Pericarditis and valvular disorders Flashcards

1
Q

Most common CV manifestation associated w/ SLE

A

Pericarditis

Characterized by sharp pleuritic chest pain that is relieved by sitting up and leaning forward

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2
Q

Most common type of pericarditis

A

Fibrinous pericarditis

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3
Q

Common causes of fibrinous pericarditis

A
  1. Viral infection
  2. Myocardial infarction
  3. Uremia
  4. Rheumatologic disease (i.e. SLE/RA)
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4
Q

Most common cause of acute pericarditis

A

Viral infection

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5
Q

C wave of venous pressure

A

Occurs due to RV contraction against a closed tricuspid valve, which buldes into the right atrium

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6
Q

A 33-year-old woman with a history of systemic lupus erythematosus presents with the sudden development of fever and anterior chest pain (the pain is worse when lying down and improved by sitting up). Physical examination finds a triphasic scratchy heart sound of varying intensity located over the lower left sternal border. What is the most likely cause of these clinical findings?

A

Pericarditis

Fibrinous pericarditis, which is the most common type of pericarditis, is characterized by pleuritic chest pain and a triphasic friction rub. Pericarditis, which is the most common cardiovascular manifestation associated with systemic lupus erythematosus, presents with sharp pleuritic chest pain that is relieved by sitting up and leaning forward.

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7
Q

Signs of constrictive pericarditis include:

A
  1. Pulsus paradoxus
  2. Pericardial knock
  3. JVD on inspiration (Kussmaul sign)
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8
Q

Beck’s triad

A
  1. Muffled heart sounds
  2. Hypotension
  3. JVD

Signs of cardiac tamponade

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9
Q

A 71-year-old woman presents with increasing chest pain and occasional syncopal episodes (especially with physical exertion). She has trouble breathing at night and when she lays down. Physical examination reveals a crescendo-decrescendo midsystolic ejection murmur with a paradoxically split S2. Pressure studies reveal that the LV pressure during systole is markedly greater than the aortic pressure. What is the best diagnosis?

A

Aortic stenosis

Aortic stenosis, which is characterized by a crescendo-decrescendo murmur that has a paradoxically split S2 best heard at the right upper sternal border (right second parasternal intercostal space) with radiation to the carotid arteries (sounds like bruits), may cause symptoms (eg, dyspnea on exertion, presyncope) due to restriction of cardiac output.

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10
Q

What is the most likely cause of aortic stenosis that developed in a 79-year-old woman?

A

Dystrophic calcification

Age-related calcific degeneration of a normal tri-leaflet aortic valve (dystrophic calcification) is the most common cause of aortic stenosis in developed countries, typically affecting patients older than 70.

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11
Q

A 55-year-old man presents with bobbing of his head and signs of congestive heart failure. Physical examination finds a hyperdynamic (water-hammer) bounding pulse. Physical examination finds a murmur that is loudest just after closure of the aortic valve. Which of the listed abnormalities is most likely the cause of these findings?

A

Aortic regurgitation

Aortic regurgitation is characterized by bounding peripheral pulses and head bobbing. Aortic regurgitation causes a decrescendo diastolic murmur with maximal intensity occurring just after closure of the aortic valve, when the pressure gradient between the aorta and left ventricle is the highest.

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12
Q

A 54-year-old woman presents with exertional dyspnea, dysphagia and hoarseness. A lateral projection of a barium swallow finds that the anterior wall of the esophagus is compressed by an enlarged structure immediately anterior to it, which is noted to be a dilated left atrium. What is the most common cause of this individual’s cardiac valvular disease?

A

Chronic rheumatic fever

Hoarseness with mitral stenosis (Ortner syndrome) is caused by extrinsic impingement of the recurrent laryngeal nerve by the enlarged left atrium, which can also press on the esophagus causing dysphagia. Chronic rheumatic fever is the most common cause of mitral stenosis, which is characterized by fibrosis of the mitral valve.

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13
Q

Describe the murmur of severe mitral regurgitation

A

High-pitched holosystolic murmur heard best over the apex with radiation to the axilla

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14
Q

Which one of the following is the most common underlying cause of mitral valve prolapse, which is characterized by a midsystolic click followed by a systolic murmur at the cardiac apex?

