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Cardiovascular 4 > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

This is an inflammatory condition as a complication of group A strep.

A

Acute Rheumatic Fever (ARF)

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2
Q

What is it in the strep that causes the autoimmune reaction against cardiac antigens?

A

bacterial antigens

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3
Q

How many of these major criteria must you have to serve the Dx of rheumatic fever?

Carditis
Polyarthritis
Syndenham chorea
Erythema marinatum
SubQ nodules
A

2

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4
Q

If you only have 1 major criteria, how many of these MINOR criteria must you have to serve the Dx of rheumatic fever?

Migratory arthralgias
Fever
Increased acute phase reactants
Prolonged PR interval on EKG

A

2

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5
Q

What drugs do you give for the inflammation in rheumatic fever? infection?

A

ASA for inflmammation

PCN for infection

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6
Q

Which antibodies can u screen for to see if the pt has a strep infection, leading to rheumatic fever?

A

Antistreptolysin 0 Ab’s

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7
Q

Where can u swab to get a culture for Strep A?

A

throat

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8
Q

What should be given to pt’s who have had ARF before until early adulthood?

A

low-dose PCN

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9
Q

This is an area of focal fibrinoud necrosis surrounded by inflammatory cells that eventually form scar tissue in ARF,

A

Aschoff body

buzz word!

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10
Q

Rheumatic fever can cause what type of valvular problem, leading to a murmur?

A

MS

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11
Q

MS can lead to what problem in the lungs?

A

pulmonary edema from increased back pressure

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12
Q

What type of pulmonary HTN can form from back pressure?

A

passive pulomnary HTN

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13
Q

What type of pulmonary HTN can form from medial hypertrophy and intimal fibrosis of the pulmonary arterioles?

A

reactive pulmonary HTN

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14
Q

Reactive pulmonary HTN can cause hypertropy of which heart chamber?

A

RV

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15
Q

And reactive pulmonary HTN can cause pulomonary edema, and subsequently what 3 conditions?

A

dyspnea, CHF, hemoptysis

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16
Q

This is the stage of MS where you likely only have dyspnea on exertion.

A

Mild MS

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17
Q

This is the stage of MS where you have dyspnea at rest, increasing fatigue, and more severe signs of pulmonary congesting.

A

More severe MS

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18
Q

This is the stage of MS where you have signs of R-sided heart failure, including JVP, hepatomegaly, ascites, and peripheral edema.

A

Advanced MS

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19
Q

How do u treat the vascular congestion in MS?

A

Diuretics

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20
Q

How do u Tx Afib if it develops in MS? (3 drugs)

A

B-blockers, CCB, or digoxin

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21
Q

What theraphy is recommended to prevent clots if the pt has both MS and Afib?

A

Chronic anticoagulation

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22
Q

What surgical treatment can u do to treat MS?

A

Percutanous baloon mitral valvuloplasty (PBMV)

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23
Q

In MR, the volume leaks back into the LA, but then returns to the LV during diastole, causing what to the SV to compensate for ↓ CO?

A

↑ SV

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24
Q

What is the eqn for the regurtitant fraction?

A

RF = (volume of MR)/(total LV SV)

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25
Q

This is the type of MR where there is sudden rupture of the chordae tendineae, the LA is stiff, and there is rapid pulmonary congestion and edema.

A

Acute MR

very bad

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26
Q

This is the type of MR where there is rheumatic valve disease, the LA is dilated and compensatory, ↓ CO, and possible Afib.

A

Chronic MR

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27
Q

In acute MR, what can u give to treat the pulmonary edema?

A

vasodilators (IV Na nitroprussides)

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28
Q

What is the best treatment for chronic MR?

A

Mitral valve repair

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29
Q

What causes the mid-systolic click in MVP?

A

tensing of the mitral leaflet or chordae tendineae as the leaflet is forced back toward the LA

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30
Q

And then what causes the actual murmur in MVP?

A

regurgitant flow through the incompetent valve

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31
Q

True or False: the clinical course of MVP is usually benign.

A

True

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32
Q

What is the age-related change of the aortic valve, leading to AS?

A

calcification

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33
Q

Which chamber can be hypertorphic in AS?

A

LV

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34
Q

If the LV becomes concentrically hypertrophied, what happens to the compliance?

A

decreases

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35
Q

And a decreased compliance of the LV can lead to hypertrophy in which chamber?

A

LA

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36
Q

What are the 3 classic Sx of AS?

A

Angina
Exertional syncope
CHF

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37
Q

What is the 1 year survival rate for pts with severe AS?

A

1 year

38
Q

What is the only Tx for AS?

A

Replacement.

39
Q

What are the 2 indications for AS surgery?

A
  1. pt has AS and Sx

2. Progressive LV dysfxn in the absence of Sx

40
Q

What are the 2 causes of AR?

A

diseases of the aortic leadlets of dilation of the aortic root.

41
Q

Why is there dilation of the LV in chronic AR?

A

Because the LV has to pump both the volume from the LA + the regurgitant blood from the aorta.

42
Q

What happens to the pulse pressure in chronic AR?

A

Widens (high systolic, low diastolic)

43
Q

Due to decreased aortic diastolic pressure and less perfusion to the coronary arteries, what is a classical Sx of AR?

A

Angina

44
Q

True or False: it is common for pts with chronic AR to be aymptomatic and have normal LV fxn.

A

False.

45
Q

What 2 drugs can u give for pts with asymptomatic AR + preserved LV fxn + HTN?

A

CCB’s and ACEI’s

46
Q

What 2 types of AR pt’s get surgery?

