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MED233 Cardiovascular > PMT, Johnston - Valvular Heart Disease > Flashcards

PMT, Johnston - Valvular Heart Disease Flashcards

1
Q

What are the three most common VHD conditions found?

A

1) Degenerative - (progressive) senile calcification
2) Myxomatous degeneration - MVP
3) Congenital - bicuspid AV

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2
Q

Regurg v. stenosis

A
  • Regurg - failure to close adequately (vol overload, dilation). AR, MR.
  • Stenosis - failure to open fully. Impedes forward flow. AS MS.
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3
Q

RHD - cause and criteria

A

Group A strep

2 major criteria or 1 major/2minor - Jones Criteria

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4
Q

Jones Major criteria

A 
Joint - migratory polyarthritis
Carditis
Nodules (subq)
Erythemous Marginatum
Syndham chorea
(Minor: fever, arthralgia, CRP or sed rate, leukocytosis, prolonged PRi, elevated ASO)
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5
Q

MS - what is it?

A

Narrowing leading to pulm HTN and RVF

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6
Q

4th decade
DOE, cough, orthopnea, PND, pulm edema, hemoptysis, arterial emboli, Afib.
Ortner syndrome

A

MS Symptoms

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7
Q

What is Ortner syndrome?

A

As LA enlarges due to MS, compression of Left recurrent laryngeal nerve = HOARSENESS, indicative of MS.

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8
Q

See: Malar rash
Hear: increase S1, opening snap after S2. Rumbling, diastolic MURMUR, low pitch at apex - use bell.

A

MS PE

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9
Q

MS tx (esp if in afib)

A

Anticoagulation therapy if in afib!!

Balloon valvuloplasty MVReplacement

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10
Q

If a person has MS, why do they develop progressive symptoms, leading to RV-Failure?

A

pressure b/u in LA&raquo_space; pulm edema&raquo_space; r side involvement

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11
Q

MS looks like what on ECG? What other tests are indicative of MS?

A

afib
LAE - see straight left heart broder on chest xray

Indicative of MS due to RF

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12
Q

**Causes of Mitral Regurgitation (MR): Chronic and Acute

A
  • Acute: rupture of chordal tendineae, rupture of papillary muscle, ischemic papillary muscle dysfunction, IE, valve perforation.
  • Chronic: MVP (most common), Mitral Annular Calcification
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13
Q

Left straight heart border indicative what?

A

LAE (possibly due to MS)

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14
Q

MR s/s

Immediately apparent?

A
  • Inc LA pressure abruptly.
  • Pulmonary edema, LVF.

**ASYMPTOMATIC FOR YEARS&raquo_space; fatigue, DOE. Then ACUTE onset of orthopnea, PND, RHF/LHF, volume overload.

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15
Q

MS v. MR murmur (murmur and s1)

A
  • MS = DIASTOLIC rumbling murmur, low pitch at apex. Increased S1, opening snap after S2.
  • MR = SYSTOLIC murmur at apex, radiating to left axilla (correlates with severity of disease). Decreased S1 w/ systolic click.
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16
Q

Tx of MR (3)

A

Vasodilator - afterload reduction
Decrease resistance to flow
ACEi - chronic MR

17
Q

MVP - what sex predominant, what is it, what happens during it?

A

F>M 7:1
Associated with Marfans
Mitral leaflets prolapse into LA during systole to cause MR.

18
Q

What are s/s of MVP?

Tx hyper-adrenergic state with what (i.e. if pt has MVP and thyroid disorder)?

A
  • Asymptomatic to arrhythmias, chest pain, syncope
  • Systolic murmur (may have systolic click)
  • Tx with BB (for anxiety and palpitations)
19
Q

Etiology of AS

A

Degenerative (calcific or senile)
Congenital bicuspid aortic valve
Rheumatic or post inflammatory scarring

20
Q

AoV Area in normal aortic valve v. in AS

A

Normal is 4square cm.

Severe AS if AoV is less than 1square cm.

21
Q

** exertional DYSPNEA, ANGINA, SYNCOPE, HF **

A

AS s/s

22
Q
  • Narrowed Pulse Pressure
  • Delayed pulses - Parvis/Tardus
  • Harsh systolic murmur, 2nd ICS RSB, radiates to supra sternal notch/carotids.
  • Gallavardin phenomenon (murmur)
A

AS PE

23
Q

Pulse pressure: AI v. AS

A 
AI = wide pp
AS = narrow pp
24
Q

What is Gallavardin phenomenon and what is it associated with?

A

Associate with AS.

When the murmur radiates to the apex.

25
Q

Tx of AS

A

percutanous balloon valvuloplasty - temporary AVReplaecemmt

26
Q

Aortic Regurgitation (AR) is due to what and caused by what?

A

Due to leaf abnormalities (bicuspid AoV, IE)
Due to aortic root abnormalities (Marfans, aortic dissection, HTN, aging).
Caused by acute AR: IE, aortic dissection, BAV
Caused by chronic AR - syphilis, ankylosing spolylitis

27
Q

What type of murmur can mimic MS?

A

Austin Flint murmur - the blood can hit the anterior leaflet of the MV and the MV won’t open as well as it should. Looks and sounds like MS.

28
Q

PE of AR

A

Wide pulse pressure

  • Quincke’s pulse - blanching, flushing of nailbed as blood flow goes in and out.
  • De Musset sign - head bobbing
  • Durozrey’s Sing - to and fro murmur over femoral artery
  • Hill’s sign - BP higher in legs than arms
  • Bisferious pulse - double notch to systolic flow (bifid pulse)
  • See slide 83 for other signs

Hear: Diastolic, decrescendo murmur, 3rd ICS LSB. Soft systolic murmur may be present.

29
Q

Tx of AR

A

ARB - decrease afterload to dec regurg volume

Surgery for AoV Regurg when symptomatic or EF less than 55%.

30
Q

Tricuspid Stenosis (TS) is associated with what three things?

A

MS, TR, RHD

31
Q

What indicates TS? (ECG and PE)

A

ECG: Prominent “A” wave in JVP ascites
PE: (Possible) Pulsatile hepatomegalia, Carvallo’s sign, Diastolic murmur LSB that increases with inspiration (Carvallo’s sign) and decreases with expiration.

32
Q

Tricuspid Regurgitation (TR) is associated with what three things?

A

pulmonary HTN, inferior MI, RV infarction

33
Q

What indicates TR? (ECG and PE)

A

ECG: Prominent “V” wave in JVP
PE: blowing systolic murmur LSB; increase with inspiration (Carvallo’s sign).

34
Q

Pulmonary stenosis (PS) - PE

A

Systolic murmur with ejection click.
2nd-3rd ICS, LSB/radiates to left shoulder and increases on inspiration. RVH
Can cause angina and syncope.
Tx: if >50mmHg, then balloon commissurotomy

35
Q

Pulmonary Regurgitation (PR or PI) - PE

A

Blowing diastolic murmur 2SB (Graham Steell).

Most cases are due to pulmonary HTN

36
Q

What has systolic murmurs?

A

MR, TR
AS, PS (ejection click)
VSD
Aortopulmonary shints

37
Q

What has diastolic murmurs?

A

AR, PR (blowing, Graham Steell)
MS, TS (LSB, Carvallo)
Atrial Myxoma

38
Q

Continuous murmurs

A

PDA-machinery (neonatal)
AV fistula
ASD with high LA pressure
Coarctation

MED233 Cardiovascular (18 decks)

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