreased systemic diastolic pressure? Increased?

A

Aortic Regurg

Aortic Stenosis

44
Q

In undeveloped nations, what is the main cause of aortic insufficiency?

A

Rhuematic fever

45
Q

Causes of aortic regurg?

[not from lecture]

A

Age related deterioration in patient with HTN

Congenital mono or bicuspid

Endocarditis

Rheumatic fever

Marfans

Trauma

Aortic dissection, anuerysm or root dilation

46
Q

Rhuematic fever as a child can lead to what valvular problem many years later?

A

Mitral stenosis most likely, but can cause stenosis or regurg in mitral & aortic valves

47
Q

What is the main cause of mitral stenosis?

A

Rhuematic fever

48
Q

What is suggested by a loud first heart sound?

A

Mitral stenosis

49
Q

What is suggested by a loud pulmonic component of the second heart sound?

A

Pulmonary hypertension secondary to Mitral stenosis

50
Q

What is suggested by an opening snap?

A

Mitral stenosis

Forceful opening of the mitral valve as atrial pressure increases & the valve now opens at a relatively higher diastolic ventricular pressure

51
Q

What is suggested by a rumbling mid-diastolic murmur?

A

Mitral stenosis

52
Q

What is suggested by prominent neck veins?

A

Mitral stenosis

Everyone has visible neck veins while lying down, this is when people have it while standing/sitting

LA pressure backs up into venous system

53
Q

What is suggested by irregularly irregular ecg?

A

Mitral stenosis

54
Q

What is suggested by prominent pulmonary arteries?

A

Mitral regurg

55
Q

What is suggested by kerly b lines?

A

Mitral regurg

56
Q

What is suggested by a barium swallow with displaced esophogus?

A

Mitral regurg –> big LA –> pushes esophagus posteriorly

57
Q

What is suggested by trivial aortic insufficiency?

A

Mitral regurg –> mitral & aortic valve connected somewhat

58
Q

What is suggested by L atrial size of 5 cm?

A

Mitral regurg

59
Q

What is suggested by mitral gradient of 15 mm Hg?

A

Mitral regurg

60
Q

What valvular problem gives you a big LV? Big LA?

A

Aortic regurg

Mitral regurg

61
Q

What is Rhuematic fever?

[From Wikipedia, Not lecture]

A

Strep pyogenes (group A) infection in pharynx –> molecular mimicry –> autoimmune Ab cross reactivity –> progressive inflammation & scarring of heart tissue –> over many years causes leaflet thickening & commisural fusion

Effects mainly mitral valve, but also aortic valve some. Can cause stenosis or regurg

62
Q

What is infective endocarditis?

[From wikipedia, not lecture]

A

Valve damaged by some other process (likely rhuematic heart disease) –> makes valve good landing place for bacterial attachment –> during bacteremia (dental work) bacteria attach –> forms vegetation

Can effect mitral or aortic valves. Can cause regurgitation or stenosis

63
Q

What is suggested by a mitral gradient of 5 mm Hg?

A

Normal (no mitral regurg)

64
Q

What is normal pulse pressure?

A

40 mm Hg

30 or less is low

65
Q

What does a slow pulse mean?

A

Delayed compared to heart beat

66
Q

What causes increased S1? Decreased? Absent? Normal?

A

Aortic Regurg

Mitral Stenosis

Mitral Regurg

Aortic stenosis

67
Q

What causes loud S1 & S2?

A

Mitral stenosis

68
Q

What causes decreased S2? Increased?

A

Aortic stenosis & regurg

Mitral Stenosis

69
Q

Which valvular problems do not effect pulses?

A

Mitral problems

70
Q

Which valvular problem has a diastolic murmur?

A

Mitral stenosis

71
Q

What does ES stand for?

A

Ejection sound/Ejection click

72
Q

Size of enlarged LV? Normal?

A

6.5 cm

5-5.5 cm

73
Q

Size of enlarged LA? Normal?

A

4 cm

3.5 cm

74
Q

Which valvular disorder is more common in females?

A

Mitral stenosis

75
Q

Which valvular disease can present with breathelessness?

A

Basically all of them

76
Q

Which valvular problems present with aortic dilation?

A

Aoritc Stenosis

Aortic Regurg

77
Q

What valvular problem can present with crackles?

A

Aortic Regurg

Mitral Stenosis

78
Q

Which valvular problems present with mitral gradient?

A

Mitral stenosis

Mitral regurg

UF COM ClinDx Unit 4 (10 decks)

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