A

Dermatan sulfate deposition in the mitral valve leaflets is characteristic of myxomatous degeneration of the mitral valve in mitral valve prolapse

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15
Q

Murmur of aortic regurgitation

A

Aortic regurgitation causes a decrescendo diastolic murmur with maximal intensity occurring just after closure of the aortic valve, when the pressure gradient between the aorta and left ventricle is the highest.

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16
Q

Murmur of aortic stenosis

A

crescendo-decrescendo murmur that has a paradoxically split S2 best heard at the right upper sternal border (right second parasternal intercostal space) with radiation to the carotid arteries (sounds like bruits)

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17
Q
A
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18
Q
A
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19
Q

Key differences between cardiac tamponade and constrictive pericarditis

A
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20
Q

JVD in pericarditis vs. tamponade

A
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21
Q

Pulsus paradoxus

A

> 10 mmHg drop in systolic BP during inspiration

Observed in pathologies such as severe asthma, tension pneumothorax, constrictive pericarditis, and moderate to severe cardiac tamponade - outward expansion of the RV is limited as blood flows during inspiration

22
Q

Pathenogensis of dystrophic calcification seen in aortic stenosis

23
Q

Erb’s point

A

Left sternal border in the third intercostal space

24
Q

Pulsus parvus et tardus

A

Parvus The pulse has a small volume
Tardus The pulse has a delayed peak

So the pulse is week and peak is delayed

Seen in Pt’s w/ aortic steonsis - harsh crescendo-decrescendo laste systolic ejection murmur

25
Q

S2 splitting

26
Q

Potential symptom manifestations of left atrium hypertrophy

A

Dysphagia and hoarsness

Enlarged LA compressed left recurrent laryngeal nerve and esophagus

27
Q

Actions to assess murmurs

28
Q

Conditions associated w/ mitral valve prolapse

29
Q

Blowing, diastolic murmur heard best at the Erb poin

A

Aortic regurgitation

31
Q

High-frequency, diastolic murmur heard best at the second left intercostal space

A

Pulmonary regurgitation

32
Q

Harsh, late systolic murmur that radiates to the carotids

A

Aortic stenosis

33
Q
A

Mitral stenosis

34
Q
A

Aortic stenosis

36
Q

S3 heart sound is associated with what diseases

A
  1. CHF
  2. Aortic or mitral regurgitation
37
Q

S4 heart sound is associated w/ what diseases

A
  1. HOCM
  2. Essential hypertension
  3. Aortic stenosis

Due to concentric left ventricular hypertrophy

38
Q

Cause of loud P2

A

Pulmonary hypertension

39
Q

What is cause of a crescendo0decrescendo systolic murmur with paradoxically split S2 heard best at RUSB

A

Aortic stenosis

40
Q

Cause of systolic ejection murmur heard at the left second parasternal intercostal space (may radiate to neck) with a widely split S2 that varies with breathing (not fixed) but the murmur does not increase with breathing

A

Pulmonic stenosis

No increase with breathing because low pressure of RB can’t overcome stenosis

41
Q

Cause of diastolic decrescendo murmur heard at the left second parasternal intercostal space that increases with inspiration

A

Pulmonic regurgitation

43
Q

Cause of decrescendo diastolic murmur heard best at left third parasternal intercostal space at left sternal border

A

Aortic regurgitation

44
Q

Sitting up and leaning forward increases the second heart sound and the murmru of what valvular disocrder

A

Aortic regurgitation

45
Q

Cause of holosystolic murmur heard at fourth intercostal space at left sternal border that does nto change with respiration

46
Q

Causes of mid-diastolic murmur with opening snap heard best at the apex?

A

Mitral stenosis

48
Q

Cuase of high-pitched blowing holosystolic murmur heard best over the apex with radiation to the axilla

A

Mitral regurgitation

49
Q

Cause of high-frequency mid-systolic click followed by late systolic murmur that is heard best at apex

A

Mitral valve prolapse

50
Q

What is a low-frequency, late diastolic sound that immediately precedes S1, caused by blood striking a stiffened ventricular wall during atrial contraction?

51
Q

Myxomatous degeneration

A

Mitral valve prolapse is most often caused by defects in connective tissue proteins that predispose to myxomatous degeneration of the mitral leaflets and chordae tendineae.

Myxomatous degeneration occurs when there’s a buildup of mucopolysaccharides, a type of sugar molecule, in the heart valve tissue.