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Q2 Clin Med Final (Cardiology, Hyperlip) > Valve Disease > Flashcards

Valve Disease Flashcards

1
Q

Typical sxs of valvular dx?

A 
fatigue
dyspnea
angina
syncope
palpitations
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2
Q

Aortic Stenosis definition?

A

narrowing of aortic outflow tract

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3
Q

Levels of Aortic Stenosis?

A

Aortic Valve (75%)
Supravalvular
Subvalvular

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4
Q

Aortic Stenosis etiology?

A

Congenital:

Sxs < 30yo = unicuspid valve
Sxs 30-65 = bicuspid valve
Sxs >65yo = degeneration and sclerosis of valve

Rheumatic valve disease

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5
Q

Course of Aortic Stenosis?

A

(U) asympt until severe

Death w/i 4 yrs of sxs

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6
Q

Aortic Stenosis sxs?

A

Early:
fatigue
dyspnea on exertion

Later:
dyspnea w/ ADL
angina
syncope
heart failure
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7
Q

Aortic Stenosis physical findings? (3)

A

1) Systolic ejection murmur - 2nd right ICS
2) Thrill - 2nd right ICS
3) Early systolic ejection click

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8
Q

Aortic Stenosis physical findings when severe?

A

Late peak systolic ejection murmur

Small pulse pressure

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9
Q

Gradation of murmurs: 1 out of?

A

6

barley audible to very loud

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10
Q

Aortic Stenosis lab findings:

ECG?

A

Initially normal
As LV hypertrophy (LVH) develops:
↑ QRS
Left axial deviation

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11
Q

Aortic Stenosis lab findings:

CXR?

A

Initially normal
LVH shows:
post-stenotic dilation of aorta

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12
Q

Aortic Stenosis lab findings:

Echo?

A

LVH:

calcified leaflets

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13
Q

Aortic Stenosis management?

A

Mild: follow
Mod: annual ECG, Echo, CXR
Severe: cardiology

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14
Q

Aortic Stenosis indications for intervention? (4)

A

1) Sxs: CHF sxs
2) Ejection fraction < 50%
3) CAD
4) Valve opening < 1cm

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15
Q

Hypertrophic Cardiomyopathy (HCM) definition?

A

Form of subvalvular AS:

Disease cardiac mm w/ severe hypertrophy in ABSENCE of cause for 2º hypertophy

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16
Q

Hypertrophic Cardiomyopathy etiology?

A

60% FH

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17
Q

Hypertrophic Cardiomyopathy affects LV how?

A

LV is hypercontractile w/ high wall stress,

Ejects all blood during systole

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18
Q

Hypertrophic Cardiomyopathy sxs?

A

Similar to AS
Murmur louder when standing or valsalvas (ascending aorts)
Aortic valve not calcified
No ejection sounds

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19
Q

Hypertrophic Cardiomyopathy tx?

A

Ca2+ channel blockers

β blocker

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20
Q

Aortic Regurgitation (Insufficiency) definition?

A

leak of blood back thru aortic valve @ diastole

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21
Q

Acute Aortic Regurg etiology? (3)

A

1) Aortic dissection
2) Latrogenic - cath/surgical
3) Endocarditis

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22
Q

Chronic Aortic Regurg etiology? (4)

A

1) Rheumatic val dx
2) Bicuspid aortic val
3) Dilated aortic root
4) CT dx (RA, Marfans, Ehler’s)

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23
Q

Aortic Regurg indications for intervention? (3)

A

1) Symptomatic
2) Asymp w/ EF < 55%
3) LVESD > 55mm, EDD >70mm

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24
Q

Chronic Aortic Regurg progression?

A

LV overload w/ gradual dilation/hypertrophy

Mild DOE

DOE and rest, orthopnea, noctural dyspnea

Post sxs survival <2yrs

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25
Q

Acute Aortic Regurg progression?

A

Pulmonary edema

Req’s urgent referral

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26
Q

Aortic Regurg physical findings?

A

Austin Flint murmur
Watson Waterhammer pulse
Widened pulse pressure
Low diastolic

27
Q

Austin Flint murmur?

A

low-pitch diastolic @ apex

similar to diast mitral stenosis murmur

28
Q

Wide pulse pressure due to?

A

↑ systolic P and ↓ diastolic P

29
Q

Watson Waterhammer pulse?

A

Powerful upstroke, sudden disappearance

hallmark of AR

30
Q

Aortic Regurg lab findings:

ECG?

A

LVH

31
Q

Aortic Regurg lab findings:

CXR?

