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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
Q

Tricuspid sten. EKG

A

Prominent P waves unless Afib is present

26
Q

Tricuspid sten. Echo

A

RA enlargement

Leaflet thickening

Measure gradient + look for associated lesions

27
Q

Tricuspid sten. cath to..

A

ID gradient

28
Q

Tricuspid regurg. causes (7)

A 
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
Q

Tricuspid regurg auscultation

A

Pansystolic murmur over lower sternal border

Increases with inspiration

30
Q

Tricuspid regurg exam

A

Enlarged liver shows systolic pulsations, tender
JVD
Hepato-Jug reflex
Edema/ascites/anasarca

31
Q

Tricuspid regurg. may have _____

A

dyspnea or orthopnea

Majority will get afib

32
Q

Tricuspid regurg. Echo quantitates…

A

degree of insufficiency/annular size

33
Q

Tricuspid regurg. treatment often inolves treating…

A

the left sided valve lesion for functional disease

34
Q

Tricuspid ring valvuloplasty /repair is for

A

Symptomatic severe disease of functional mitral regurg
OR
Moderate-severe MR when performing other concomitant valve or coronary procedures

35
Q

Pulmonary valve - mainly ______

A

congenital lesions - Tetrology, Pulm atresia

36
Q

Ross procedure

A

Remove Pulm Valve to use as auto-graft to replace aortic valve

(valve can grow with child)
(can be done in adults occasionally)

37
Q

Mitral stenosis - effects

A 
Reduced CO
LAH (Afib, mural thrombi, systemic embolism)
Pulm HTN
Increased Pulm Vascular resistance
Pulmonary edema
38
Q

Mitral stenosis - Pulm Edema occurs if…

A

Mean LA pressure exceeds oncotic pressure of plasma

39
Q

Portion of mitral valve that is fixed, connected to skeleton

A

Anterior leaflet

40
Q

Mitral stenosis - Symptoms

A 
Pulm congestion
Cough./hemop/orthopnea
PND
Pulm edema
Exertional dyspnea****
Cardiac cachexia
41
Q

Mitral stenosis - Auscultation

A

Asculltatory triad:

Apical diastolic rumble
Increased first heart sound
opening snap

42
Q

Mitral stenosis - CXR

A

Increased LA, straight left heart border (increased LA/PA obliterates the normal concavity between Ao and LV

43
Q

Often MV is ____ in Mitral stenosis

A

calcified

see on cxr, echo, cath

44
Q

Kerley’s lines =

seen with ?

A

Engorged pulmonary lymphatics

Seen with severe MS

45
Q

The near exclusive cause of Mitral stenosis

A

Rheumatic disease

except for rare congenital lesions, extravalve stuff like myxoma, and severe senile calcific disease

46
Q

Mitral stenosis epid.

A

2/3 female

47
Q

Mitral stenosis - progressive disease results in _____

A

FIBROSIS of Leaflet, commisure, and sub-valvular apparatus…with eventual calcification

48
Q

Mitral stenosis - Echo

A

LA enlargement, leaflet thickness
Vegetatations
Lowered EF
Thrombus, calcification

**Leaflet doming, secondary to restrictive opening

49
Q

Mitral stenosis - catheterization is to…

A

check coronaries prior to surgery

50
Q

Mitral stenosis - Treatment

A

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
Q

Mitral stenosis - Percutantous balloon commissurotomy for…

A

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
Q

Tx for severe Mitral stenosis (MVA less than or equal to 1.5… with severe Sx or for those undergoing other cardiac surgery

A

Commissurotomy or MV replacement

53
Q

________ is difficult and not routinely done secondary to_______

A

Repair for Rheumatic Mitral stenosis

secondary to significant fibrosis

54
Q

_____ usually reverses postop

A

Pullm HTN

55
Q

Mitral stenosis - _______ is obliterated if thrombus present

A

Left atrial appendage

ICM Exam 3 Cardiology (8 decks)

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