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Cardiology > Valvular Disorder Part 2 > Flashcards

Valvular Disorder Part 2 Flashcards

1
Q

What side of the heart is MC to have a valvular disorder?

A

Left - the higher pressure side

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2
Q

Whenever you hear a murmur, what must you do?

A

Order an ECHO!

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3
Q

What is a common finding in aortic stenosis?

A

Radiation to the carotids

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4
Q

What are the valves of the right side of the heart?

A

Tricuspid
Pulmonic

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5
Q

What classes of medicine are used for contractility and fluid overloads?

A

Contractility = BB
Fluid overload = diuretics

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6
Q

Difference between stenotic murmur and regurg

A

Stenotic murmur = mid (have to hear valve close first)

Regurg = early (you do not hear the valve close)

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7
Q

What is the only thing that changes from C1 to C2 stage of murmur and how do you discover this?

A

Abnormal LV function in C2
Order an ECHO

-often see dyspnea on exertion, pulmonary edema (cough because of congestion, frank hemptosis if rupture, blood tinged sputum - pink frothy sputum)

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8
Q

What closes during S1

A

Atrioventricular valves close

MV and TV

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9
Q

Aortic stenosis hearing

A

Systolic mid murmur,
Heard best over the right 2nd and 3rd intercostals
-heard over carotids
-Laterally displaced, sustained apical impulse
-S4 because you hear blood hit the wall because the heart has to contract harder
-sometimes a thrill

EKG: QRS complex in 456

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10
Q

Aortic regurg - when is it heard?

A

Dyastolic (because blood comes back from aorta and goes back to ventricle)
POLO - every regurg is like this because the valve never closes
-Heard best over the left sternal post because the blood flows back to the left sternum.
-heard best at the mitral post
- S3 or S4 gallop
-widened pulse pressure because the diastolic pressure is normal or low.

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11
Q

When do you hear mitral stenosis?

A

Diastole: because we are filling LV
Typically mid systolic
Heard over the mitral post
Radiation to the axillary space in left lateral decubitus because left atria can expand out in this position
Opening snap - because you can hear calcified
-Best heard with bell (often covered with breast tissue) - often missed

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12
Q

When do you hear mitral regurgitation?

A

Systole: mitral valve is supposed to be closed, so blood jets back up
-Hear radiation to the axilla (sometimes back) because there is a strong force assocaited with systole
-holo systolic (because it is regurg)
- Mitral valve prolapse can cause regurg, so sometimes you hear a click

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13
Q

What is tricuspid stenosis overview

A

Heard during dyastole
Mid dyastole (because valve is calcified)
Backs up into SVC and IVC
Can see JVD
Can see ascites and hepatic congestion before LE edema

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14
Q

How common is tricuspid stenosis seen?

A

Rare - seen MC in females

Don’t normally see it by itself because the right side often can compensate for this

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15
Q

What can we expect to happen physiologically and clinically when we see a patient with tricuspid stenosis?

A

Reduced RA emptying leads to reduced LV output, meaning that the LV has to pump harder and faster

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16
Q

What is the MC of tricuspid stenosis?

A

Rheumatic heart disease
Because we treat GABHS, this is why it is rare

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17
Q

Why do you see fatigue in Tricuspid stenosis?

A

Stenotic blood and less O2 delivery

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18
Q

When do you hear the murmur in tricuspid stenosis and how do you differentiate this from mitral stenosis?

A

mid diastolic, heard better during inspiration because there is more blood in the right side of the heart

Heard best in tricuspid

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19
Q

What is the PE of tricuspid stenosis?

A

Right sided heart failure

JVD
ascites
LE edema
Possibly palpable pre-systolic liver pulsation coinciding with atrial contraction

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20
Q

What do you possibly see in EKG of tricuspid stenosis?

A

RAE

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21
Q

What do you sometimes see in CXR of tricuspid stenosis?

A

Cardiomegaly specifically in the right side d/t RAE

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22
Q

How do you treat tricuspid stenosis?

A

loop diuretics: Torsemide or bumetanide if bowel edema

23
Q

How do you treat ascities from tricuspid stenosis?

A

aldosterone antagonist if liver congestion or ascites is present

24
Q

What often leads to Tricuspid regurgitation?

A

Dilation of the RV and tricuspid annulus leads to this regurge

puts strain on the tricupsid valve, allowing blood to go back into the RA

25
Q

Where does blood not reach in tricuspid regurg?

