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ACNP 1 > Valvular HD > Flashcards

Valvular HD Flashcards

1
Q

What are some causes of a systolic murmur

A

Aortic stenosis, mitral regurgitation, pulmonary stenosis

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2
Q

What are some causes of a diastolic murmur

A

Aortic or pulmonary regurg. Or mitral stenosis

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3
Q

Who do we always Echo?

A 
Symptomatic Valve Dx
Diastolic murmur
Late or holosystolic murmur
Radiating murmur 
Click murmur
Grade 3 or louder
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4
Q

Who do we not echo?

A

Grade 2 or lower

Mid systolic murmur less than grade 3

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5
Q

A murmur that is 4/6 late peaking systolic murmur that radiates to the carotid and a paradoxically split S2 is what type of murmur?

A

Aortic stenosis

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6
Q

With aortic stenosis what findings would you anticipate?

A

EKG- hypertrophy
CXR-cardiomegally
Systolic murmur

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7
Q

What are the treatments with aortic stenosis

A

Don’t want tachycardia
Be careful lowering BP
Exercise restrictions for moderate to severe
Severe- AVR mechanical or prosthetic

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8
Q

With mechanical and prosthetic valves. You must do what to prevent clots? How do you do this?

A

Anticoagulate all mechanical valves with Coumadin and ASA for INR goal of either 2-3 or 2.5-3.5 for severe high risk (AF/Left ventricle dysf.)

Prosthetic valves ASA daily 75-100mg
With risk factors INR 2-3

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9
Q

Cause of aortic stenosis

A

Congenital
Calcification
Rheumatic heart Dx

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10
Q

Causes of aortic regurgitation

A 
Idiopathic aortic dilation
Bicuspid valve
Calcification
Rheumatic heart disease
Marfans 
Dissection of the aorta
Endocarditis
Systemic HTN
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11
Q

Aortic regurg causes what symptoms?

A

Pulmonary edema from backing up into the lungs

Cardiogenic shock

Diastolic murmur
Widened pulse pressure (30-50 normal)
Austin-Flint rumble

LVH- EKG
Lv dialation

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12
Q

If Aortic Regurgitation is caused by bicuspid aortic valves then what is a concern?

A

AAA

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13
Q

What is the treatment for a AAA?

A

Beta blockers until operate.

Once it grows more then 5cm or more than 0.5cm in one year

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14
Q

What is the plan for AR

A

TEE/ECHO EKG
Beta blocker

If trauma or aortic dissection then-
Surgical emergency
Nipride and Inotropic agents may be helpful

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15
Q

Mitral stenosis is caused by?

A

Rheumatic fever
Congenital
SLE
Calcification

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16
Q

What are symptoms of Mitral stenosis?

A 
CHF
Orthoptera
AF
Diastolic murmur
Opening snap 
EKG Left atrial enlargement
17
Q

What murmur causes a diastolic murmur, low pitch rumbling radiating to axilla

A

Mitral stenosis

18
Q

What is the treatment for mitral stenosis?

A 
No strenuous exercise 
Fluid and salt restrictions
Treat AF
No echo annually unless severe
Watch for pulmonary HTN
19
Q

If pulmonary HTN occurs with mitral stenosis what should the patient have done?

A

Per cutaneous mitral balloon valvuloplasty

If severe MVR

20
Q

What causes mitral regurgitation?

A 
Rheumatic fever
CAD
Dilated LV
I.E.
Mitral prolapse
21
Q

What murmur causes a pansystolic murmur loudest at apex and radiating to axilla and an S3 sound?

A

Mitral regurg

22
Q

What is the treatment for mitral regurgitation?

A

None for general A symptomatic treatment

No vasodilators

ACEI, Coreg, bivebtricular pacing of severe

23
Q

If the patient has a new murmur and fever what should you check for?

A

Endocarditis

24
Q

What puts someone at risk for I.E.?

A 
Heart defect
IVDU
Valve
Previous I.E. 
Poor dentition
25
Q

What are Janes way lesions?

A

Non painful lesions in hands that I.E. Patients can get

26
Q

What are Oslers nodules

A

Painful lesions on toes that IE can get

27
Q

If a patient with I.E. Is being treated with ABX and isn’t getting better what do you anticipate?

A

Paravalvular abscess

28
Q

What are some diagnostic tests you’ll want with I.E.?

A

Blood cultures
CBC
Sediment rate
Echo TEE

29
Q

Who would you prescribe prophylactic ABX to?

A

Previous I.E. Patients
Prosthetic HV patients
CHD that is I repaired or repaired with residual effects and 6 months after repair
Cardiac transplant with valvulopathy

30
Q

When do you cover selected patients with ABX?

A

Dental work or work on skin, respiratory and musculoskeletal

31
Q

What do you prescribe for ABX prophylactic coverage?

A

Amoxicillin 2GM 1 hour prior

Clindamycin 600 1 hour before

ACNP 1 (12 decks)

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