valvular disease Flashcards
passive leg raise increases ____
preload
squatting increases ____
preload (because when you squat, vasoconstrict and shunt blood back to heart)
decrease preload- which manuevers
valsalva (straining) inspiration (increase the preload on RV)
standing (moving blood down from the legs)
expiration effect on preload
decrease the RV preload
right sided murmur what intensifies
inspiration
expiration increases intensity of
left sided murmur
What increases afterload (manuever)
increased hand grip
squatting
because it increases SVR
diastolic murmurs are almost always
abnormal
classic triad of aortic stenosis
SAD: syncope, angina, dyspnea
pulsus parvus et tardus- what does it mean
seen in aortic stenosis. weak and late pulse. longer, because it takes a long time to get the high pressure out of the aorta.
A2P2- seen in
aortic stenosis
harsh crescendo decresendo systolic ejection murmur- radiates to carotids: which murmur
aortic stenosis
location of aortic stenosis
R 2ND ICS
Cause of aortic stenosis (3)
dystrophic calcification (normal levels of calcium) but high deposition of calcium on aortic valve esp in elderly patients
bicuspid aortic valve- fusion of aortic leaflets in young patients
rhuematic fever
aortic regurgitation
regurg blood back into the left ventricle
can be acute or chronic
difference between dystrophic calcification and metastatic calcification
dystrophic calcification: normocalcemia, damaged tissue
metastatic calcification: hypercalcemia, normal tissue
What are the causes of aortic regurgitation?
aortic valve sclerosis,
bicuspid aortic valve
aortic diltation (aneursym, connective tissue diesase, tertiary sypllis)
poorly controlled HTN ( aortic dissection and thoracic aortic aneurysm)
water hammer pulse- meaning?
increased systolic pressure
lower diastolic pressure
increased pulse pressure
murmur of aortic regurg
early decrescendo diastolic murmur
increase murmur intensity for aortic regurg
increase preload, increase afterload, and expiration
presentation of aortic regurg
exertional dyspnea
pulmonary edema
head bobbing
is the most common cause of mitral stenosis
rheumatic fever
systolic heart failure is associated with which type of hypertrophy due to ___ overload
eecentric- volume overload
diastolic heart failure is associated with ___ hypertrophy due to _____ overload
concentric hypertrophy due to pressure overload
diastolic rumbling murmur opening snap. which kind of murmur
mitral stenosis
4 signs of atrial dilatation
pulmonary edema, hoarseness, dysphagia, atrial fibrillation
mitral stenosis where to auscultate
L 5th ICS midclavicular line (apex)
time between S2 and opening snap
less time- worse severity of mitral stenosis
MCC of mitral stenosis
rheumatic heart disease
manifestation after acute rehumatic fever (group A step- pyogenes)
acute rhuematic fever presentation
migratory arthritis
pancarditis
syndeam chorea
subcutraneous nodules
erythema marginatum
JONES
holosytolic blowing murmur- which murmur
mitral regurg
relationship between mitral regurg and PCWP/LVEDV
increased PCWP, LVEDV
cause of mitral regurg
posterior papillary muscle
mitral valve prolapse
infective endocarditis
mitral valve prolapse
myoxomatous generation of mitral valve, increased tension on chordae tendinae and papillary muscles
causes of mitral valve prolappse
marfan
papillary rupture
infective endocarditis
rheumatic heart disease
decrease the preload, increases the murmur of which one?
mitral valve prolapse
infective endocarditis- what bug
staph aureus
tricuspid reurg
regurg blood into the RA
carcinoid syndrome associated with which murmur
tricuspid regurg
5-HIAA goes to lungs (metabolized)
