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Cardio > MTB 3 > Flashcards

MTB 3 Flashcards

1
Q

MCC Mitral Stenosis

A

Rheumatic Fever

MC in young adults

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2
Q

When do we treat Mitral Stenosis

A

Symptomatic

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3
Q

Pregnant and Immigrant - Valvular dz?

A

Mitral Stenosis

Pregnancy - 50% increase in plasma volume

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4
Q

Presentation of Mitral Stenosis

A 
SOB/Dyspnea/Orthopnea
CHF
Dysphagia- Esophagus
Hoarseness - Laryngeal N
A fib/Stroke
Hemoptysis
Right sided HF
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5
Q

Presentation of Right sided HF

A

Hepatomegaly
Ascites
Peripheral Edema

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6
Q

Murmur with Mitral Stenosis

A

Diastole right after opening snap
Loud S1 = MV opens when ventricle contracts, slams the valve shut
Opening Snap = MV opening after S1

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7
Q

What increases the intensity of Mitral Stenosis

A

Squatting
Leg raising
Increased venous return to the heart

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8
Q

Best initial test for Mitral Stenosis

A

TTE

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9
Q

Most accurate test for Mitral Stenosis

A

Catheterization

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10
Q

EKG of Mitral Stenosis

A

A fib very common

LA Hypertrophy = biphasic P wave in V1 and V2

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11
Q

CXR of Mitral Stenosis

A

LA Hypertrophy

  • Straightening of left heart border
  • Elevation of left main-stem bronchus
  • Second bubble behind heart
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12
Q

TX for Hypertrophy

A
  1. Diuretics + Sodium restriction if fluid overload in lungs
  2. Balloon Valvuloplasty done with catheter
  3. Valve replacement if catheter cannot be done
  4. Warfarin for A fib
  5. Rate control of a fib
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13
Q

AE of Diuretics in pregnancy

A

IUGR

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14
Q

Causes of Aortic Stenosis

A

Congenital bicuspid valve

Calcifications with aging

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15
Q

Pathophys of Calcifications in Aortic Stenosis

A

Calcium leaves bones and enters aorta

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16
Q

Presentation of Aortic Stenosis

A 
Angina = MC 
Syncope
CHF 
Pulsus tardus et parvus
Carotid thrill
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17
Q

What is Pulsus tardus et parvus

A

Pulse that is small and late

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18
Q

TX for Aortic Stenosis

A 
If SAD (Syncope, Angina, Dyspnea) = Valve replacement
No good medical TX
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19
Q

Test for Aortic Stenosis

A

TTE
TEE
Catherization

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20
Q

Murmur of Aortic Stenosis

A 
Systolic 
Crescendo-decrescendo 
Peaks mid-systole
Heart best at 2nd right IC space
Radiates to Carotid
Valsalva/standing - decrease murmur/improve
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21
Q

Why does Valsalva/standing decrease or improve murmur in Aortic Stenosis

A

Decreased venous return to heart

22
Q

What softens murmur of Aortic Stenosis

A

Handgrip b/c of decreased ejection of blood

23
Q

What is carotid thrill

A

Palpable vibration of murmur

24
Q

EKG of Aortic Stenosis

A

LVH

S wave in V1 + R wave in V5

25
Q

How long will stenotic valve survive

A

12-24 months

26
Q

Causes of Mitral Regurgitation

A

HTN
Endocarditis
MI w Papillary muscle rupture
Any cause of heart dilation

27
Q

Presentation of Mitral Regurgitation

A

CHF sx’s - distended neck veins

28
Q

Murmur of Mitral Regurgitation

A

Holosystolic - obscure both S1 and S2
Best heard along sternal border
Radiates to Axilla

29
Q

What worsens murmur of Mitral Regurgitation

A

Handgrip pushes more blood backwards through the valve

Squatting and leg raising -increase venous return to heart

30
Q

Handgrip worsens which murmurs

Impact on preload/afterload

A

MR
AR
Handgrip increases afterload

31
Q

Valsalva and standing do what to blood flow

A

Decrease venous return to heart

32
Q

Squatting and leg raising do what to blood flow

A

Increase venous return to heart

33
Q

Do all left sided murmurs increase w expiration

A

No

NOT HOCM + MVP

34
Q

If the EF is < 60%, what does this mean for LV?

Management?

A

LV End systolic Diameter (LVESD) is > 40 mm
Unable to empty ventricle
Replace or repair valve before dilates more

35
Q

EKG for Mitral Regurgitation

A

LVH and LA Enlargement

36
Q

Echo for Mitral Regurgitation

A

LA and/or LV Dilatation

37
Q

TX for Mitral Regurgitation

A 
1. Vasodilators - ACE, ARBs = BEST.  Increase EF
Hydralazine if can't tolerate. 
2. Digoxin, diuretics
3. Valve Replacement - symptomatic pt.
ASAP when heart starts to dilate
If LVESD > 40 mm OR EF < 60%
38
Q

Causes of Aortic Regurgitation

A 
Heart of Aorta Dilated
MI 
HTN
Endocarditis
Marfan
Cystic Medial Necrosis 
Inflammatory Dz - Ankylosing Spondylitis, Reiter
Syphilis - Tertiary
39
Q

Presentation of Aortic Regurgitation

A 
CHF Si/Sx's
Wide pulse pressure
Water-hammer pulse (wide, bounding) pulse
Quincke pulse (pulsations in nail bed) 
Hill sign (BP in legs > arm BP) 
Head bobbing (de Musset sign)
40
Q

Murmur of Aortic Regurgitation

A

Diastolic
Decrescendo
Heard best at lower left sternal border
Duzoziez sign - S/D thrill/murmur over Femoral Area

41
Q

Diagnostic test for Aortic Regurgitation

A

Echo - TTE, TEE

Catheterization

42
Q

TX for Aortic Regurgitation

A
  1. ACEi/ARBs, Nifedipine as Vasodilators - increase forward flow and delay progression
  2. Digoxin, diuretics - little benefit
  3. Valve replacement if acute valve rupture
    - EF < 55% or LVESD > 55mm
43
Q

What improves murmur of Aortic Regurgitation

A

Valsalva and standing

44
Q

What worsens murmur of Aortic Regurgitation

A

Handgrip increase afterload, compressing arteries of the arms

45
Q

What is PPX for Endocarditis

A

Amoxicillin

Clindamycin

46
Q

MVP causes

A

Anatomic variant - esp women
Marfan
Ehlers-Danlos
Myxamatous degeneration of MV leaflets/chordae

47
Q

Presentation of MVP

A 
Asymptomatic 
When Sx's
- CHF sx's ABSENT
- Atypical chest pain
- Palpitations
- Panic Attack
48
Q

Murmur of MVP
Worse w?
Improved w?

A

Midsystolic click
Valsalva and standing Worsen
Squatting and handgrip Improve

49
Q

What can MVP progress to

A

Endocarditis
Arrhythmias
Valve Calcifications
TIAs

50
Q

TX for MVP

A
  1. Beta blockers when symptomatic for pain, palpitations, panic attack
  2. Valve repair w catheter - place clip to tighten
51
Q

Is endocarditis PPX needed for MVP

A

Not recommended

Cardio (6 decks)

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