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Cardiac > Valvular Disorders > Flashcards

Valvular Disorders Flashcards

Module 3

1
Q

Which valvular disease is most common in patients >60 years old due to calcific changes related to advanced age?

A

Aortic stenosis

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2
Q

S1 is louder at the

A

Apex

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3
Q

S2 is louder at the

A

Base

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4
Q

Where can the aortic valve be auscultated?

A

Right upper sternal border, 2nd ICS

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5
Q

Where can the pulmonic valve be auscultated?

A

Left upper sternal border, 2nd ICS

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6
Q

Where can the tricuspid valve be auscultated?

A

Lower left sternal border, 4th ICS

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7
Q

Where can the mitral valve be auscultated?

A

Cardiac apex, mid clavicular line, 5th ICS

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8
Q

The diaphragm of a stethoscope is best used for

A

Higher-pitched sounds of S1 and S2
Murmurs of aortic and mitral regurgitation and pericardial friction rub

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9
Q

The bell of a stethoscope is best used for

A

Lower-pitched sounds of S3 and S4
Low-rumbling murmur of mitral stenosis

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10
Q

S1 indicates

A

Beginning of systole - tricuspid and mitral valves close

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11
Q

S2 indicates

A

Beginning of diastole - aortic and pulmonic valves close

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12
Q

A split S2 is not uncommon during

A

Inspiration
(Right heart filling time, right ventricular stroke volume, and right ventricular ejection duration are all increased, causing delay in closure of the pulmonic valve)

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13
Q

The intensity of a split S2 decreases with

A

Aortic stenosis or pulmonic stenosis

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14
Q

S3 should not be audible and occurs in

A

Early diastole, heard just after S2S

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15
Q

When would an S3 heart sound be normal?

A

Pregnancy and kids

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16
Q

S3 is an early sign of

A

Fluid overload

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17
Q

S4 occurs at the end of

A

Diastole and should not be audible
Just before S1

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18
Q

S4 occurs due to

A

Ventricles resistant to filling/weak ventricles

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19
Q

An S4 heart sound is

A

Pathologic

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20
Q

What valvular disorders can be heard during diastole?

A

Aortic regurgitation, Mitral stenosis

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21
Q

What valvular disorders can be heard during systole?

A

Aortic stenosis, Mitral regurgitation, Mitral valve prolapse, Pulmonic stenosis

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22
Q

Which 2 valvular disorders create an early diastolic murmur?

A

Aortic regurgitation, pulmonic regurgitation

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23
Q

Which 2 valvular disorders create a mid-diastolic murmur?

A

Mitral stenosis, tricuspid stenosis

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24
Q

Which 2 valvular disorders create a mid-systolic crescendo-decrescendo murmur?

A

Aortic stenosis and pulmonic stenosis

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25
Q

Which 2 valvular disorders create a late-systolic crescendo murmur?

A

Mitral valve prolapse, tricuspid valve prolapse

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26
Q

Which 3 valvular disorders create a holosystolic/pansystolic murmur?

A

Mitral regurgitation, tricuspid regurgitation, VSD

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27
Q

Which valvular disorder creates a continuous murmur?

A

PDA or AV fistula

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28
Q

What are 3 causes of mitral and tricuspid stenosis?

A

VSD, ASD, rheumatic fever

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29
Q

What are 5 causes of aortic stenosis or pulmonic stenosis?

A

Aortic obstruction, dilation of ascending aorta, dilation of pulmonary artery, ASD (left to right shunt), hypertrophic obstructive cardiomyopathy

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30
Q

What causes mitral valve prolapse or tricuspid valve prolapse?

A

Papillary muscle dysfunction

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31
Q

What causes mitral regurgitation or tricuspid regurgitation?

A

VSD (high pressure to low pressure chamber)

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32
Q

The valsalva maneuver can increased the sound of which murmur?

A

Mid-systolic murmur (aortic stenosis, pulmonic stenosis)

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33
Q

What are initial diagnostic tests for valvular disorders?

A

Echo, 12-lead EKG, chest x-ray

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34
Q

If indicated, what are additional diagnostic tests for valvular disorders?

A

Stress test with exercise EKG, cardiac MRI, cardiac catheterization

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35
Q

What are 5 differential diagnoses for a systolic murmur?

A

Aortic stenosis, pulmonic stenosis, MVP, mitral regurgitation, tricuspid regurgitation

36
Q

What are 4 differential diagnoses for a diastolic murmur?

A

Aortic regurgitation, pulmonic regurgitation, mitral stenosis, tricuspid stenosis

37
Q

What are the 4 stages of valvular heart disease?

A

Stage A: at risk
Stage B: progressive (mild-mod severity and asymptomatic)
Stage C: asymptomatic severe
Stage D: symptomatic severe

38
Q

Stage C: Asymptomatic severe valvular heart disease can be broken into 2 additional stages

A

C1: left or right ventricle remains compensated
C2: decompensation of the left or right ventricle

39
Q

What are 5 red flags of valvular disorders that require immediate referral?

A

Diastolic murmurs, holosystolic murmurs, systolic murmurs grade 3+, murmur with presence of a new extra heart sound (S3, S4 or a click), or a murmur that increases in intensity when patient stands

40
Q

Which valve operation is most common and for what valvular disorder?

