valvular disease

Question 1

Wide pulse pressure, hammer pulse, muller sign (uvula), quinke sign (nail beds), de musset sign (head bob)
PMI enlarged and laterally displaced
No S1, S4, blowing and mid to late diastolic decrescendo mr, austin fline mr

Answer 1

aortic regurg

Question 2

Causes

Congenital, bicuspid, rheumatic

Answer 2

aortic stenosis

Question 3

Chest pain, syncope, SOB, CHF, angina

Answer 3

aortic stenosis classic traid

Question 4

No carotid upstroke
Delayed peripheral impulses
Displaced apical pulse
SEM crescendo decrease high pitched RUSB
No S2
S4

Answer 4

aortic stenosis

Question 5

Avoid hypotension

Answer 5

aortic stenosis

Question 6

mercedes sign

Answer 6

aortic stenosis

Question 7

gold std forcath

Answer 7

aortic stenosis and pulm htn

Question 8

SBE PPX

Answer 8

mitral stenosis

Question 9

Congenital (MC), carcinoid, RV outflow obstruction

Answer 9

pulm stenosis

Question 10

PE
Systolic crescendo decrescendo mr over 3rd and 4th intercostal space
Palpable thrill, RV heave
Split S2
Jvd
RHF

Answer 10

pulm stenosis

Question 11

Cause
MCC dilation of valve ring from pulm HTN or dilation of pulm artery
Acquired from infective endocarditis, carcinoid, RH dysplasia

Answer 11

pulm regurg

Question 12

Diastolic mr over 3rd and 4th intercostal space
Split S2
Gram steel mr- high pitched blowing decres diastolic mr after P2 with pulm systolic pressure over 70 mmHg

Answer 12

pulm regurg

Question 13

JVD, diastolic MR over LLSB (3rd or 4th intercostal space)
Opening snap
Systemic venous congestion
No orthopnea

Answer 13

tricuspid stenosis

Question 14

AR trmt

Answer 14

Vasodilators (conflicting)
AVR
Immediate if acute

Question 15

as trmt

Answer 15

Statin
Avoid hypotension
Percutaneous valvuloplasty
TAVR
AVR

Question 16

PS trmt

Answer 16

Balloon valvuloplasty trmt of choice

Replace valve

Question 17

gram steel murmur

Answer 17

pr

Question 18

pr trmt

Answer 18

Usually dont repair

Treat underlying disease of pulm HTN

Question 19

ts trmt

Answer 19

Balloon valvuloplasty

Valve replacement with bioprosthesis

Question 20

tr trmt

Answer 20

No trmt if no pulm HTN
Diuretics
Dec afterload
Fix leaflets if damaged
Repair tricuspid

Question 21

_____ MR are always pathologic

Answer 21

Diastolic

Question 22

Bacterial endocarditis

trmt

Answer 22

Get rid of infection quick with ATB
IV PCN, ceftriaxone, gentamicin, vancomycin, rifampin, nafcillin, doxycycline at least 4 wks
No antiplatelets or antithrombins
Surgery if valve is damaged, persistent bacteremia, recurrent emboli
Dental PPX
Prosthetic cardiac valve, previous endocarditis, congenital heart disease, cardiac transplant
Take these meds in order if allergic to the one before it
Oral amoxicillin, IV or IM ampicillin/cefazolin/ ceftriaxone, IV or IM clindamycin

Question 23

“Horseshoe valve”

Answer 23

MR

Question 24

Holosystolic MR: blowing, high pitched, heard best at apex
Loud S4 if acute MR
S3 if LV dysfunction

Answer 24

MR

Question 25

MR trmt

Answer 25

Dec afterload Treat CHF (RAAS and SNS -> ACEI, ARBs, beta blockers, aldosterone antagonists) Treat CMP PCI or CABG if ischemic cause Cardiac resynchronization therapy (CRT)- BIV device Ring repair/annuloplasty ring Mechanical or bioprosthetic MVR

Question 26

MVP trmt

Answer 26

Reassurance No SBE Beta blockers if palpitations

Question 27

RHD MCC

Answer 27

MS

Question 28

Facial flush

Answer 28

MS

Question 29

MS trmt

Answer 29

``` SBE PPX if valve area less than 1.5 cm or rheumatic involvement Diuretics Treat AFib Beta blockers, anticoag No vasodilators Valvuloplasty Commisurotomy or MVR ```

Question 30

no vasodilators

Answer 30

MS