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Cardiology > Valvular HD > Flashcards

Valvular HD Flashcards

1
Q

VHD

Main two types

A
  • Congenital
  • Acquired
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2
Q

VHD

S1

A

Mitral and tricuspid closure

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3
Q

VHD

S2

A

aortic and pulmonary V closure

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4
Q

VHD

Apex beat

A

5th ICS just medial to the midclavicular line

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5
Q

VHD

Peds murmurs heard above the nipple line

A

ejection systolic

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6
Q

VHD

peds murmurs heard below the nipple line

A

Pansystolic

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7
Q

VHD

Mitral valve normal size

A

4-6 cm2

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8
Q

VHD

Mitral stenosis PC

A
  • SOB
  • Orthopnea
  • PND
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9
Q

VHD

Pulse in MS

A

irregularly irregular due to AF

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10
Q

VHD

JVP in MS

A

prominent “a” wave if complicated by Pulm HTN

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11
Q

VHD

Palpation in MS

A

tapping apex, parasternal heave

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12
Q

VHD

Auscultation findings in MS

A
  • Loud S1
  • Opening snap
  • Rumbling low- pitched mid diastolic murmur with presystolic accentuation
  • Best heard in mitral area w expiration and left lateral position
  • Pulm HTN - Loud P2
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13
Q

VHD

S1 in MS

A

Loud

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14
Q

VHD

Murmur in MS

A

rumbling low pitched mid diastolic murmur w presystolic accentuation

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15
Q

VHD

murmur is MS is heard on

A

mitral area with expiration on left lateral position

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16
Q

VHD

Signs of Pulm HTN

A
  • Parasternal heave
  • Loud palpable P2
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17
Q

VHD

DDs of MS

A
  • Carey coombs Murmur in acute rheumatic carditis
  • Austin flint murmur in severe AR
  • Atrial myxoma
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18
Q

VHD

whats a carey coombs murmur

A

mitral V is swollen

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19
Q

VHD

Atrial myxoma

A

a tumor growing through the mitral valve

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20
Q

VHD

main cause of MS

A

Rheumatic fever

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21
Q

VHD

MS is mostly affected among

A

Females> males

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22
Q

VHD

severe stenosed MS

A

<1 cm2

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23
Q

VHD

Complications of MS

A
  • A fib
  • Pulm edema
  • IE
  • Stroke ( AF can form thrombus)
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24
Q

VHD

Ix of MS

A
  • ECG
  • 2D echo
  • CXR
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25
Q

VHD

ECG on MS

A

P mitrale ( bifid P wave)

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26
Q

VHD

Ix of choice in Dx MS

A

2D echo

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27
Q

VHD

CXR on MS

A

small heart w an enlarged L/ atrium

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28
Q

VHD

Mx of MS

A
  • Mx A fib
  • interventional Mx
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29
Q

VHD

Interventional Mx of MS

A
  • PTMC ( Percutaneous transluminal mitral commisurectomy)
  • Valvotomy
  • Valve replacement ( rarely)
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30
Q

VHD

When is PTMC considered in MS

A
  • isolated MS
  • Minimal MR
  • L/atrium free of thrombus
  • MV mobile and pliable
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31
Q

VHD

Most Pts w MS present during

A

PG

32
Q

VHD

Two types of valve replacement

A
  • metallic- Pt should be on long- standing warfarin
  • Bioprosthetic - durability is ~ 10 years.
33
Q

VHD

why is bioprosthetic V not replaced on young females

A

it can get damaged during PG. so they are usually put in elderly

34
Q

VHD

MR apex

A

thrusting displaced apex

35
Q

VHD

Murmur in MR

A

pansystolic murmur at the apex radiating to the axilla

36
Q

VHD

Etiology of MR

A
  • RF
  • IE
  • Degenerative
  • IHD
  • dilated cardiomyopathy
37
Q

VHD

Why does IHD cause MR

A

ruputre of papillary muscles

38
Q

VHD

Complicated MR can lead to

A

heart failure

39
Q

VHD

Ix for MR

A
  • ECG - P mitrale, AF
  • CXR- LV and LA dilated
  • 2D echo
40
Q

VHD

Mx of MR

A
  • MV repair, MV replacement
41
Q

VHD

Indications for surgery in MR

A
  • Severe acute MR
  • Severe chronic symptomatic MR
  • ASx Chronic MR w evidence of progression of LV dilatation
42
Q

VHD

How can an austin flint murmur in severe AR cause MS

A

When blood backflows through the aortic V, it can hit the MV causing a MS

43
Q

VHD

PTMC

A

send a guiding wire and cute the stenosed V

44
Q

VHD

Isovolumic contraction

A

The Ventricles will be contracting as a closed chamber until it’s pressure increases to snap open the aortic and pulmonic valves

