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CV 2 Exam 2 > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

Grade 1/6

A

barely audible

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2
Q

Grade 2/6

A

audible, but soft

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3
Q

Grade 3/6

A

easily audible

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4
Q

Grade 4/6

A

easily audible with associated thrill

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5
Q

Grade 5/6

A

easily audible, associated thrill, heard with stethoscope lightly on the chest

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6
Q

Grade 6/6

A

easily audible, associated thrill, heart without stethoscope

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7
Q

systolic murmurs (8)

A

AS, PS, MR TR, MVP, ASD, VSD, HOCM

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8
Q

diastolic murmurs (5)

A

AR, PR, MS, TS, Austin-Flint murmur

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9
Q

when someone has Rheumatic heart disease think…

A

mitral stenosis

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10
Q

severe mitral stenosis can lead to (4)

A
  • pulmonary HTN
    -L side heart failure sx (dyspnea, orthopnea, PND)
  • R heart failure
    -rare hemoptysis
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11
Q

low pitch, rumbling murmur heard best at apex, in L lateral decubitus with bell

A

mitral stenosis

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12
Q

murmur accentuated with exercise?

A

mitral stenosis

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13
Q

Graham Steell Murmur is …

A

“functional” pulm regurg heard at left sternal border
-soft blowing decrescendo early diastolic

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14
Q

arrhythmia associated with mitral stenosis

A

paroxysmal or chronic A fib
-important to slow the HR if tachycardic

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15
Q

what do you see on ECG with mitral stenosis?

A

left atrial enlargement

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16
Q

what do you see on CXR with mitral stenosis

A

left atrial enlargement with possible cephalization

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17
Q

what do you see on an echo with mitral stenosis?

A
  • hockey stick sign (anterior leaflet tethering, posterior becomes immobile)
    -fish mouth appearance (commissures fusing)
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18
Q

tx for mitral stenosis?

A
  • limited meds (consider loop diuretic)
    -rate and rhythm control with Afib
    -balloon valvuloplasty (echo less than 8)
    -valve replacement (echo grater than 8-10, combined stenosis & regurg)
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19
Q

2 types of mitral valve replacements

A
  1. mechanical (combo Warfarin & low dose ASA, more prone to thrombus than aortic replacement)
  2. bioprosthetic (degenerate after 10-15 years)
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20
Q

Describe mitral regurgitation

A
  • something interferes with closing of mitral valve so you have backflow of blood back into the atrium
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21
Q

what can cause mitral regurgitation

A

anything that causes left ventricle dilation
-remodeling post MI
-dilated cardiomyopathy
-early rheumatic fever
-endocarditis
-chroda tendineae
-calcification
-Ebstein anomaly

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22
Q

mitral regurg sx? (3)

A
  • asymptomatic
    -arrhythmias
    -heart failure sx (left, orthopnea, dyspnea, PND)
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23
Q

signs of mitral regurg?

A
  • chronic L atrial & L ventricular enlargement
    -A fib
    -left ventricular dysfunction
    -brisk carotid upstroke
    -3rd heart sound
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24
Q

when does mitral regurg occur & where is it best heard & where does it radiate?

