Valve Disease (Newman)

Question 1

2 causes of endocarditis

Answer 1

bugs in blood and diseased valve

Question 2

What determines the integrity of the valves?

Answer 2

leaflets/cusps
support network
cardiac chambers, great vessels

Question 3

a narrowing of an orifice, lumen

Answer 3

stenosis

Question 4

leakage upstream

Answer 4

regurgitation

Question 5

What the size diff of healthy and stenotic valve?

Answer 5

3 cm vs 0.5 cm

Question 6

in what valve does regurgication happen most common?

Answer 6

aorta (in diastole)&raquo_space; mitral/left ventricle (in systole)

Question 7

What is the cardiac adaptation to a stenotic valve?

Does a stenotic valve cause a pressure or volume overload?

Answer 7

inc thickness of wall = concentric hypertrophy

pressure overload due to inc pressure upstream

Question 8

What is the cardiac adaptation to regurgitation?

Does a regurgitation cause an pressure or volume overload?

Answer 8

eccentric hypertrophy (enlarged chamber inc mass but normal thickness)

= heart dialtes without getting thicker!!
(volume overload bc volume increases upstream)

Question 9

What is the thickness of the inter-ventricular septum?

Answer 9

1 cm

Question 10

loud murmur without hypertrophy (eccentric)

Answer 10

acute regurgitation

Question 11

What causes acute regurg? (3)

Answer 11

ischemia, infection, dissection

Question 12

heart failure (PND, edema, JVD)
chest pain
syncope
arrhymias
** could be asymptomatic

Answer 12

acute regurgitation

chest pain (angina)

Question 13

Where on the chest would you hear mitral regurg

Answer 13

right under left nipple

Question 14

mitral regurg murmur is heard during _____

Answer 14

systolic murmur

lub –fhh–dub

Question 15

aortic regurg murmur is heard during _____

Answer 15

diastolic murmur

lub-dub-fhh

Question 16

Where on the chest would you hear aortic regurg?

Answer 16

under right clavicle

Question 17

aortic stenosis murmur is heard during _____

Answer 17

Systole

lub-ugh-dub (cough sound)

Question 18

in mitral stenosis the first heart sound is

Answer 18

louder

Question 19

how must a pt be positioned? WHat part of hand do you use to feel for it?

Answer 19

left lateral dequibitis

interphalngeal joints

Question 20

Where will PMI be felt with eccentric hypertrophy?

Answer 20

axilla

Question 21

What should the size of the PMI be normally? pathologic?

Answer 21

size of dime–> quarter

Question 22

concentric hypertrophy is a risk factor for …

Answer 22

CAD

Question 23

the gradient

Answer 23

?

left ventricle pressure < aorta

Question 24

to determine the severity of the stenosis you must know…

Answer 24

gradient

CO (or Q)

Question 25

inflammation, scarring of leaflets, chordae, and papillary muscles, frequent calcification

Answer 25

mitral stenosis

Question 26

Clinical pres: | dyspnea, RHF, thrombi

Answer 26

mitral stenosis

Question 27

HTN: left atrium > pulmonary bed > right heart

Answer 27

mitral stenosis

Question 28

pulmonary artery catheter measures

Answer 28

left ventricular pressure?

Question 29

disease affecting: supporting valve structures leaflets dilation of left atria

Answer 29

mitral regurg

Question 30

loud first heart sound

Answer 30

mitral stenosis

Question 31

what is the most common cause of mitral regurg?

Answer 31

mitral prolapse

Question 32

leaflets replaced by myxomatous tissue

Answer 32

mitral valve prolapse --> mitral regurg

Question 33

eccentric hypertrophy is the result of

Answer 33

Chronic mitral regurg

Question 34

inc preload with dec afterload

Answer 34

mitral regurg

Question 35

What are the 2 most common causes of mitral regurg?

Answer 35

infection (endocarditis) | ischemia (MI)

Question 36

loud murmus, pulmonary edema, without enlarged ventricle or atia

Answer 36

acute mitral regurg

Question 37

hwo is accute and chronic regurg diff?

Answer 37

lack of hypertrophy = acute

Question 38

lub- ugh -dub heard under right clavicle

Answer 38

aortic stenosis

Question 39

tardus

Answer 39

delayed arterial pressure (stays a little longer on your finger)

Question 40

parvus

Answer 40

weakened arterial pulse

Question 41

concentric hypertrophy + tardus + parvus

Answer 41

aortic stenosis

Question 42

angina syncope HF sudden death

Answer 42

arotyic stenossi

Question 43

lub-dub-shh under right clavicle

Answer 43

aortic regurg

Question 44

wide pulse pressure

Answer 44

chronic aortic regurg

Question 45

bacteremia + disease valve (or lesion)

Answer 45

2 requirements for endocaditis

Question 46

combo of platelets + fibrin + bugs + RBCs and WBCs

Answer 46

vegetation

Question 47

valve destruction -->

Answer 47

acute regurg

Question 48

complications of infective endocarditis

Answer 48

valve destruction --> acute regurg embolization immunologic phenomena

Question 49

What are the 3 indications for surgery in IE

Answer 49

1. heart failure unresponsive to medical management 2. uncontrolled infection 3. recurrent major emboli

Question 50

Turbulent flow is indicative of...

Answer 50

stenosis

Question 51

Inappropriate timing is indicative of...

Answer 51

regurgitation

Question 52

Severity of stenosis is determined by:

Answer 52

pressure gradient | CO

Question 53

In mitral stenosis, the severity is proportional to

Answer 53

HR

Question 54

SIgns of aortic regurg

Answer 54

widened pulse pressure | head bobbing

Question 55

Endocarditis requires:

Answer 55

bacteremia | diseased valves