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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
Q

Where can a murmur radiate with aortic stenosis?

A

carotids

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26
Q

Where can a murmur radiate with aortic regurgitation?

A

left sternal border

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27
Q

Classic triad of aortic stenosis (usually severe AS)

A
  1. Angina
  2. Syncope
  3. Heart Failure
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28
Q

What type of murmur is associated with aortic stenosis?

A
  • mid systolic,
  • crescendo-decrescendo
  • harsh
  • radiating to neck
29
Q

Aortic stenosis exam

A
  1. Delayed carotid upstroke
  2. Sustained apicial impulse
  3. Split S2, S3, if heart failure.
    S4 due to stiff LV
30
Q

What type of test is contraindicated in patients with severe aortic stenosis?

A

Exercise stress test

31
Q

What is the medical therapy for severe aortic stenosis?

A

ineffective, need surgery or TAVR (transcatheter AV replacement)

32
Q

Indications for surgical intervention for aortic stenosis

A
  • severe AS with symptoms
  • LV dysfunction as result of AS
  • Moderate aortic stenosis when the patient needs CABG (class IIa recommendation)
33
Q

Balloon valvuloplasty is a safe and effective treatment for AS in what population?

A

pediatric with congenital stenosis

34
Q

What are the two types of valves?

A
  1. Bioprosthetic

2. Mechanical

35
Q

Bioprothetic valves

A
  1. Shorter lifespan than mechanical (10-15 years)

2. usually used in elderly

36
Q

Mechanical valve

A
  1. Longer lifespan (should last lifetime of patient)
  2. Life long anticoagulation (Warfarin only!)
  3. Usually used in younger populations
37
Q

Name 3 issues/complications with a TAVR (transcatheter aortic valve replacement)?

A
  1. CVA
  2. Complete heart block
  3. Paravalvular leak
38
Q

Chronic causes of aortic regurgitation

A
  1. Degenerative valve disease
  2. Root dilation
  3. Rheumatic fever
  4. Endocarditis
  5. Collagen vascular diseases
39
Q

Acute causes of aortic regurgitation

A
  1. Aortic dissection
  2. Endocarditis
  3. Post valve replacement
  4. Valvuloplasty
40
Q

Aortic regurgitation physical exam findings

A
  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
Q

What might be found on a CXR of aortic regurgitation?

A
  1. Cardiomegaly
  2. Dilated aortic knob
  3. Pulmonary edema (maybe)
42
Q

What is medical management of patients who are nonsurgical candidates with aortic regurgitation?

A
  • Vasodilators
  • Calcium channel blockers
  • ACE -inhibitors
43
Q

What type of patient with aortic regurgitation would benefit from Beta blocker?

A
  1. Marfan syndrome

2. Bicuspid aortic valves

44
Q

What should you think with acute aortic regurgitation?

A

AORTIC DISSECTION!

45
Q

What physical exam findings would you expect in acute aortic regurgitation?

A
  1. Signs of hemodynamic compromise
  2. Diastolic murmur is softer than chronic
  3. Thready weak pulse
  4. Soft or absent S1
46
Q

Are Beta blockers indicated in acute aortic dissection?

A

yes, beta blockers help reduce force from LV ejection to the arterial wall

47
Q

What is the most common cause of mitral regurgitation?

A

mitral valve prolapse

48
Q

What is the classic finding of mitral valve prolapse?

A

mid systolic click

also, holosystolic blowing murmur of mitral regurg

49
Q

How does the heart compensate for chronic mitral regurgitation?

A

the heart increases inotropy (or contraction strength) to keep flow going forward

50
Q

What type of murmur is classic in mitral regurgitation?

A

holosystolic, apical, blowing murmur

  • radiation to the axilla
  • often with thrill
51
Q

Which heart sound is associated with mitral regurgitation?

A

pansystolic murmur

52
Q

Why is repair better than replacing the valve in mitral regurgitation?

A

repair has less morbidity and mortality (need to anticoagulate for 3 months)

53
Q

What is the treatment for acute mitral regurgitation?

A
  • IV nitro (afterload reduction)

- IABP implant as bridge to urgent surgery

54
Q

What is the cause for nearly all mitral valve stenosis?

A

rheumatic fever

55
Q

High thromboembolic risk if patient has Afib and ______

A

mitral valve stenosis

56
Q

Enlarged left atrium from mitral stenosis impinges on recurrent laryngeal nerve causing _____

A

hoarseness

57
Q

The opening snap followed by low pitched rumbling mid-diastolic murmur of mitral stenosis is best heard with _______

A

Bell while patient is in left lateral decubitus position

58
Q

What 3 tests would you consider for a tricuspid stenosis?

A
  1. EKG
  2. Echocardiogram
  3. Cardiac cath (if concern for other valve abnormalities or open repair planned)
59
Q

Which type of valve is preferred in the tricuspid postion? Why?

A

bioprothesis is preferred as mechanical prothesis have high thrombotic risk in tricuspid position

60
Q

Most common cause of Tricuspid regurgitation

A

dilated right ventricle dilating the annulus of the valve

61
Q

what murmur is associated with tricuspid regurgitation?

A
  • pansystolic
  • 3rd to 4th intercostal space
  • increases with inspiration
62
Q

what murmur is associated with pulmonic stenosis

A
  • harsh
  • systolic
  • crescendo-decrescendo
  • best heard at 3-4 ICS
63
Q

What might pulmonic stenosis show on EKG?

A

right axis deviation and Right ventricular hypertrophy

64
Q

A brief low pitched diastolic murmur heard at the 3rd and 4th ICS

A

pulmonary regurgitation murmur

65
Q

Name the 4 defects of Tetralogy of Fallot

A
  1. Ventricular septal defect
  2. Pulmonic stenosis
  3. Overriding aorta (over the ventricular septal defect)
  4. Right ventricular hypertrophy
66
Q

What does squatting accomplish in tetralogy of Fallot?

A

Squatting decreases right to let shunt

67
Q

Describe the murmur associated with Tetralogy of Fallot

A

Harsh and systolic. Largely due to the ventricular septal defect

68
Q

What antibiotic is the go to for prohylaxis before a dental proceedure?

A

Amoxicillin

Foundations of Clinical Practice II (25 decks)

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