45
Q

VHD

Ejection systole

A

When the pressure increases in the ventricles to open, blood will enter into the aorta and pulmonary artery

46
Q

VHD

Pressure changes in the cardiac cycle is reflected in the

A

internal jugular V

47
Q

VHD

waves in JVP

A
  • a wave
  • c wave
  • v wave
48
Q

VHD

Two descents in JVP

A
  • X descent
  • Y descent
49
Q

VHD

a wave

A

due to atrial systole. SVC and IVC are valveless. So when the atria is contracting during systeole, some of the blood will regurgitate and see a pulsatile wave

50
Q

VHD

c wave

A

during isovolumetric contraction. when the ventricles contract as a closed chamber, due to the force, the TV and MV will be pushed out while remaining shut. this causes a reflex wave

51
Q

VHD

V wave

A

during atrial filling

52
Q

VHD

X descent

A

atrial relaxation

53
Q

VHD

Y descent

A

ventricular filling

54
Q

VHD

Abnormalities of JVP

A
  • Non- pulsatile raised JVP
  • Loss of a wave
  • Prominent a wave
  • canon a wave
  • cv wave
  • sharp x descent
55
Q

VHD

non- pulsatile raised JVP

A

SVC obstruction. due to the block, nothing from the atria will be transmitted to the int. jugular V. Also because of the block, blood gets backedup increasing JVP

56
Q

VHD

loss of a wave

A

no proper atrial contraction like in A fib

57
Q

VHD

Prominent a wave

A

tricuspid stenosis
Pulm HTN

58
Q

VHD

How can Pulm HTN cause a prominent a wave

A

Pulm artery pressure increase overtime. RV will undergo hypertrophy. High pressure in atria to push blood into RV coz the pressure in RV increase due to the hypertrophy. More blood regurgitated to the SVC

59
Q

VHD

Canon a wave

A

in complete heart block
No connection netween the atria and ventricles. Atria is unaware of what happened in the ventricles. So atria will contract while the TV and MV closed. ( It’s the SA node that tells TV and MV to open for atrial systole) since there is a heart block, cardiac process not in sync. Pressure in atria increase more blood regurgitate to SVC.

60
Q

VHD

cv wave

A

tricuspid regurgitation. c & v become one large wave together

61
Q

VHD

sharp x descent

A

constrictive pericarditis

62
Q

VHD

AR Sx

A
  • Exertional dyspnea
  • palpitations
63
Q

VHD

Pulse AR

A
  • collapsing pulse
  • Prominent peripheral pulses
64
Q

VHD

AR apex

A
  • displaced and hyperkinetic ( thrusting )
  • Palpitations
65
Q

VHD

Murmur in AR

A

early diastolic M best heard at lower left sternal edge and patient sitting up and holding the breath on expiration

66
Q

VHD

Peripheral signs of AR

A
  • head nodding ( de Musset’s sign)
  • Visible carotic pulsations ( Corrigan’s sign)
  • Capillary pulsations (Quincke’s sign)
  • Pistol shot femorals
  • examination of the pupils - argyll robertson ( syphillis)
  • Examine the joints and back for RA, ankylosing spondylitis
67
Q

VHD

etiology of AR

A
  • Acquired
  • Congenital
68
Q

VHD

Congenital causes for AR

A
  • Marfans - aortic root dilatation
  • Osteogenesis imperfecta
69
Q

VHD

Acquired causes of AR

A
  • Rheumatic heart disease
  • IE
  • Trauma
  • Aortic dissection
  • Severe HTN
  • Syphillid
  • Seronegative arthritis
  • Rheumatoid Arthritis
70
Q

VHD

a longer and a louder murmur

A

severe lesion

71
Q

VHD

How would you say is an AR is severe

A
  • the longer the murmur the louder the murmur
  • Presence of the austin - flint murmur
  • Wide pulse pressure
  • Features of LV failure
72
Q

VHD

Ix for AR

A
  • ECG - LVH in advanced cases
  • CXR- LV dilatation and aortic rootdilatation in some cases
  • Echo
73
Q

VHD

Mx of AR

A
  • Medical - Mx HF ( ACEI, diuretics)
  • Surgical
74
Q

VHD

When to consider surgery in AR

A
  • acute AR
  • Sx patients
  • ASx pts w progressively increasing ventricular dilatation and declining LV function
75
Q

VHD

PC of AS

A
  • syncope
  • SOB
  • Chest pain
76
Q

VHD

A

Cardiology (7 decks)

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