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CV <3 > Lecture 6: Valvular Disorders Part 2 > Flashcards

Lecture 6: Valvular Disorders Part 2 Flashcards

1
Q

How can we differentiate between a Stage C1 vs a C2 murmur?

A

C2 has abnormal LV function, which typically requires an Echo.

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2
Q

Who is tricuspid stenosis more common in?

A

Females

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3
Q

What is tricuspid stenosis typically associated with?

A

AS or MS

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4
Q

What are the primary causes of tricuspid stenosis?

A
  • Rheumatic heart disease (worldwide)
  • US: carcinoid disease or prosthetic valve degen
  • Can also be caused by congenital anomalies or leaflet tumors/vegetations.

Carcinoid disease is a cancer that presents with multilocation tumors.

Since it is rarely isolated, a congenital deformity is the most likely etiology if it does present isolated.

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5
Q

What are the primary S/S of tricuspid stenosis?

A
  • JVD/elevated JVP
  • Peripheral pitting edema
  • Fatigue
  • Hepatomegaly
  • Ascites
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6
Q

What are the PE findings of tricuspid stenosis?

A
  • Increased sound on inspiration
  • Opening snap may be heard
  • Soft, high-pitched, diastolic rumbling murmur along lower left sternal border.
  • Signs of right-sided HF.
  • Pulsatile liver coinciding with atrial contraction
  • Pitting edema

The right side of the heart receives more blood during inspiration.

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7
Q

What might be expected on an EKG and CXR for tricuspid stenosis?

A
  • Right atrial enlargement
  • Cardiomegaly
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8
Q

What are the medications used to treat tricuspid stenosis?

A
  • Diuretics (loops)
  • Aldosterone antagonist for liver congestion or ascites.
  • TVR if patient is symptomatic.

Bumetanide/torsemide is preferred over lasix for bowel edema specifically.

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9
Q

What is the typical cause of tricuspid regurg?

A
  • Dilation of the RV and tricuspid annulus
  • RV dilation is caused by pulmonary HTN, LV failure, PV stenosis, severe PVR, cardiomyopathy, and sarcoidosis

TV annulus is saddle-shaped, resulting in it becoming elliptical as the RV fails/dilates.
I imagine it getting stretched wide

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10
Q

What is the difference between the papillary muscles and chordae tendinae of the TV vs the MV?

A
  • TV has smaller papillary muscles and less chordae tendinae.
  • MV is more able to handle increased pressure.
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11
Q

How does TR typically present?

A
  • If pulmonary HTN is not present, compensates well.
  • With pulmonary HTN, fatigue, ascites, and peripheral edema are common.

R sided HF is known as cor pulmonale.

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12
Q

How does a murmur present for tricuspid regurg?

A
  • High-pitched, holosystolic at left sternal border
  • Accentuated by inspiration OR leg-raising.

Leg-raising increases venous return

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13
Q

How is TR managed?

A
  • Treat underlying cause and RHF symptoms.
  • Repair for pts with persistent symptoms.
  • Replacement for underlying leaflet pathology. (No AC if no Afib)

RHF is a low-pressure symptom, so it generally doesn’t cause severe symptoms.

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14
Q

What is the typical etiology of pulmonic stenosis?

A
  • PS is most commonly an isolated, congenital defect.

Fusion of pulmonary leaflets leading to RVH.

Rarely caused by rheumatic disease.
Purely stenosis = isolated

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15
Q

What are the two genetic syndromes that usually cause PS?

A
  • Noonan syndrome
  • Trisomy 13

These syndromes often present with a myriad of deformities.

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16
Q

What is the typical presentation of PS due to a congenital abnormality? Due to other causes?

A
  • Congenital is usually severe PS and presents with severe cyanosis on birth.
  • Other causes often result in mild-mod PS and present asymptomatically.
17
Q

What PE findings are typical of PS?

A
  • Systolic ejection murmur best heard at left upper sternal border.
  • Increases with inspiration
  • Radiates to left shoulder
  • S1 followed by opening click that is LOUD on expiration.
  • RV lift on palpation of precordium.
18
Q

How is mild PS managed? Mod? Mod-Sev?

