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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
Q

what do you see on ECG with mitral regurg?

A
  • LVH with strain (left axis)
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26
Q

what do you see on CXR with mitral regurg?

A

enlarged cardiac silhouette w/ enlarged L atrium

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27
Q

what do you see on echo with mitral regurg?

A
  • LV size increase
    -blood going back into the LA
    -LA enlargement
28
Q

mitral regurg tx?

A
  • 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
Q

what is MVP?

A

mitral valve prolapse = myxomatous mitral valve degeneration

30
Q

what systemic diseases is MVP associated with?

A
  • Marfan’s
    -Ehlers-Danlos
    -dilated aortic root & aortic regurg
    -female, thin with skeletal abnormalities like scoliosis
31
Q

MVP Syndrome sx

A

-non specific chest pain
-dyspnea
-fatigue
-syncope
-palpitations
-anxiety/panic attacks

32
Q

when does MVP occur and describe it?

A
  • mid systolic click
  • late systolic murmur
    -valsalva = louder & longer
    squatting = shortens but louder
33
Q

what do you see on pressure tracing with mitral regurg?

A

combined c and v wave which is large

34
Q

aortic stenosis etiology

A

< 30 yo = unicom valve calcification
30-70 = bicuspid valve calcification
> 70 yo = calcification of a normal valve

35
Q

risk factors for developing aortic stenosis?

A

HTN, hypercholesterol, smoking

36
Q

signs & sx of aortic stenosis

A
  • 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
Q

describe what aortic stenosis is like

A
  • harsh
  • systolic
  • R upper sternal border
  • radiation to carotids
38
Q

Gallavardin phenomenon

A

muscial at apex
- mimics mitral regurg
-no radiation to axilla

39
Q

signs of aortic stenosis (pulses)

A
  • smaller delayed upstroke of pulses
  • apical impulse is sustained
  • pulse pressure decreases
  • S4 can be present
40
Q

what happens to S2 in aortic stenosis?

A

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
Q

what do you see on ECG with aortic stenosis?

A

LVH with secondary repolarization changes

42
Q

what do you see on CXR with aortic stenosis?

A

normal or enlarged cardiac silhouette
- calcification of aortic valve
- dilation & calcification of ascending aorta

43
Q

what do you see on echo with aortic stenosis?

A

aortic valve calcification, valve opening, severity of LVH, LV function, increases LAP (Afib w/ atrial kickback)

44
Q

valve replacement types for aortic stenosis?

A
  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
Q

what can cause aortic regurg?

A
  • post inflammatory
  • congenital bicuspid valve
  • aortic root dilation
  • age related
  • infective endocarditis
46
Q

chronic aortic regurg from?

A
  1. increased LV pressure (progressive LVH)
  2. decreased diastolic pressure / increased systolic pressure (inc pulse pressure)
47
Q

sx of aortic regurg?

A
  • exertional dyspnea
  • fatigue
  • PND & pulmonary edema
  • angina / atypical chest pain
  • presyncope & syncope
  • left ventricular failure (late finding)
48
Q

signs of aortic regurg?

A
  • wide pulse pressure (forceful then suddenly collapses)
  • prominent, laterally displaced & hyperdynamic apical pulse
  • high pitched diastolic decrescendo murmur
49
Q

what is an Austin Flint murmur?

A

regurgitated fluid can force the mitral valve to close early – “functional MS”

50
Q

what do you see on ECG with aortic regurg?

A

LVH

51
Q

what do you see on CXR with aortic regurg?

A

cardiomegaly w/ LV prominence, dilated aorta possible

52
Q

aortic regurg indications for surgery?

A

LVEF < 50%
LVESD > 50 mm
LVEDD >65 mm
undergoing other heart surgery

53
Q

Carvallo’s sign

A
  1. tricuspid regurg gets louder with inspiration
  2. all of R sided murmurs increase w/ inspiration
  3. negative pressure – more blood
54
Q

tricuspid stenosis

A
  • pacemaker lead injury
    -similar to mitral murmurs but diff location
55
Q

what do you see on CXR & ECG with tricuspid stenosis?

A

CXR: R atrial enlarged, dilated SVC

ECG: R atrial enlarged, A flutter or A fib

56
Q

tx for tricuspid stenosis?

A
  • diuretics
  • aldosterone inhibitors
  • balloon valvuloplasty
  • rare valve replacement
57
Q

what do you see with the venous pressure curve in tricuspid stenosis?

A

giant a wave, slow y descent

58
Q

tricuspid regurg etiology

A
  • pulm HTN
  • pacemaker lead injury
  • just like mitral regurg but different location
59
Q

what does CXR and ECG look like for tricuspid regurg?

A

CXR: R atrial enlarged, dilated SVC

ECG: R atrial enlarged, A flutter or Afib, incomplete RBBB

60
Q

tx for aortic regurg

A

maintain good fluid balance, rare valve replacement

61
Q

what do you see on venous pressure curve for tricuspid regurg?

A

large v wave, blunted a wave

62
Q

pulmonary stenosis etiology

A

carcinoid

similar to aortic regurg but diff location

63
Q

what does ECG show for pulmonary stenosis?

A

concentric RVH

64
Q

tx for pulmonary stenosis

A

balloon valvuloplasty, rare replacement

65
Q

pulmonary regurg etiology

A

pulm HTN, Tetralogy of Fallot, carcinoid

similar to aortic regurg but diff location & fixed split w/ loud P2

66
Q

what does pulm regurg show on ECG & CXR & echo?

A

ECG: eccentric RVH, RBBB

CXR: RV enlarged, pulmonary artery enlarged

Echo: paradoxical septal wall motion d/t RV overload

67
Q

tx for pulm regurg?

A

bioprosthetic valve replacement

  • carcinoid = porcine valve replacement

CV 2 Exam 2 (2 decks)

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