A

Does not get to the lungs

26
Q

What differs tricuspid regurg from tricupsid stenosis on PE?

A

ONLY THE MURMUR

same s/s of right sided HF, because blood will back up into the RA and then into the SVC and IVC

27
Q

What is a complication of pulmonary system in tricupsid regurg?

A

Pulmonary hypertension

28
Q

What type of murmur do you hear in tricuspid stenosis and when is it louder?

A

Holosystolic murmur (because during systole, the blood is supposed to enter the pulmonary artery, but can get regurged from the RV into the the RA)

Loudest when increasing venous return

29
Q

How do you diagnose a tricuspid regurg?

A

ECHO!

30
Q

Treatment for tricuspid regurg?

A

Underlying cause
Managing for medical therapies based on s/s

31
Q

Do you normally replacing the valve for tricuspid regurg?

A

Typically not (low pressure system)

Will replace if there is another underlying problem like a tumor

32
Q

Do you do anticoagulation therapy for tricuspid regurg?

A

No - only if Afib is present

33
Q

What typically causes pulmonic stenosis?

A

Congenital disorder
Seen with right-sided HF at a young age and confirmed with echo
Tri 13 and Noonan syndrome

34
Q

Where does blood back up with pulmonary stenosis?

A

Backs up into the RV, then the RA, and then the SVC and IVC

35
Q

What is the presentation of pulmonic stenosis at birth

A

central cyanosis

36
Q

What is the murmur of pulmonary stenosis?

A

Systolic ejection murmur that is heard at the upper sternal border

37
Q

Why do you hear an opening click in pulmonic stenosis?

A

Opening click and RV lift on palpation of precordium because the heart is trying hard

38
Q

How do you treat pulmonic stenosis?

A

Cardio referal

39
Q

When do you hear pulmonic stenosis?

A

holo diastolic, whooshing sound over pulmonic post

40
Q

What is group 2 pulmonary HTN?

A

pulmonary hypertension due to left heart disease leads to right hearted problems

41
Q

In addition to an echo, what is often ordered for pulmonic stenosis?

A

Cardiac MRI and CT in order to see dilated pulmonary system

42
Q

How do you manage pulmonary regurg?

A

Treat underlying pulmonary HTN

Valve replacement is rare

43
Q

What valves do we use for valve surgery?

A

Mechanical valve: need to be on warfarin (INR 2.5-3.5)

Prosthetic valve:

44
Q

Which valves last the longest?

A

Mechanical can last forever - but need to be on Warfarin all of the time

Prosthetic valve: last 10 years

45
Q

What is a risk of a mechanical valve?

A

High thromboembolic risk
NEED to be on warfarin (no other anticoag)
Goal INR 2.5-3.5

46
Q

What is an advantage of prosthetic valve?

A

Lower risk of thrombosis
Just need aspirin therapy

only lasts like 10 years

47
Q

What causes rheumatic heart disease and what age is it typically seen?

A

GABHS
Child 4-9 yo

48
Q

What does rheumatic fever lead to?

A

Pancarditis often with excudate

would see lymphocytes in myocardium if there is biopsy (not normally done) because of infection

49
Q

If you were to do a biopsy of rheuatic heart, what would you see?

A

Aschoff body (Collection of myocytes and macrophages surrounded by fibrous tissue)

50
Q

What do you see commonly on the mitral valve of rheumatic heart disease?

A
  1. Valvulitis is characterized by verrucous lesions on leaflet edge
  2. MV most commonly affected, followed by AV
51
Q

What is the major criteria of JONES criteria for rhemuatic fever?

A

Joints (polyarthritis)
O (carditis) = looks like a heart
Nodules (subcutaneous)
Erythema marginatum
Sydenham chorea (rhytmic movenets that are not controlled)

52
Q

What do you need to dx rheuamtic fever with JONES criteria?

A

2 major criteria met
1 major and 2 minor criteria met
AND if criteria are present following a recent, DOCUMENTED strep infection from a provider

needs to be confirmed with an ECHO!

53
Q

What are the minor criteria of rheumatic fever?

A

CAFE PAL

CRP
Arthralgia
Fever
Elevated ESR

Prolonged PR interval
Anamnesis of Rheumatism
Leukocytosis

54
Q

What is the treatment plan of rheumatic heart disease?

A

PCN to eradicate strep
Salicylates used for fever and arthritis
Prophylaxis with PEN G for 10 years

Cardiology (22 decks)

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