A
  1. symptomatic pts

2. impaired LV fxn with an ejection fraction <0.50

47
Q

What is the most common cause of TR?

A

RV elargement

48
Q

Which bowel syndrome can cause TR?

A

carcinoid syndrome

49
Q

Which waves on JVD is prominent in TR?

A

v wave

when the RV is contracting

50
Q

True or False: TR is louder during inspiration.

A

True!

it’s on the R side of the <3

51
Q

What makes mechanical valves great?

A

They’re durable.

52
Q

What is the big problem with mechanical valves?

A

Thrombus formation and hemolysis

53
Q

So what must the pt’s with a mechanical valve be placed on for life?

A

Anticoagulation

54
Q

Bioprosthetic valves have the advantage over mechanical ones in that they don’t cause what as easily?

A

Thrombi

55
Q

What is the problem with bioprosthetic valves?

A

structural failures

56
Q

What is the most common organism to cause native valve endocarditis (NVE)?

A

Oral strep and enterococci

57
Q

What is the most common organism to cause early prosthetic valve endocarditits (PVE)?

A

Coagulase-neg staph

58
Q

What is the most common organism to cause late PVE?

A

Oral strep and enterococci

59
Q

What is the most common organism to cause endocarditis in IV drug users (IVDU)?

A

Staph aureus

60
Q

What does HAECK stand for the caustive organisms for subacute endocarditis?

A 
Haemophilus
Actinobacillus
Cardiobacterium hominis
Eikenella corrodens
Kingella
61
Q

Haemophilus- characteristics

A

pleomorphic, coccobacilli

62
Q

Actinobacillus- characteristics

A

immotile, non-spore forming, oval to rod shape

63
Q

Cardiobacterium hominis- characteristics

A

Catalase neg, oxidase +, indole producing

64
Q

Eikenella corrodens- characteristics

A

faculative anaerobe, oxidase +, catalase 0, urease -, indole -

65
Q

Kingella- characteristics

A

Aerobic coccobacilli, oxidase +, catalase -, B-hemolytic

66
Q

Endocardial surface injury, thrombus formation, bacterial entry form the circulation, and bacterial adherance to injured endocardial surface can all lead to what condition?

A

infective endocarditis

67
Q

What is the most common mechanism for endothelial injury?

A

Turbulent blood flow from valvular disease

68
Q

What it is on injured endocardium that the bacteria adheres to?

A

fibrin-platelet deposits

69
Q

What may protect the bacteria from phagocytosis once they adhere?

A

fibrin

70
Q

What are the Sx to acute infective endocarditis (IE)?

A

explosive and rapidly progressive illness with high fever and shaking chills

71
Q

What are the Sx to aubacute IE?

A

low-grade fever with nonspecific Sx like fatigue, anorexia, weakness myalgia and night sweats.

72
Q

R-sided valvular lesions (TR) is common in endocarditis associated with what?

A

IV drug use

73
Q

Where is the common place for embolism in a R-sided IE?

A

lung

74
Q

Embolitic infarction of the vasa vasorum can lead to what condition of arteries?

A

aneurysm

75
Q

These are small longitudinal hemorrhages found beneath the nails, and are indicative of septic embolism or immune complex deposition.

A

Splinter hemorrhages

76
Q

These are painless, flat, irregular discolerations found on the palms and soles and are indicative of septic embolism or immune complex deposition.

A

Janeway lesions

77
Q

These are tender, pea-sized erythematous nodules on the fingers and toes and are indicative of septic embolism or immune complex deposition.

A

Osler nodes

78
Q

These are emboli to the retina that produces inroinfarctions, appear as white dots surrounded by hemorrhages, and are indicative of septic embolism or immune complex deposition.

A

Roth spots

79
Q

What is the most common mechanism to get PVE?

A

Dental work

80
Q

What is the bug to cause IE from GI surgery?

A

Enterococcus

81
Q

What is the bug to cause IE from colon cancer?

A

S. bovis and S. equinus

82
Q

What is the bug to cause IE from pregnancy?

A

S. agalactiae

83
Q

What is the most common congenital valve anomaly?

A

Calcific stenosis of bicuspid aortic valve.

84
Q

Mitral calcification is common in waht types of people?

A

Women > 60

85
Q

In mitral calcification, what do the nodules provide a site for?

A

Thrombi formation (can lead a stroke)

86
Q

What are the main complications to MVP?

A

Infective endocarditis, MR, stroke, systemic infarct, arrhythmias

87
Q

SLE can set up vavlvulitis of which valves?

A

Mitral and tricuspid

88
Q

Carcinoid heart disease usually affects which side of the heart?

A

R

89
Q

Which condition leads to small and warty nodules in a line along the closure?

Rheumatic Heart Disease
Nonbacterial Thrombotic endocarditis
Endocarditis of SLE
Infective endocarditis

A

RHD

90
Q

Which condition leads to Large and irrgular clumped nodules, and can extend to the chordae?

Rheumatic Heart Disease
Nonbacterial Thrombotic endocarditis
Endocarditis of SLE
Infective endocarditis

A

IE

91
Q

Which condition leads to small and bland nodules, along the lines of the closure?

Rheumatic Heart Disease
Nonbacterial Thrombotic endocarditis
Endocarditis of SLE
Infective endocarditis

A

NTE

92
Q

Which condition leads to small to medium nodules, may be on either sides of the valve?

Rheumatic Heart Disease
Nonbacterial Thrombotic endocarditis
Endocarditis of SLE
Infective endocarditis

A

SLE

Cardiovascular 4 (9 decks)

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