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ICM Exam 3 Cardiology > Valvular disease (2) - Sheridan > Flashcards

Valvular disease (2) - Sheridan Flashcards

1
Q

Demusset’s sign

A

Bobbing of head with cardiac cycle (Aortic regurgitation)

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2
Q

AS CXR

A

Calcification of aortic valve/aorta

LVH

Post-stenotic aortic enlargement

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3
Q

EKG Aortic regurgitation

A

LVH

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4
Q

Mitral regurg increases __________ pressure

A

LA

PCWP

Pulmonary vein

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5
Q

Medical therapy for AS

A
  • Control HTN
  • Control Arrhythmias
  • Cautious use of diuretics
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6
Q

Occasionally can _________ the valve/commissures in Aortic regurgitation

A

repair/resuspend

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7
Q

Aortic regurgitation may result in _____ in the face of normal coronary artieries

A

angina

(microinfarcts?)

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8
Q

Watsons sign

A

Bounding Limb pulse (Aortic regurgitation)

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9
Q

Medical therapy for Aortic regurgitation

A

Afterload reduction

diuretics

treat HTN

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10
Q

Classic AS symptoms

A

angina

syncope

CHF (exertional dyspnea)

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11
Q

Normal history for AS

A

Asymptomatic for years

Clinical symptoms happens when course is malignant

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12
Q

Aortic regurgitation leads to what morphological changes

A

LV dilatataion

Eccentric Hypertrophy (opposed to concentric AS hypertrophy with increased wall thickness, but no change in chamber size - until fails long-term)

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13
Q

In MR, the ____ dilates ______

A

Annulus dilates posteriorly

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14
Q

Mitral regurg patients have increased susceptibility to

A

Bacterial endocarditis

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15
Q

Pathological effects of Aortic regurgitation

A

Subendocardial ischemia from decreased diastolic blood flow

Increased diastolic ventricular pressure, LVH, work load

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16
Q

Aortic regurgitation observation

A

serial echos

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17
Q

What is preserved in mitral regurg surgery

A

posterior leaflet chords are preserved

to preserve LV geometry and function

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18
Q

Surgical inidications for AS (asymptomatic with severe)

A
  • EF less than 50%
  • Undergoing cardiac surgery for another reason
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19
Q

Aortic regurgitation vitals changes/ Auscultation

A

Wide pulse pressure

Diastolic blowing murmur

Austin Flint murmur (when regurgitant jet hits anterior leaflet of mitral valve it tends to close it and causes murmur at apex)

Water hammer pulse = bounding periph pulse

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20
Q

If AS patient is acceptable surgical risk, the surgery should be _______

A

AV replacement

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21
Q

Mitral regurg observation

A

Serial Echos to look for LV decompensation

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22
Q

Duroziez’s sign

A

Systolic/Diastolic murmur over the femoral arteries

(Aortic regurgitation)

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23
Q

Morphological changes in AS

May lead to…

A
  • Concentric LV hypertrophy (with increased 0xygen demand, decreased subendocardial flow in diastole)
  • Microinfarcts with resulting myocardial scarring

May lead to chronic LV failure

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24
Q

Aortic regurgitation may result in massive…

A

dilatation of LV = Cor Bovinum

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25
Q

Valve surgery - types of replaements

A

Bioprosthetic (pericardial or porcine), no anticoag needed, valve can deteriorate (10-20 year lifespan)

Mechanical - Titanium, anticoag’s required, life-long

26
Q

Severe AVA =

A

less than 0.8

27
Q

Acute mitral regurg is caused by…

Result?