A

pansystolic murmur best heart at apex & radiates to axilla

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25
what do you see on ECG with mitral regurg?
- LVH with strain (left axis)
26
what do you see on CXR with mitral regurg?
enlarged cardiac silhouette w/ enlarged L atrium
27
what do you see on echo with mitral regurg?
- LV size increase -blood going back into the LA -LA enlargement
28
mitral regurg tx?
- goal is to correct prior to onset of LV systolic dysfunction -repair the valve is possible (if not all of valve is diseased& chordae can be maintained)
29
what is MVP?
mitral valve prolapse = myxomatous mitral valve degeneration
30
what systemic diseases is MVP associated with?
- Marfan's -Ehlers-Danlos -dilated aortic root & aortic regurg -female, thin with skeletal abnormalities like scoliosis
31
MVP Syndrome sx
-non specific chest pain -dyspnea -fatigue -syncope -palpitations -anxiety/panic attacks
32
when does MVP occur and describe it?
- mid systolic click - late systolic murmur -valsalva = louder & longer squatting = shortens but louder
33
what do you see on pressure tracing with mitral regurg?
combined c and v wave which is large
34
aortic stenosis etiology
< 30 yo = unicom valve calcification 30-70 = bicuspid valve calcification > 70 yo = calcification of a normal valve
35
risk factors for developing aortic stenosis?
HTN, hypercholesterol, smoking
36
signs & sx of aortic stenosis
- pressure in LV increases = hypertrophy & decreased compliance - increased pressure in LA (LA enlarged, Afib) - angina pectoris - dyspnea - sudden death *** progressive afterload increases on LV
37
describe what aortic stenosis is like
- harsh - systolic - R upper sternal border - radiation to carotids
38
Gallavardin phenomenon
muscial at apex - mimics mitral regurg -no radiation to axilla
39
signs of aortic stenosis (pulses)
- smaller delayed upstroke of pulses - apical impulse is sustained - pulse pressure decreases - S4 can be present
40
what happens to S2 in aortic stenosis?
A2 now comes after P2 (reversed) d/t increased pressure in the ventricle - A2 is later but still fixed in pklace - P2 still changes with inspiration/expiration ** S2 is often absent
41
what do you see on ECG with aortic stenosis?
LVH with secondary repolarization changes
42
what do you see on CXR with aortic stenosis?
normal or enlarged cardiac silhouette - calcification of aortic valve - dilation & calcification of ascending aorta
43
what do you see on echo with aortic stenosis?
aortic valve calcification, valve opening, severity of LVH, LV function, increases LAP (Afib w/ atrial kickback)
44
valve replacement types for aortic stenosis?
1. mechanical valve - requires Warfarin & low dose ASA 2. bioprosthetic (bovine, porcine) - 10-15 years it lasts, over the age of 60 3. TAVR (for pts with intermediate or high surgical risk)
45
what can cause aortic regurg?
- post inflammatory - congenital bicuspid valve - aortic root dilation - age related - infective endocarditis
46
chronic aortic regurg from?
1. increased LV pressure (progressive LVH) 2. decreased diastolic pressure / increased systolic pressure (inc pulse pressure)
47
sx of aortic regurg?
- exertional dyspnea - fatigue - PND & pulmonary edema - angina / atypical chest pain - presyncope & syncope - left ventricular failure (late finding)
48
signs of aortic regurg?
- wide pulse pressure (forceful then suddenly collapses) - prominent, laterally displaced & hyperdynamic apical pulse - high pitched diastolic decrescendo murmur
49
what is an Austin Flint murmur?
regurgitated fluid can force the mitral valve to close early -- "functional MS"
50
what do you see on ECG with aortic regurg?
LVH
51
what do you see on CXR with aortic regurg?
cardiomegaly w/ LV prominence, dilated aorta possible
52
aortic regurg indications for surgery?
LVEF < 50% LVESD > 50 mm LVEDD >65 mm undergoing other heart surgery
53
Carvallo's sign
1. tricuspid regurg gets louder with inspiration 2. all of R sided murmurs increase w/ inspiration 3. negative pressure -- more blood
54
tricuspid stenosis
- pacemaker lead injury -similar to mitral murmurs but diff location
55
what do you see on CXR & ECG with tricuspid stenosis?
CXR: R atrial enlarged, dilated SVC ECG: R atrial enlarged, A flutter or A fib
56
tx for tricuspid stenosis?
- diuretics - aldosterone inhibitors - balloon valvuloplasty - rare valve replacement
57
what do you see with the venous pressure curve in tricuspid stenosis?
giant a wave, slow y descent
58
tricuspid regurg etiology
- pulm HTN - pacemaker lead injury - just like mitral regurg but different location
59
what does CXR and ECG look like for tricuspid regurg?
CXR: R atrial enlarged, dilated SVC ECG: R atrial enlarged, A flutter or Afib, incomplete RBBB
60
tx for aortic regurg
maintain good fluid balance, rare valve replacement
61
what do you see on venous pressure curve for tricuspid regurg?
large v wave, blunted a wave
62
pulmonary stenosis etiology
carcinoid similar to aortic regurg but diff location
63
what does ECG show for pulmonary stenosis?
concentric RVH
64
tx for pulmonary stenosis
balloon valvuloplasty, rare replacement
65
pulmonary regurg etiology
pulm HTN, Tetralogy of Fallot, carcinoid similar to aortic regurg but diff location & fixed split w/ loud P2
66
what does pulm regurg show on ECG & CXR & echo?
ECG: eccentric RVH, RBBB CXR: RV enlarged, pulmonary artery enlarged Echo: paradoxical septal wall motion d/t RV overload
67
tx for pulm regurg?
bioprosthetic valve replacement * carcinoid = porcine valve replacement

CV 2 Exam 2 (2 decks)

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