A
  • Mild: Asymptomatic, no intervention.
  • Mod: symptomatic requires balloon valvuloplasty or replacement.
  • Mod-Severe: Balloon valvuloplasty or replacement.
19
Q

What typically causes pulmonic regurg?

A
  • Dilation of the PV annulus 2/2 pulmonary HTN
20
Q

Describe the murmur of pulmonic regurg.

A
  • Diastolic
  • High-pitched
  • Blowing quality
  • Best heard at 2nd left ICS.
21
Q

What secondary diagnostic studies can help with suspected pulmonic regurgitation?

A
  • Cardiac MRI
  • CT Chest
22
Q

What is the most likely EKG finding for pulmonary regurgitation?

A

RBBB

23
Q

When is PV replacement indicated for pulmonic regurg?

A

Intractable RV failure.

Low-pressure system, so symptoms arent as common.

24
Q

What are the benefits and cons of a mechanical valve?

A
  • Extremely durable.
  • However, high thromboembolic risk and requires lifelong anticoagulation.

Can only use warfarin!!!!!!!! 2.5-3.5 INR

Normal INR for something like a DVT is 2-3.

25
Q

What are the pros and cons of a prosthetic valve?

A
  • 10 year duration usually.
  • Lower risk for thromboembolic risk.
  • Usually only uses baby asa for AC.

Less management/AC, but may require replacement in the future.

26
Q

What is the most common cause of acute rheumatic fever?

A

GABHS

27
Q

How does RHD typically occur?

A

Child with a recent strep infection 2-4 weeks ago and had an abnormal immunologic reaction.

Takes time between infection and development of vegetation.

28
Q

When does acute rheumatic fever tend to occur age-wise?

A

4-9.

29
Q

What is the pathophysiology of RHD?

A
  • Pancarditis (diffuse inflammation)
  • Exudative pericarditis
  • Lymphocytic infiltration of myocardial tissue. (may also result in necrosis)
30
Q

What is the hallmark histiologic finding of RHD?

A

Aschoff body from the myocardium.

Collection of myocytes and macrophages surrounded by fibrous tissue.

31
Q

What characterizes valvulitis and what valve is most commonly affected?

A
  • Verrucous lesions on leaflet edge.
  • MV is most commonly affected, then AV.
32
Q

What are the major criteria for Jones Criteria?

A
  1. Carditis
  2. Polyarthritis (joint pain)
  3. Chorea (movement disorder)
  4. Erythema marginatum (rash)
  5. Subcutaneous nodules

J O N E S
J = Joints
O = heart (carditis)
N = nodules
E = erythema marginatum
S = sydenham chorea (sudden chorea)

33
Q

What are the minor criteria for Jones criteria?

A
  • Fever (38C or 100.4F)
  • Arthritis
  • Previous rheumatic fever or known RHD.

CAFE PAL
C = CRP inc
A = Arthralgia
F = Fever
E = Elevated ESR
P = Prolonged PR Interval
A = Anamnesis of Rheumatism
L = Leukocytosis

34
Q

What is diagnostic for Jones criteria?

A
  • 2 Major
  • OR
  • 1 Major + 2 minor
  • AND
  • Must have evidence of recent GABHS infection (for both)

To fully confirm, need echo as well.

Echo must demonstrate both morphological valvular involvement of MV +/- AV and doppler for pathologic valve regurg.

35
Q

What is carditis?

A
  • Pleuritic chest pain
  • Friction rub
  • HF
36
Q

How is RHD treated?

A
  1. PCN for strep infection.
  2. Salicylates for fever and arthritis (Minor)

Salicylates include aspirin usually.

37
Q

How long is RHD prophylaxis?

A
  • up to 10 years
  • PCN G 1.2mil units IM monthly
  • Oral PCN or erythromycin.

If RHD has appeared once, recurrence is common, so prophylaxis is needed.

CV <3 (25 decks)

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