A

normal if acute
LVH if chronic
(P) CHF/pulm edema

32
Q

Aortic Regurg lab findings:

Echo?

A

LVH

33
Q

Aortic Regurg management?

A

Aysmp/mild: follow 6-12mo,
(P) Vasodilators (ACE inhib)

Symp: valve replacement

34
Q

Mirtal Regurge definition?

A

leak of blood from LV into L atrium

35
Q

Acute Mirtal Regurge etiology?

A

Papillary mm necrosis/rupture from eschemia

Endocarditis

36
Q

Acute Mirtal Regurge tx?

A

(U) emergent surgery

37
Q

Chronic Mirtal Regurge etiology?

A 
Barlow's Synd
Inherited MV prolapse
Sub-acute endocartitis
Rheumatic HD
Acquired CT dx (SLE)
38
Q

Barlow’s Syndrome is?

A

Common cause of Mirtal Regurge
Degeration of value tissue -> stretched leaflets
(C) w/ Grave’s, Marfan’s, MD

39
Q

Mirtal Regurge progression?

A 
LV enlarges to accommodate ↑ volume ->
SV ↑ ->
LA enlarges to accom ↑ vol ->
Atrial fibr
Pulm HTN
RV hypertrophy
40
Q

Mirtal Regurge sxs?

A

Dyspnea, fatigue
Arrhythmias
Pulm HTN

41
Q

Mirtal Regurge physical findings?

A

High-pitch pansystolic murmur (apex to axilla)

Late:
S3, S4 gallops
JVD
hepatomegaly

42
Q

Mirtal Regurge lab findings:

EKG?

A

LAEnlargement
LVH
(P) RVH

43
Q

Mirtal Regurge lab findings:

CXR?

A

LAE

LVH

44
Q

Mirtal Regurge lab findings:

Echo?

A

LAE
LVH
Hyperdynamic LV wall motion

45
Q

Mirtal Regurge tx?

A

Afterload reduction w/ ACE inhib, vasodial
↓ sodium
Valve repair/replace

46
Q

Mitral Valve Prolapse etiology?

A

Ballooning of mitral leaflets into LA during systole

47
Q

Mitral Valve Prolapse physical findings?

A

mid-late systolic clicks

48
Q

Mitral Valve Prolapse tx?

A

(U) benign

(P) β blockers

49
Q

Mitral Stenosis definition?

A

Narrowing of mitral valve

Obstructs flow from LA to LV

50
Q

Mitral Stenosis etiology?

A

(U) Rheumatic HD

51
Q

Mitral Stenosis results in?

A

↑ LA P

↑ pulmonary HTN

52
Q

Mitral Stenosis progression?

A

Asymp 20+ yrs post Rheum fever

7yrs between sxs and total disability

53
Q

Mitral Stenosis sxs?

A

Plumonary congestion sxs

(U) atrial fibr

54
Q

Mitral Stenosis physical findings?

A

Loud S1 w/ opening snap
Mid-dias rumbling murmur followed by pre-syst kick

Late:
loud P2 and RV heave

55
Q

Mitral Stenosis lab findings:

EKG?

A

LAE

Late:
RVH
a fib

56
Q

Mitral Stenosis lab findings:

CXR?

A

LAE
calcified mitral annulus

Late:
Kerley B lines
RVH
pulm cong

57
Q

Mitral Stenosis lab findings:

Echo?

A

DIAGNOSTIC
Thick valves
↓ vale excursion

58
Q

Mitral Stenosis lab findings:

Angio/Cath?

A 
Giant LA
Small LV
LA HTN
pulm HTN
gradient LA to LVEDP
59
Q

Mitral Stenosis management?

A

Mild: diauretics
Warfarin for a fib or significant LA enlarg
Valve surgery

60
Q

Endocarditis sxs?

A

Viral-like
SOB, persistent cough
New murmur
Skin ∆s

61
Q

Endocarditis indications for surgery: Class 1

A

Valve stenosis or regurg HF
Regurge w/ ↑ LVEDP or mod pulm HTN
Resistant organisms
Heart block, abscess, lesion

62
Q

Endocarditis indications for surgery: Class 2

A

Recurrent emboli

Persistent veg > 1cm

63
Q

Anticoag and Thromboembolism (TE) risks?

A 
Older
Female
DM
Malig
HTN
Alcohol
64
Q

Tricuspid Valve Regurge etiology?

A

(U) 2º to RV dysfxn (vol overload, pulm HTN)
Result of LV failure
a/w pulmonary regurge, mechanical interference

Q2 Clin Med Final (Cardiology, Hyperlip) (8 decks)

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