Mumurs And Valve Disease and Anti Arrhythmia Drugs Flashcards
What are 4 common symptoms of Valve disease and which one is most common?
Dyspnea on exertion (most common), angina, syncope and palpitations.
As far as etiology, what are the 3 most common conditions encountered today and what valve problem does it lead to?
- Degenerative process like calcification. Just happens with age. Aortic calcification.
- Myxomatous degeneration in Mitral Valve Prolapse
- Congenital issues like bicuspid aortic valve.
What 3 things are we thinking as to the patho behind a valve issue?
Pressure overload, volume overload, or a specific disease process like an infection or heart failure.
What is the jones major criteria for RHD?
J: joints involved O: myOcarditis N: Nodules that are subcutaneous E: Erythema marginatum S: Syndenhams Chorea
What are the minor criteria for RHD? What is the mnemonic?
C: CRP increased A: Arthralgia F: Fever E: Elevated ESR and ASO titer or anti DNAse B P: Prolonged PR A: medical history of rhumatism L: leukocytosis
What is the criteria to diagnose RHD?
2 major criteria or
1 major and 2 minor
RF is virtually the only cause of what?
Acquired MS
5 common symptoms of a patient with Mitral Stenosis?
Exertional Dyspnea, Fatigue with low CO, cough orthopnea, PHT and RHF with edema.
What age does the typical patient with MS present with?
4th decade
What is the syndrome associated with MS and explain whats going on?
Ortner syndrome. Hoarseness because of compression of the left recurrent laryngeal nerve.
3 physical exam findings for MS?
Malar rash or blue face
Increased s1
Opening snap after s2.
How do we describe what we hear when listening to a MS murmur?
Low frequency that starts at the opening snap and decreases in volume. During diastole. Starts back up again right before S1 during atrial contraction.
What is the best way to hear the MS murmur?
Use bell, have patient lay left lateral decubitus position and listen at the apex.
When do you use anticoagulant for MS?
If there is Afib. Don’t want to have an embolism.
What is the most common etiology of chronic MR?
MVP, so myxomatous degeneration
3 common causes of Acute MR?
Rupture of Chordae tendinae, rupture of pap muscle, or IE.
Big picture, what is the problem going on with acute MR?
Got to think forwards and backwards. LA pressure is jacked up and then there isn’t enough blood getting through the heart to pump for the body.
What is going on with the symptoms of MR?
Can be asymptomatic for years, but then you can appreciate LA dilation and backing up to the right side of heart.
What kind of murmur is MR?
Holosystolic
Where is MR best heart and what part of the stethoscope is used?
Apex and diaphragm
Where does MR murmur radiate?
Left axilla
What happens to s1 during MR murmur?
Decreased or normal
When do cardiac troponin levels increase, when do they hit peak levels after MI, how long are they typically elevated for?
They elevate in 4-6 hours and peak at 8-12 hours. 5-7 days.
What are the same levels for CK-MB?
Rise in 4-8 hours, peak at 24 hours and return in 48-72 hours.
3 symptoms of MVP?
Asymptomatic to arrhythmias, chest pain, and syncope
What type of murmur is MVP?
Systolic
What is a state you can find your patient in with MVP?
Hyper adrenergic state because of anxiety or palpitations
What is a “click” and why would you have a systolic click with MVP?
A click is abnormal closure of a valve, so you would have a systolic click with MVP because the valves, which prolapsed during systole, are closing.
Top 3 causes of AS?
Calcification due to age, Rheumatic, and radiation scarring
4 symptoms of AS?
Exertional dyspnea, angina, syncope and CHF.
What happens with pulse pressure, SV, and systolic pressure in a patient with AS?
Pulse pressure becomes more narrow, SV and systolic pressure decrease.
What’s going on with pulses and AS?
Either have parvis pulses which are weka and decreased due to CO drop or tarsus pulses which are delayed and decreased as you go up the carotid.
What kind of murmur is AS and where do you best hear it and where can it radiate to?
Harsh systolic murmur. Right 2nd intercostal space. Radiates into carotid.
What is the gallavardin phenomenon?
Murmur radiates to the apex like MR
2 causes of acute AR?
IE and dissection
5 causes of chronic AR?
Syphilis, calcification, aortic dilation, ankylosing spondylitis, RF
What is the main pathophysiology of AR?
Volume overload starting in left side of heart and working backwards.