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Cardio > Valve Disorders - Part 2 - Exam 1 > Flashcards

Valve Disorders - Part 2 - Exam 1 Flashcards

1
Q

_____ is when the valve doesn’t open properly. _____ is when the valve doesn’t close properly.

A

stenosis= doesn’t open

regurgitation= doesn’t close

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2
Q

ejection click think ______

midsystolic click think ______

A

ejection= aorta

midsystolic = mitral valve prolapse

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3
Q

marfarn, trisomy think ____ because the valves are stretching

A

regurgitation

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4
Q

not enough leaflet think ______

what side of the stethoscope do you use to listen to mitral?

A

not enough leaflets think stenosis

mitral= use bell

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5
Q

palpable P2 at the upper left sternal border think _____

A

mitral stenosis

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6
Q

tricuspid stenosis is MC in _______

What is the MC cause in the US?

A

women

MCC in US: Carcinoid syndrome, prosthetic valve degeneration

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7
Q

What is the MC cause of tricuspid stenosis worldwide?

A

rheumatic heart disease

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8
Q

What are the s/s of right sided heart failure? left sided?

A

right: s/s are peripheral edema and then SOB. floods feet up

left: SOB, angina and then peripheral edema. floods lungs down

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9
Q

What are some additional s/s of right sided heart symptoms? What wave will be elevated in JVP?

A

hepatomegaly, ascites, peripheral edema, fatigue, palpable pre systolic liver pulsation may be appreciated

elevated A wave

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10
Q

What will tricupsid stenosis murmur sound like?

A

Soft, high-pitched, diastolic rumbling murmur along lower left sternal border Mimics mitral stenosis, except for INCREASED sound with inspiration - increased return with inspiration

opening snap may be heard

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11
Q

What is a possible EKG finding for tricuspid stenosis? CXR? Why?

A

right atrial enlargement because the right atrium is pumping much harder

CXR: cardiomegaly

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12
Q

cardiomegaly is closely associated with what valve disorder?

A

tricuspid stenosis

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13
Q

What is the tx for tricupsid stenosis? When would you add on an aldosterone antagonist?

A

loop diuretics (torsemide or bumetanide)

liver congestion or ascites present

OR

triscupid valve replacement if the pt is symptomatic

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14
Q

What is the tricuspid valve shaped like? What happens to the shape when regurgitation is present?

A

TV annulus is saddle shaped, so as the valve collapses and becomes elliptical with RV failure/dilation, regurgitation worsens

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15
Q

What is the major cause of tricuspid regurgitation? What are some additional causes?

A

right ventricle dilation due to PULMONARY HTN

Endocarditis, carcinoid syndrome, congenital abnormality, chest wall trauma

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16
Q

tricuspid regurgitation causes ______ and tricuspid stenosis causes _____-

A

regurg= increased RA pressure

stenosis= reduced right atria emptying into right ventricle

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17
Q

When you have tricuspid regurgitation without pulm HTN, what happens?

A

present with symptoms of RV failure
Fatigue, ascites, and peripheral edema

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18
Q

What does a tricuspid regurgitation sound like? Where is it best heard? What makes it worse?

A

Murmur is high-pitched and pansystolic, best heard at left sternal border

Accentuated with inspiration/leg-raising/squatting by increasing venous return

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19
Q

on echo, RV systolic pressure _____ highly suspicious for TV regurg. What will EKG show?

A

<40 mmHg

afib/flutter possible

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20
Q

When is a tricupsid regurgitation repair indicated? replacement? When is anticoagulation needed?

A

Repair is typically considered (annuloplasty) to restore TV function for patients with persistent symptoms

replacement: must be considered for underlying primary leaflet pathology

anticoag is only needed if Afib is present

21
Q

What is the underlying cause of pulmonic stenosis?

A

**CONGENITAL and usually isolated

genetic syndromes such as Noonan and Trisomy 13

22
Q

What is the MC acquired cause of pulmonic stenosis? What is the stenosis a result from?

A

carcinoid syndrome

pulmonic stenosis is usually the result of fused pulmonary leaflets due to pressure overloaded state that results in right ventricle hypertrophy

23
Q

How will critical pulmonary stenosis present? How will moderate/severe pulmonary stenosis present?