A

Aortic valve replacement for aortic stenosis

41
Q

What is the most common type of valvular heart disease?

A

Aortic stenosis

42
Q

An aortic valve <1 cm indicates

A

Poor prognosis

43
Q

If an aortic valve becomes a bicuspid valve in utero, risk of aortic stenosis is increased by

A

50%

44
Q

What kind of murmur does aortic stenosis produce?

A

Mid-systolic crescendo-decrescendo murmur

45
Q

Aortic stenosis may lead to

A

Left atrial enlargement, LVH, pulmonary HTN

46
Q

Treatment for asymptomatic patients with aortic stenosis

A

Not needed

47
Q

If a patient has stage D and asymptomatic or stage C with surgical risks, they may require

A

Transcatheter aortic valve replacement (TAVR)

48
Q

The chronic slow leak of aortic regurgitation leads to

A

Increased left ventricular volume leading to LVH

49
Q

Acute aortic regurgitation is often related to

A

Infective endocarditis or trauma

50
Q

Clinical presentation of aortic regurgitation may progress to

A

HF, ascites, hepatomegaly, pulmonary congestion

51
Q

What are the unique findings of aortic regurgitation?

A

Large, high-pitched diastolic murmur (not common), Austin Flint murmur (mitral mid-diastolic murmur)

52
Q

An Austin Flint murmur indicates

A

Large regurgitant flow

53
Q

When aortic regurgitation is secondary to inflammation, it may cause what results on an EKG?

A

Prolonged PRI

54
Q

What are complications of aortic regurgitation?

A

1st degree block, atrial fibrillation, bradycardia

55
Q

What is the most common cause of mitral regurgitation and mitral valve disease?

A

Mitral valve prolapse

56
Q

What is the most common cause of mitral valve prolapse?

A

Idiopathic myxomatous degeneration

57
Q

Mitral valve prolapse is more prevalent in

A

Young women

58
Q

What kind of murmur does a mitral valve prolapse create?

A

Late systolic crescendo murmur that is loud and musical, preceded by a mid-systolic click (not always) best heard at the lower left sternal border or at the apex

59
Q

Patients with MVP should have clinical and echocardiographic follow-up evaluation every

A

3-5 years

60
Q

Mitral stenosis is common in

A

Pregnancy due to increased circulatory blood volume

61
Q

The predominant cause of mitral stenosis is

A

Rheumatic fever

62
Q

What is the principal symptom of mitral stenosis?

A

Dyspnea (class II)

63
Q

For a patient with asymptomatic mitral stenosis, what classification is considered?

A

Functional class I

64
Q

What kind of murmur does mitral stenosis cause?

A

Low-pitched rumble diastolic murmur best heard with the bell over the apex in exhalation in left lateral position

65
Q

Patients with mitral stenosis who have fib associated with ventricular dysfunction can be treated with

A

Digoxin and need anticoagulation

66
Q

What is the treatment for recurring rheumatic fever?

A

PCN prophylaxis, PO diuretics and sodium restriction

67
Q

Mitral stenosis may lead to

A

Right ventricular hypertrophy

68
Q

Which arrhythmia is common with mitral stenosis?

A

Atrial fibrillation

69
Q

What is the hallmark of rheumatic disease?

A

Aschoff bodies in myocardium

70
Q

What would an EKG of mitral stenosis show?

A

NSR with left atrial enlargement, notched p wave in limb leads

71
Q

What are the second leading causes of mitral regurgitation?

A

Ischemic LV dysfunction and dilated cardiomyopathy

72
Q

What connective tissue disease can cause mitral regurgitation?

A

Marfan’s syndrome

73
Q

Marfan’s syndrome can cause mitral regurgitation due to

A

Acute, spontaneous rupture of chordae tendinae

74
Q

What kind of murmur does mitral regurgitation cause?

A

Harsh pansystolic/holosystolic blowing murmur best heard at the apex and radiating to the axilla, back, or left sternal border

75
Q

What medications can be used in mitral regurgitation?

A

B-adrenergic blockade, ACEIs, ARBs, aldosterone antagonists

76
Q

Pulmonary stenosis commonly occurs in

A

Congenital defects - related to mothers with rubella

77
Q

What are rare causes of pulmonary stenosis?

A

Endocarditis or rheumatic heart disease

78
Q

What kind of murmur does pulmonary stenosis create?

A

Mid-systolic murmur over 2nd ICS left sternal border

79
Q

Pulmonary stenosis may cause a pulmonic ejection sound best heard in the

A

2nd and 3rd left ics and may reveal a normal S1 and widely split S2

80
Q

What is the treatment for pulmonary stenosis in infants?

A

Percutaneous balloon pulmonary valvuloplasty

81
Q

What would an EKG reveal in pulmonary stenosis?

A

Right axis deviation

82
Q

Patients with pulmonary stenosis should receive

A

Precautionary antibiotics

83
Q

Pulmonary regurgitation is rare and is usually related to

A

Congenital heart disease

84
Q

What kind of murmur does pulmonary regurgitation cause?

A

Early diastolic murmur over 2nd ICS left sternal border

85
Q

What is the treatment for pulmonary regurgitation?

A

Focused on infective endocarditis and pulmonary HTN

86
Q
A

Cardiac (7 decks)

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