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Cardio > Valve Abnormalities > Flashcards

Valve Abnormalities Flashcards

1
Q

Systolic Murmurs

A

Mitral Regurg

Aortic Stenosis

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2
Q

Diastolic Murmurs

A

Mitral Stenosis

Aortic Regurg

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3
Q

Describe pressure and volume changes as they pertain to Mitral regurgitation

A

LV pressure is decreased

LV Volume is INCREASED

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4
Q

Auscultatory sounds of MR

A

Holosysystolic murmur: loudest at the apex and radiates to the axilla

Present S3

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5
Q

Causes of Mitral regurgitation

A

Ruptured papillary muscle in MI

Rheumatic heart disease

Mitral valve prolapse

infective endocarditis

dilated cardiomyopathy

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6
Q

What is the best indicator o the severity of MR

A

audible S3

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7
Q

Auscultatory findings of MVP

A

Mid systolic click followed by a mid-late systolic murmur

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8
Q

Compare and contrast the changes in Acute, chronic and decompensated chronic MR as it pertains to:

preload:

afterload:

contractile function:

Ejection Fraction

forward stroke volume

A

Preload: All increased, most in acute MR

Afterload: Acute (decreased), Chronic (no change), Chronic Decompensated:(increased)

Contractile function: only chronic decompensated MR changes (decreased)

Ejection Fraction: Only decompensated MR decreases

Forward Stroke volume: Acute and decompensated decrease, chronic MR doesnt change

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9
Q

Another name for MVP

A

Myxomatous Degeneration of the Mitral Valve

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10
Q

Describe pressure and volume changes as they pertain to Aortic Stenosis

A

Describe pressure and volume changes as they pertain to LVEDP and LVEDV

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11
Q

Auscultatory sounds of Aortic Stenosis

A

Harsh Crescendo-decrescendo systolic ejection murmur

loudest at the R upper sternal border with radiation to the carotids, down the left sternal border and the apex

S4

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12
Q

Causes of Aortic Stenosis

A

senile degeneration/ calcification

Bicuspid/ Hypertrophic Aortic Valve

Rheumatic Endocarditis

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13
Q

signs of fixed LV obstruction in Aortic Stenosis

A

weakened parvus and delayed tardus upstroke of the carotid

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14
Q

what causes the S4 in Aortic Stenosis

A

Atrial contraction into the still LV

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15
Q

Morphology of Aortic Stenosis

A

calcified valvular degeneration with nodular masses of calcium within the sinuses of the Valsalva fibrosa of the outflow surface

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16
Q

Morphological differences between calcific aortic stenosis and congenital bicuspid aortic valve

A

Senile type: mounded calcified masses within the aortic cusps that ultimately protrude through te outflow surfaces into the sinuses of Valsava

Congenital Type: only 2 functional cusps f the valve, usually unequal in size with the larger having a midline raphe where calcified masses attach

17
Q

Complications/ Associations of Senile Aortic Stenosis

A

Cardiac decompensation

CHF

18
Q

Complications/ Associations of Congenital Bicuspid aortic valve

A

Aortic Stenosis

Aortic regurg

infective endocarditis

aortic dissection

Associated with loss of function mutations to NOTCH of chromosome 9

19
Q

Describe pressure and volume changes as they pertain to Aortic Regurg

A

increased LVEDV

decreased aortic diastolic pressure

20
Q

Auscultatory findings of Aortic Regurgitation

A

Blowing Diastolic decrescendo murmur

loudest along the left sternal border

radiation to the apex and right sternal border

best heard while leaning forward

21
Q

Causes of Aortic regurgitation

A

syphilitic aortitis

ankylosing spondylitis

RA

Marfan Syndrome

22
Q

signs of Aortic Regurgitation

A

laterally displaced apical impulse

Corrigan Pulse: sudden rise and drop in pressure

Quinke Pulse- atrial pulsation seen in the nailbed

DeMusset Sign: head bobbing

Muller sign: rhythmic pulsation of the uvula

23
Q

Describe pressure and volume changes as they pertain to Mitral stenosis

A

decreased pressure and volume

24
Q

Auscultatory findings of Mitral stenosis

A

delayed diastolic decrescendo murmur usually localized to the apex

25
Q

Auscultatory findings of Mitral stenosis

A

high pitched opening snap following S2 with a low rumbling descrescendo diastolic rumble

26
Q

how does one get dyspnea, hemoptysis and RHF from Mitra stenosis

A

Dyspnea: increase pulmonary venous pressure leads to transudation of plasma into lung interstitium and alveoli

Hemoptysis: increased pulmonary venous pressure leads to collaterals opening between bronchial and pulmonary veins. rupturing of these veins causes hemoptysis

RF: LF backflow

27
Q

most common cause of tricuspid regurgitation

A

IV Drug abuse

28
Q

clinical presentation of Rheumatic heart disease

A

Joint pain

Carditis

Nodules

Erythema marginatum

Sydenham Chorea

10days -6 weeks after a strep infection

29
Q

morphology of rheumatic heart disease

A

focal inflammatory lesions with Aschoff bodies and Anitschkow cells

Inflammation of the endocardium with L sided valve fibrinoid necrosis within the tendinous cords

small verrucous vegetations along the valve closure lines

30
Q

Clinical Presentation of Infective Endocarditis

A

splinter hemorrhages

fever/ malaise

arthralgias/myalgias

hemorrhagic nontender lesions on palms and soles

subQ nodules on the pulp of the digits

retinal hemorrhages

31
Q

discern between

acute

subacute

prosthetic valve endocarditis

A

acute: < 2 weeks with quick progression

subacute: >2 weeks but < 60 days with slow progression

prosthetic valve endocarditis: onsets at least 60 days after surgery

32
Q

Auscultatory findings of Infective endocarditis

A

Mitral valve regurg: holosystolic murmur heard loudest at the apex and radiates to the axilla

Aortic regurg: early diastolic murmur

33
Q

Morphology of infective endocarditis

A

friable bulky lesions containing inflammatory cells, fibrin and infectious bacteria that possibly erode into underlying myocardium

possible access and fibrosis at the base of the erosions with calcification of tendinous cords and chronic inflammation

34
Q

complications of infectious endocarditis

A

bacterial thromboemboli

formation of immune complexes and antibodies against tissue antigens

glomerulonephritis

Valve regurgitation

heart block

bacteremia

35
Q

causes of Nonbacterial thrombotic endocarditis

A

underlying trauma from an indwelling catheter

malignancy

hypercoagulability states

autoimmune disorders

36
Q

Morphology of NBTE

A

deposition of small sterile thrombi on the leaflets of the cardiac valves without inflammatory reaction

37
Q

where do vegetations typically occur in Leibman Sachs Endocarditis

A

undersurfaces of the AV valves

valvular endocardium

chords

mural endocardium of atria and ventricles

38
Q

complications of Leibman sachs endocarditis

A

mitral and tricuspid valvulitis

Cardio (10 decks)

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