A

Ruptured papillary muscle (post MI)

normal/small atrium cant accomodate = pulmonary edema and possible in extremis status

28
Q

Average survival after onset of AS symptoms

A

CHF - 2 years

Syncope - 3 years

Angina - 5 years

29
Q

______ is increased in M regurg

A

LA size

ccan accomodate extra load if gradual

30
Q

Corrigan’s sign

A

bounding carotid pulse (Aortic regurgitation)

31
Q

AS typical ECG

A

LVH

IVC delays like right or left BBB, AV-nodal block, or Afib

32
Q

AV replacement for…

A
  1. Severe regurg with symptoms
  2. Severe regurg with no Sx, but or severe LV dilatation (LVESD >50%)
  3. Moderate Aortic regurgitation with another concommittent surgery
33
Q

Surgical indications for AS (symptomatic with severe)

A

Symptomatic patients wtih severe AS

  • 0.8 AVA
  • mean gradient more than 40mmHg
  • Aortic velocity more than 4 m/sec
34
Q

Dx of AS

A

Cath (assess coronaries, measure gradients, look for AI)

CTA chest with 3D reconstruction

35
Q

Pulse effects of Aortic regurgitation

A

Lateral displacement of LV apical pulse

Widened PP

36
Q

depending on the etiology of the Aortic regurgitation, may need to _____

A

replace the ascending aorta

37
Q

Treatment for symptomatic mitral regurg

A

valve repair/ annuloplasty

(this is also preferred for asymptomatic with severe regurg, LVESD at or above 40mm and ej. faction less than 60)

38
Q

Most untreated AS patients die from

A

CHF

39
Q

Most common for congenital AS

A

Bicuspid

40
Q

Therapies for Mitral regurg

A
  • diuresis
  • afterload reduction
  • rhythm control

Possible anticoag and beta blockers

41
Q

Auscultation - AS

Carotid pulse?

A

Systsolic ejection murmur in right 2nd ICS (radiates to carotids

Carotid pulse as a dimished upstroke

42
Q

What is performed when surgical risk is too high

A

TAVR

Trascatheter Aortic valve replacement

*For high risk when life expectancy is greater than 1 year

43
Q

AR results in increased….

A

LVEDP

LV diastolic volume

Wall stress

44
Q

AS Echo (what we’re looking for)

A

Measure AVA

Look for associated lesions

EF

Wall motion

Chamber size

Leaflet motion

aorta size

45
Q

Aortic regurgitation Echo, assessing:

A

regurgitant jet

EF

chamber sizes

**helps define etiology

46
Q

20% of AS result in

A

ventricular arrhythmias (sudden death)

*the most fatal valve lesion

47
Q

Most common AS cause

A

Degenerataive/calcific

48
Q

Aotic stenosis types (causes)

A

Degenerative/calcific (senile calcific)

Congenital

Rheumatic

49
Q

CXR - Aortic regurgitation

A

LV enlargement

AA enlargement

Pulm. edema

increased LA

50
Q

Mitral regurg results in _______ (Sx)

A

Fatigue

Dyspnea

Reduced exercise tolerance

Palpitations/Afib

51
Q

Aortic regurgitation surgery is usually ____

A

Aortic valve replacement

52
Q

Quincke’s pulse

A

Pulsating nail beds (Aortic regurgitation)

53
Q

Mitral regurg causes

A

Too many to list. review.

54
Q

AS may affect the conduction system if

A

Ca extends to conduction system

55
Q

LV function in MR?

A

Usualy remains adequate for a while (even if severe MR)

Eventually decompensates with LV dilation and decreased ej. fraction

56
Q

CXR for mitral regurg

A

Enlarged LA (and eventually LV)

Various degrees of pulmonary congestion

57
Q

Aortic regurg causes

A

Too many. Review.

58
Q

Mitral valve replacement is indicated if..

A

repair is not possible

59
Q

AS pathology - cardiac cycle

A

Increased afterload

Secondary impaired LV emptying during systole

60
Q

Traube’s sign

A

Pistol shot sound over large arteries

(Aortic regurgitation)

61
Q

Sx for Aortic regurgitation

A

Dyspnea, othopnea, PND, angina, syncope (rare)

May be asymp. for yearss with moderate-severe AR (when sx appear they herald LV dysfunction with frank CHF coming several yeaaras later)

ICM Exam 3 Cardiology (8 decks)

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