A

neonates with central cyanosis at birth

teenager who is participating in sports for the first time who is SOB. progressive fatigue and dyspnea on exertion

24
Q

**What will a pulmonic stenosis murmur present like? Where is it best heard? Where will it radiate?

A

Systolic ejection murmur best heard at left upper sternal border, increases with inspiration

radiate to left shoulder

25
Q

What is the extra heart sound associated with pulmonic stenosis?

A

S1 followed by opening click that is louder with expiration

RV lift on palpation of precordium

26
Q

What will the CXR with pulmonic stenosis look like? EKG?

A

CXR → may reveal prominent RV and RA with cardiomegaly; dilation of the pulmonary arteries is common

EKG → right axis deviation, RV hypertrophy; peaked P waves demonstrating right atrial overload

27
Q

What are the different grades of pulmonic stenosis? What are the txs for each?

A

Mild: less than 36mmHg, asymptomatic - no tx required (asymptomatic)

Moderate: 36-64mmHg and symptomatic
require balloon valvuloplasty or surgical valve replacement

moderate/severe: over 64mmHg
require balloon valvuloplasty or surgical valve replacement

28
Q

What is pulmonic regurgitation due to?

A

Typically due to dilation of the PV annulus secondary to pulmonary HTN

29
Q

What does a pulmonic regurgitation murmur sound like? Where is it best heard?

A

Murmur is diastolic, high-pitched, blowing quality, best heard at second left intercostal space

second left intercostal space

30
Q

for pulmonic regurgitation EKG is typically NOT helpful but _____ is common

A

right bundle branch block

31
Q

**What is the tx for pulmonic regurgitation?

A

tx the pulm HTN!!!

Pulm valve replacement is rare and is usually only done in intractable right valve failure

32
Q

What are the 2 types of valve replacements? How do you decide between the two options? What are younger pts more than likely to get?

A

tissue and mechanical

based on pt factors: Patient age, compliance for anticoagulation, and valve position

younger= more likely to get mechanical valve

33
Q

a pt got a mechanical valve, what are the longterm management necessities? What is the goal INR?

A

Coumadin (warfarin)!!!

Goal INR 2.5 - 3.5 general rule of thumb

34
Q

a pt got a tissue heart valve, what are the longterm management necessities? How long do they last?

A

ASA 81 mg may be sufficient to reduce risk of thromboembolism development

10 years

low bleeding risk: consider anticoag for 3-6 months

35
Q

**What is rheumatic heart disease caused by? What age? **What valve does it commonly affect?

A

caused by infection with group A beta-hemolytic strep

kids 4-9

mitral valve

36
Q

What is rheumatic heart disease characterized by? What is the pathophys behind it?

A

Characterized by diffuse inflammation of the heart (pancarditis)

Myocardium is infiltrated with lymphocytes and areas of necrosis may occur

37
Q

What is pancardititis?

A

Characterized by diffuse inflammation of the heart

38
Q

What characteristic histologically finding in the myocardium is associated with rheumatic heart disease? What are they composed of?

A

Aschoff body

Collection of myocytes and macrophages surrounded by fibrous tissue

39
Q

Valvulitis is characterized by _____ on leaflet edge

A

verrucous lesions

40
Q

What valve is Rheumatic Heart Disease associated with? What is the 2nd MC?

A

mitral valve- MC

aortic valve- 2nd MC

41
Q

How does rheumatic heart disease present? How do you dx it?

A

Typically an acute, febrile illness 2-4 weeks following streptococcal pharyngitis infection

Jones criteria, there is NOT a lab test for it

42
Q

**What are the major criteria for Jones criteria?

A
43
Q

**What are the minor criteria for Jones criteria?

A
44
Q

What is the dx criteria for Jones? What dz?

A

rheumatic fever

45
Q

What is this?

A

Erythema Marginatum, one of the major Jones criteria for rheumatic heart disease

46
Q

What is the tx for rheumatic heart disease?

A

PCN

salicylates for fever and arthritis (ASA)

47
Q

Recurrent rheumatic heart disease attacks are common during _____ after initial infection. What is the tx?

A

first 5-10 years after initial infection

Prophylaxis PCN G 1.2 million units IM monthly for 10 years

can consider oral PCN or erythromycin but be mindful of compliance

48
Q
A

Cardio (9 decks)

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