valvular heart disease

Question 1

mean right atrial pressure

Answer 1

0-5

Question 2

right ventricular pressure

Answer 2

25/5

Question 3

most common cause of tricuspid stenosis in US

Answer 3

carcinoid

Question 4

carvallos sign

Answer 4

right side murmurs louder on inhalation

Question 5

a

Answer 5

atrial contraction

Question 6

x

Answer 6

atrial relaxation

Question 7

v

Answer 7

atrial filling

Question 8

y

Answer 8

atrial emptying

Question 9

cannon A waves

Answer 9

tricuspid stenosis also causes blunted y descent

Question 10

tricuspid stenosis Tx

Answer 10

diuretics torsemide, spirolactone(for ascites)

baloon, or bioprostetic

Question 11

prominent cV wave

Answer 11

tricuspid regurg

Question 12

tricuspid regurg Tx

Answer 12

treat primary issue: LV failure or pulmonary HTN

true valvular defect, then use bioprosthetic valve

Question 13

causes of tricuspid regurg

Answer 13

RV dilation (pulmonary HTN)
pulmonic regurg
LV failure
inherent valvular problems
pacemaker catheter injury
endocarditis
MI
sarcoid
RV dysplasia
FenPhen

Question 14

high pressure PI

Answer 14

prolonged RV systole w/split S2 from pulmonary HTN
graham steell murmur
treat by treating pulmonary HTN

Question 15

low pressure PI

Answer 15

very little murmur

watch carefully

Question 16

mitral valve stenosis on echo

Answer 16

honey stick

Question 17

mitral valve stenosis venous curve

Answer 17

high LV wave

Question 18

mitral valve stenosis of CX

Answer 18

straightening of left heart border

Question 19

mitral stenosis auscultory findings

Answer 19

loud S1 (unless calcified)
opening snap (unless calcified) 
rumbling diastolic murmur

Question 20

syndromes of mitral stenosis

Answer 20

mild-moderate w/early pulmonary edema

severe w/bpulmonary HTN right CHF, AF, and low CO

Question 21

Graham steell murmur

Answer 21

at left sternal border from relative PI

Question 22

Mitral stenosis on EKG

Answer 22

neg P wave in V1

RAD

Question 23

mitral stenosis Tx

Answer 23

ECHO evaluation scoreing system 8 or less- vavuloplasty

8-10 needs mechanical or bioprosthetic valve

Question 24

S3

Answer 24

marker for severe mitral regurg

Question 25

pansystolic murmur causes

Answer 25

VSD mitral regurg tricuspid regurg

Question 26

what lab might reveal onset of CHF

Answer 26

BNP

Question 27

What is the effect of handgrip on mitral regurg murmur

Answer 27

causes blood to backup -> louder

Question 28

what is the effect of squatting on mitral regurg murmur

Answer 28

increased backup and increased pre-load -> louder

Question 29

mitral regurg EKG

Answer 29

LVH, LAH or AF

Question 30

differentiate sudden onset MR from chronic MR

Answer 30

sudden- high LA pressure | chronic- dilated LA w/normal pressure

Question 31

sudden MR causes

Answer 31

papillary m dysfunction ruptured chordae infective endocarditis w/valve perforation

Question 32

chronic MR

Answer 32

LA and LV enlargement seen on CXR

Question 33

venous curve MR

Answer 33

large cV

Question 34

Tx MR

Answer 34

failing heart yields decreased EF (40mm) | needs surgery even when asymptomatic

Question 35

ERO

Answer 35

effective regurgitant ofrifice >40 seen in asymptomatic severe MR patients may show as exercise induced pulmonary HTN on ECHO

Question 36

MR surgery

Answer 36

repair if no calcification in annulus or valve, ERO >40 and chordae can be maintained if not replacement

Question 37

things that make mitral prolapse murmur lounder and longer

Answer 37

standing valsavla amyl nitrate

Question 38

mitral prolapse associated w/

Answer 38

aortic root disease may be part of hyperadrenergic syndrome in young females myxomatous degeneration atrial and ventricular arrhythmias

Question 39

myxomatous degeneration

Answer 39

marfans, ehlers danlos, | associated w/aortic regurg

Question 40

mitral prolapse Tx

Answer 40

beta blockers | mitral valve repair or replacement

Question 41

gallaverdin phenomenon

Answer 41

apex murmur increases after ectopic beat and decreases w/squatting

Question 42

syncope due to aortic stenosis

Answer 42

peripheral vasodilation due to high ventricular pressures stimulating baroreceptors in LV reduced afterload -> increased SV, but that cannot occur due to aortic stenois so BP falls and patient passes out

Question 43

aortic stenosis EKG

Answer 43

LVH and LAH

Question 44

peak valvular gradient

Answer 44

when it reaches 64 can cause LV failure, angina, or syncope

Question 45

aortic stenosis treatment percautions

Answer 45

crossing arotic vavle w/cath for CAD can induce cardiogenic shock, pulmonary edema, stroke or death nitrates also dangerous

Question 46

parvus et tardus

Answer 46

aortic stenosis

Question 47

low gradient, low flow aortic stenosis with reduced EF

Answer 47

failure as a result of increased afterload or another cardiac contractility problem from IHD, MI, fibrosis, or other cardiomyopahty

Question 48

Dx and Tx of aortic stenosis

Answer 48

dobutamine ECHO | <20% increase in SV = no muscle reserve do not replace valve

Question 49

BNP and aortic stenosis

Answer 49

poor prognosis >550 regardless of result of dobutamine echo

Question 50

treating young aortic stenosis

Answer 50

percutanesou vavluloplasty

Question 51

treating old aortic stenosis

Answer 51

bovine valve

Question 52

middle aged aortic stenosis Tx

Answer 52

mechanical plus anticoagulation may need root replacement transcutaenous aortic vavle replacement , but associated w/strokes

Question 53

causes of wide pulse pressure

Answer 53

``` aortic regurg atherosclerosis AV fistula thryrotoxicosis anemia fever heart block ```

Question 54

alfred mussets

Answer 54

nodding of head w/heart beat

Question 55

corrigans pulse

Answer 55

large carotid pulse

Question 56

duroziers pulse

Answer 56

diastolic murmur over femoral a on distal pressure

Question 57

light house

Answer 57

major flushing w/heart beat

Question 58

HIlls

Answer 58

systolic BP in LL >UL by 20

Question 59

quinckes

Answer 59

pulsatile blanching and reddening of nail w/slight pressure applications

Question 60

austin flint murmur

Answer 60

a low-pitched r murmur at cardiac apex. systolic associated with severe aortic regurgitation

Question 61

absent M1

Answer 61

``` aortic insuffiency aortic dissection endocarditis HTN inflammatory disease ```

Question 62

Tx of aortic insufficiency

Answer 62

BNP >130 for surgical indication | EF50mm