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Foundations of Clinical Practice II > Valvular Heart Disease 1.25.18 > Flashcards

Valvular Heart Disease 1.25.18 Flashcards

1
Q

How many cusps does the mitral valve have?

A

2 (posterior cusp -smaller, and anterior cusp - bigger)

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2
Q

S1 is created by the closing of what?

A

mitral and tricuspid (AV valves)

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3
Q

S2 is created by the closing of what?

A

semilunar valves

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4
Q

How many phases of diastolic filling are there?

A

2

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5
Q

Describe the two phases of diastolic filling

A
  1. Passive rapid filling as ventricles relax (80% of ventricular filling)
  2. Atria contract
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6
Q

Name 5 causes of Left Ventricular diastolic dysfunction

A
  1. Longstanding HTN
  2. Ventricular hypertrophy
  3. Fibrosis
  4. Infiltrative cardiomyopathy
  5. Pericardial constriction
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7
Q

S3, or ventricular gallop, is most commonly associated with what?

A

Left ventricular failure/overload

blood from the left atrium slams into an enlarged ventricle during early diastole

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8
Q

When can S3 be heard?

A

early diastole

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9
Q

S4, or atrial gallop, is most often associated with what?

A

left ventricular hypertrophy

blood trying to enter a stiff, non-compliant left ventricle during atrial contraction

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10
Q

Which murmurs increase with inspiration?

A

right-sided murmurs

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11
Q

What murmur is harsh, systolic, best heard at left sternal border?

A

Ventricular septal defect (VSD)

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12
Q

Dyspnea (exertional, postural, nocturnal paroxysmal) rales, pleural effusion (diminished breath sounds) pallor/cyanosis, fatigue, tachycardia are signs of what?

A

Left heart failure

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13
Q

JVD, peripheral edema, hepatomegaly, ascites, hepatojugular reflex, weight increase are signs of what?

A

Right heart failure

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14
Q

What type of murmur is heard in a quiet room by an expert examiner?

A

Grade I

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15
Q

What type of murmur is heard by most examiners?

A

Grade II

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16
Q

What type of murmur is loud without thrill?

A

Grade III

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17
Q

What type of murmur is loud with thrill?

A

Grade IV

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18
Q

What grade of murmur has a thrill with a VERY loud murmur audible with stethoscope placed lightly over the chest?

A

Grade V

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19
Q

Grade of murmur with thrill and very loud murmur audible even with stethoscope slightly away from chest?

A

Grade VI

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20
Q

When can a continous murmur be heard?

A

throughout systole and diastole

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21
Q

What diagnostic test/eval is indicated for systolic murmur greater than grade II and any diastolic murmur?

A

Echocardiogram

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22
Q

Most common cause of aortic stenosis

A

calcified valve

also caused by rheumatic fever

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23
Q

What is the initial compensatory response of the heart with aortic stenosis?

A

Left ventricular hypertrophy

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24
Q

Describe the changes in the left atrium with aortic stenosis

A

the left atrium will also hypertrophy in attempt to overcome the increased resistance due to the hypertrophy of the left ventricle

