Valvular disease

Question 1

Mitral Stenosis

Answer 1

Loud S1 murmur, low pitched, mid diastolic; apical “crescendo” rumble

Question 2

Mitral Regurgitation

Answer 2

Systolic murmur at 5th intercostal space midclavicular line (Apex); may radiate to bass or left axilla; musical, blowing, or high-pitched; may follow an S3

Question 3

Aortic Stenosis

Answer 3

Systolic, “blowing” rough harsh murmur at second right intercostal space usually radiating to the neck

Question 4

Aortic Regurgitation

Answer 4

Diastolic, “blowing” murmur at 2nd L ICS

Question 5

Acronym for murmurs

Answer 5

MS ARD and MR ASS

Mitral stenosis aortic regurgitation diastolic and mitral regurgitation aortic stenosis systolic

Question 6

Where is the murmur

Answer 6

5th ICS = Apex = Mitral

2-3rd ICS = Base = Aortic

Question 7

Heart Failure

Answer 7

A syndrome that results when the cardiac output is insufficient to meet the metabolic needs of the body

Question 8

Heart failur with reduced ejection fraction (HFrEF)

Answer 8

Systolic

Inability to contract results in decreased cardiac output

Question 9

Heart failure with preserved ejection fraction (HFpEF)

Answer 9

Diastolic

Inability to relax and feel results in decreased cardiac output

Question 10

Acute Heart Failure

Answer 10

Abrupt onset usually follow acute MI or valve rupture (left)

Question 11

Chronic heart failure

Answer 11

Develops as a result of inadequate compensatory mechanisms that have been employed over time to improve cardiac output

Question 12

L failure signs/symptoms

Answer 12

Dyspnea at rest
course rails over all lung fields
Wheezing, frothy coffee
Appears generally healthy except for acute event
S3 gallop
Murmur of mitral regurgitation (systolic murmur loudest at Apex)

Question 13

R failure sign/symptoms

Answer 13

JVD
**Hepatomegaly, splenomegaly
**Dependent edema. As a result of increased capillary hydrostatic pressure
**Proximal nocturnal dyspnea
Appears chronically ill
Diffuse chess wonky
Displaced points of maximal impulse
Abdominal fullness
Fatigue on exertion
S3 and or S4

Question 14

NYHA class 1

Answer 14

No limitations of physical activity

Question 15

NYHA class 2

Answer 15

Slight limitations of physical activity but comfortable at rest

Question 16

NYHA class 3

Answer 16

Marks limitation of physical activity but comfortable at rest

Question 17

NYHA class 4

Answer 17

Severe; an ability to carry out any physical activity without discomfort

Question 18

Heart failure labs/diagnostics

Answer 18

Hypoxemia and hypocapnia on ABG
BMP usually normal unless chronic failures present
BNP to get a baseline
Your analysis
Chest x-ray: pulmonary edema, Kurley B lines, effusions
Echocardiogram will show contract tile/relaxation, valve function, injection for action; 2-D echo cardio gram to access left ventricular function
ECG measure deviation or underlying problem: acute myocardial infarction, dysrhythmia
Pulmonary function tests for wheezing

Question 19

Heart failure management

Answer 19

Nonpharmacologic
Sodium restriction
Rest activity balance
Weight reduction
Pharmacologic
Ace inhibitors 
Diuretics
Interest to; useful and management of heart failure with reduced ejection fraction
Digoxin  maybe useful in some patience
Anticoagulation therapy for atrial fibrillation

Question 20

Pulmonary Edema Management

Answer 20

Go to at one to 2 L per minute while awaiting ABGs
Place in and sitting or semiFowlers position
Morphine 2–4 mg IVP; repeat 20–30 minutes PRN; stop if hypercapnia occurs
Furosemide 40 mg IVP; repeat in 10 minutes if no response
If a severe bronchospasm presents, given held sympathomimetics
If severe, afterload and preload reduction with nitroprusside, hydralazine
If cardiac index remains low dobutamine 2.5–20 UG/KG/MIN; if preferred