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ICM Exam 3 Cardiology > Valvular Disease (1) - Sheridan > Flashcards

Valvular Disease (1) - Sheridan Flashcards

1
Q

Effects of Right Fail

A

Increased: RVP > RAP > CVP > JVD -> Hepatomegaly, ascites, Edema

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2
Q

Left failure effects

A

Increased pressure: LV-> LA -> PA

Shortness of breath
CHF
Decreased ej. fraction

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3
Q

Cardio Diagnostic tools (7)

A 
H & P
Ekg
CXR
Echo (TTE, TEE)
Cardiac cath
Swan ganz cath
CT/Gated MRI
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4
Q

Cardiac cath is mainly for ____

A

preop coronary artery eval

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5
Q

CT / Gated MRA for…

A

Myxoma

eval for aorta size

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6
Q

CXR to visualize…

A

Chamber size
Aortic dilatation
Pulm. Edema

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7
Q

Mainstay for valvular disease evaluation

A 
Echo
Transthoracic (bedside) or TEE (sedate, intubate)
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8
Q

Percutaneous valve Tx

A

Balloon valvuloplasty

TAVR

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9
Q

Mitral valve surgery usually involves ____

A

repair (instead of replacement)

If replaced, POSTERIOR leaflet is kept because the chordae tendinae is attached to this, so the pumping ability of the heart is preserved to a greater degree.

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10
Q

Cause of tricuspid stenosis

A

Rheumatic
Carcinoid
Congenital

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11
Q

Rheumatic not seen as ________

Seen in combination with _________

A

isolated lesion

Mitral rheumatic disease

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12
Q

Two common congenital onitions

A

Epstein’s anomaly

Tricuspid atresia

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13
Q

Hallmark of rheumatic Dz

A

Commissural fusion

thickened valve curling back on itself

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14
Q

Rare cases of tricuspid stenosis may be ______

A

pure stenosis

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15
Q

Other features of Tricuspid stenosis

A

Chordal thickening and mild fusion

Calcification absent**

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16
Q

Carcinoid is usually secondary to…

A

Serotonin production from liver mets

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17
Q

Appearance of carcinoid

A

Cicatricial deformity on Tri/Pul valves

Fibrous plaque forms on leaflets

Commissure fuion, leaflets thicken and shorten, chordae become thick and fused

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18
Q

Sx of Tricuspid stenosis

A

Excessive fatigue

Dyspnea (can be from Left sided lesions

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19
Q

Forward fail (Tri sten) causes

A

Decreased preload LV
Decreased SV
Salt and water retention (via RAAS)

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20
Q

Backward failure (tri sten) causes

A

Hepatic congestion and peripheral edema

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21
Q

Auscultation of Tri stenosis

A

Mid diastolic murmur over left lower sternal border

Murmur INCREASES on inspiration

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22
Q

Tri stenosis liver is ___ but ______

A

enlarged, not pulsatile

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23
Q

______ if Afib present in tri stenosis

rare with ___

A

Peripheral edema

rare with NSR

24
Q

Tricuspid sten. - CXR

A

inccreased RA

no pulm art. enlargement

Clear lung fields (pathognomonic)

25
Tricuspid sten. EKG
Prominent P waves unless Afib is present
26
Tricuspid sten. Echo
RA enlargement Leaflet thickening Measure gradient + look for associated lesions
27
Tricuspid sten. cath to..
ID gradient
28
Tricuspid regurg. causes (7)
``` Rheumatic Endocarditis Trauma (can avulse or tear leaflets) Carcinoid Myxoma Diffuse collagen disorders Fibroelastosis ``` (Functional diseases are the majority, often due to MV (left sided) disease, like mitral regurg.) (Congenital - Ebstein's anomaly)
29
Tricuspid regurg auscultation
Pansystolic murmur over lower sternal border | Increases with inspiration
30
Tricuspid regurg exam
Enlarged liver shows systolic pulsations, tender JVD Hepato-Jug reflex Edema/ascites/anasarca
31
Tricuspid regurg. may have _____
dyspnea or orthopnea Majority will get afib
32
Tricuspid regurg. Echo quantitates...
degree of insufficiency/annular size
33
Tricuspid regurg. treatment often inolves treating...
the left sided valve lesion for functional disease
34
Tricuspid ring valvuloplasty /repair is for
Symptomatic severe disease of functional mitral regurg OR Moderate-severe MR when performing other concomitant valve or coronary procedures
35
Pulmonary valve - mainly ______
congenital lesions - Tetrology, Pulm atresia
36
Ross procedure
Remove Pulm Valve to use as auto-graft to replace aortic valve (valve can grow with child) (can be done in adults occasionally)
37
Mitral stenosis - effects
``` Reduced CO LAH (Afib, mural thrombi, systemic embolism) Pulm HTN Increased Pulm Vascular resistance Pulmonary edema ```
38
Mitral stenosis - Pulm Edema occurs if...
Mean LA pressure exceeds oncotic pressure of plasma
39
Portion of mitral valve that is fixed, connected to skeleton
Anterior leaflet
40
Mitral stenosis - Symptoms
``` Pulm congestion Cough./hemop/orthopnea PND Pulm edema Exertional dyspnea**** Cardiac cachexia ```
41
Mitral stenosis - Auscultation
Asculltatory triad: Apical diastolic rumble Increased first heart sound opening snap
42
Mitral stenosis - CXR
Increased LA, straight left heart border (increased LA/PA obliterates the normal concavity between Ao and LV
43
Often MV is ____ in Mitral stenosis
calcified see on cxr, echo, cath
44
Kerley's lines = seen with ?
Engorged pulmonary lymphatics Seen with severe MS
45
The near exclusive cause of Mitral stenosis
Rheumatic disease | except for rare congenital lesions, extravalve stuff like myxoma, and severe senile calcific disease
46
Mitral stenosis epid.
2/3 female
47
Mitral stenosis - progressive disease results in _____
FIBROSIS of Leaflet, commisure, and sub-valvular apparatus...with eventual calcification
48
Mitral stenosis - Echo
LA enlargement, leaflet thickness Vegetatations Lowered EF Thrombus, calcification **Leaflet doming, secondary to restrictive opening
49
Mitral stenosis - catheterization is to...
check coronaries prior to surgery
50
Mitral stenosis - Treatment
Look for LA thrombus, mitral valve area, Valve gradient, PA pressures anticoagulation for thrombus, emboli, or afib medical tx for Afib and heart rate control
51
Mitral stenosis - Percutantous balloon commissurotomy for...
symptomatic patientss with MVA less than/equal to 1.5 Must have Minimal calcium and favorable anatomy (cant have LA thrombus or moderate-severe mitral regurg.)
52
Tx for severe Mitral stenosis (MVA less than or equal to 1.5... with severe Sx or for those undergoing other cardiac surgery
Commissurotomy or MV replacement
53
________ is difficult and not routinely done secondary to_______
Repair for Rheumatic Mitral stenosis secondary to significant fibrosis
54
_____ usually reverses postop
Pullm HTN
55
Mitral stenosis - _______ is obliterated if thrombus present
Left atrial appendage

ICM Exam 3 Cardiology (8 decks)

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