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25
Where can a murmur radiate with aortic stenosis?
carotids
26
Where can a murmur radiate with aortic regurgitation?
left sternal border
27
Classic triad of aortic stenosis (usually severe AS)
1. Angina 2. Syncope 3. Heart Failure
28
What type of murmur is associated with aortic stenosis?
- mid systolic, - crescendo-decrescendo - harsh - radiating to neck
29
Aortic stenosis exam
1. Delayed carotid upstroke 2. Sustained apicial impulse 3. Split S2, S3, if heart failure. S4 due to stiff LV
30
What type of test is contraindicated in patients with severe aortic stenosis?
Exercise stress test
31
What is the medical therapy for severe aortic stenosis?
ineffective, need surgery or TAVR (transcatheter AV replacement)
32
Indications for surgical intervention for aortic stenosis
- severe AS with symptoms - LV dysfunction as result of AS - Moderate aortic stenosis when the patient needs CABG (class IIa recommendation)
33
Balloon valvuloplasty is a safe and effective treatment for AS in what population?
pediatric with congenital stenosis
34
What are the two types of valves?
1. Bioprosthetic | 2. Mechanical
35
Bioprothetic valves
1. Shorter lifespan than mechanical (10-15 years) | 2. usually used in elderly
36
Mechanical valve
1. Longer lifespan (should last lifetime of patient) 2. Life long anticoagulation (Warfarin only!) 3. Usually used in younger populations
37
Name 3 issues/complications with a TAVR (transcatheter aortic valve replacement)?
1. CVA 2. Complete heart block 3. Paravalvular leak
38
Chronic causes of aortic regurgitation
1. Degenerative valve disease 2. Root dilation 3. Rheumatic fever 4. Endocarditis 5. Collagen vascular diseases
39
Acute causes of aortic regurgitation
1. Aortic dissection 2. Endocarditis 3. Post valve replacement 4. Valvuloplasty
40
Aortic regurgitation physical exam findings
1. Widened pulse pressure 2. Water hammer pulse - rapid upstroke, quick collapse 3. Blowing diastolic decrescendo murmur (LUSB) 4. Austin Flint Murmur - mid-late diastolic rumble heard at apex in severe AR
41
What might be found on a CXR of aortic regurgitation?
1. Cardiomegaly 2. Dilated aortic knob 3. Pulmonary edema (maybe)
42
What is medical management of patients who are nonsurgical candidates with aortic regurgitation?
- Vasodilators - Calcium channel blockers - ACE -inhibitors
43
What type of patient with aortic regurgitation would benefit from Beta blocker?
1. Marfan syndrome | 2. Bicuspid aortic valves
44
What should you think with acute aortic regurgitation?
AORTIC DISSECTION!
45
What physical exam findings would you expect in acute aortic regurgitation?
1. Signs of hemodynamic compromise 2. Diastolic murmur is softer than chronic 3. Thready weak pulse 4. Soft or absent S1
46
Are Beta blockers indicated in acute aortic dissection?
yes, beta blockers help reduce force from LV ejection to the arterial wall
47
What is the most common cause of mitral regurgitation?
mitral valve prolapse
48
What is the classic finding of mitral valve prolapse?
mid systolic click also, holosystolic blowing murmur of mitral regurg
49
How does the heart compensate for chronic mitral regurgitation?
the heart increases inotropy (or contraction strength) to keep flow going forward
50
What type of murmur is classic in mitral regurgitation?
holosystolic, apical, blowing murmur - radiation to the axilla - often with thrill
51
Which heart sound is associated with mitral regurgitation?
pansystolic murmur
52
Why is repair better than replacing the valve in mitral regurgitation?
repair has less morbidity and mortality (need to anticoagulate for 3 months)
53
What is the treatment for acute mitral regurgitation?
- IV nitro (afterload reduction) | - IABP implant as bridge to urgent surgery
54
What is the cause for nearly all mitral valve stenosis?
rheumatic fever
55
High thromboembolic risk if patient has Afib and ______
mitral valve stenosis
56
Enlarged left atrium from mitral stenosis impinges on recurrent laryngeal nerve causing _____
hoarseness
57
The opening snap followed by low pitched rumbling mid-diastolic murmur of mitral stenosis is best heard with _______
Bell while patient is in left lateral decubitus position
58
What 3 tests would you consider for a tricuspid stenosis?
1. EKG 2. Echocardiogram 3. Cardiac cath (if concern for other valve abnormalities or open repair planned)
59
Which type of valve is preferred in the tricuspid postion? Why?
bioprothesis is preferred as mechanical prothesis have high thrombotic risk in tricuspid position
60
Most common cause of Tricuspid regurgitation
dilated right ventricle dilating the annulus of the valve
61
what murmur is associated with tricuspid regurgitation?
- pansystolic - 3rd to 4th intercostal space - increases with inspiration
62
what murmur is associated with pulmonic stenosis
- harsh - systolic - crescendo-decrescendo - best heard at 3-4 ICS
63
What might pulmonic stenosis show on EKG?
right axis deviation and Right ventricular hypertrophy
64
A brief low pitched diastolic murmur heard at the 3rd and 4th ICS
pulmonary regurgitation murmur
65
Name the 4 defects of Tetralogy of Fallot
1. Ventricular septal defect 2. Pulmonic stenosis 3. Overriding aorta (over the ventricular septal defect) 4. Right ventricular hypertrophy
66
What does squatting accomplish in tetralogy of Fallot?
Squatting decreases right to let shunt
67
Describe the murmur associated with Tetralogy of Fallot
Harsh and systolic. Largely due to the ventricular septal defect
68
What antibiotic is the go to for prohylaxis before a dental proceedure?
Amoxicillin

Foundations of Clinical Practice II (25 decks)

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