PANCE Cardiology #4 Murmurs, pericarditis

Question 1

MCC of Mitral stenosis

Answer 1

rheumatic fever,

pregnancy from increase 50% in plasma volume

Question 2

MS sx’s, name 6

Answer 2

DYSPNEA, orthopnea, PND, fatigue, hemptysis, systemic embolisum, hoarseness and dysphagia (because the left atrium is resting on the esophagus and compressing the recurrent laryngial nerve)

Question 3

unique sx’s of Mitral stenosis?, think “big”3
and 4 others
Whats the biggest risk of MS?

Answer 3

BIG left atrium ,chf, 
big liver= hepatomegaly
big stomach= ascites
loud S1,
Opening snap after S2 (unique)
rumbling murmur
decreased pulse pressure.
A-FIB!!!!!!

Question 4

Which sx’s are associated with all valvular lesions?

Answer 4

Dyspnea, rales, CHF, TIA’s, stroke

Question 5

Mitral stenosis tests?

Answer 5

EKG= RVH and A-fib
chest x-ray= straightening of left heart border (enlarged left atrium)
-lifting of left main stem bronchus( enlargement of left atrium)
-Echocardiogram=thickened mitral leaflets

Question 6

mitral stenosis tx?
will ace inhibitors help?
will digoxin help?
whats a contra for diuretics?
what about digitalis and anti-coagulants?

Answer 6

PRE-load reduction= Na+ restriction + diuretic
-ace inhibitors are for vent emptying
digoxin help vent emptying
(diuretics are contra-indicated in pregnancy)
dig and anti-coag if pt in A-fib

Question 7

Is their a mitral stenosis surgical tx?

Answer 7

balloon valvuloplasty

Question 8

mitral regurg is a result from?

whats the MCC?

Answer 8

dilation, with ischemia think dilation

ischemic HD

Question 9

physical exam findings? 4 things

whats the difference between pansystolic and holo-systolic?

Answer 9

displaced apical impulse
murmur radiates to axilla
distended neck veins
split S2
2) nothing

Question 10

Whats the initial test fro all valvular heart disease?

Whats the most accurate test?

Answer 10

echocardiogram

cardiac catheterization

Question 11

Whats the common EKG and chest x ray?

Answer 11

LVH + LA enlargement
cardiac enlargement (all valvular heart dz)

Question 12

Single most effective therapy for mitral regurg?

Answer 12

vasodialators, ace/arb, (pt with cough) Hydralozine

then digitalis, diuretic,

Question 13

MCC of mitral valve prolapse?

What is the classic presenting sx’s (anunciate)

Answer 13

congenital valvular lesion, pts w/connective tissue dz

-chest PAIN, PALPITATIONS, sycoPE, PANIC attacks in young females.

Question 14

physical exam findings (unique)

squating and leg raise will?

Answer 14

mid-systolic click
worsens WITH valsalva manuever or standing( less blood in heart) that would decrease blood to heart.
-increase blood to the heart( mitral prolapse is opposite)
These manuvuers are developed to differentiate MVP from MR

Question 15

MVP is the MCC risk factor for?

Answer 15

bact endocarditis

Question 16

Whats the best tx?

do you need to give profylxes for endocarditis?

Answer 16

beta blockers for chest pain/arrhythmia

-only if murmur is present. what type jason?

Question 17

MCC of aortic stenosis?

Answer 17

Age. Ca+ leaves the bones as we age

Question 18

there are 3 big problems aortic stenosis can cause
which is most dangerous
which is MC

Answer 18

syncope
angina-MC
CHF- most serious

Question 19

physical exam findings with aortic stenosis

Answer 19

carotid thrill (palpatory vibratory murmur)
Pulses tardus st parvous (small late pulse)
S4 gallop (from LVH)

Question 20

ekg, chest x-ray, echo for aortic stenosis

Answer 20

LVH,
cardiomegaly, calcifications
thick aortic valve

Question 21

tx? for aortic stenosis

surgery?

Answer 21

none

this is a surgical dz= valve replacement