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Clin Med - Cardio Exam #1 > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

T/F: VHD ranks lower than CAD, stroke, HTN, DM, and obesity in M+M.

A

true

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2
Q

What is the MC cause of VHD?

A

rheumatic heart disease

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3
Q

What is a cause of VHD that is increasing its incidence, esp in developing countries?

A

infective endocarditis

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4
Q

What must all patients with mechanical/prosthetic cardiac valve replacements have prior to invasive procedures?

A

abx prophylaxis

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5
Q

define stenosis

A

inability to open the valve completely leading to obstructed blood flow going forward

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6
Q

define regurgiation

A

valve fails to close completely allowing backflow of blood

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7
Q

define the classifications of VHD

A
  • stage A: at risk for VHD
  • stage B: progressive VHD and asx
  • stage C1: asx w/ severe VHD but normal LV function
  • stage C2: asx w/ severe VHD but abnormal LV function
  • stage D: symptomatic
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8
Q

When do you refer a patient with VHD?

A
  • new onset murmurs
  • symptomatic of VHD
  • (+) echo for VHD
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9
Q

AS etiologies

A
  • congenital

- atherosclerotic (i.e. degenerative)

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10
Q

What age does atherosclerotic AS present?

A

> 65 y/o

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11
Q

AS presentation

A
  • long, latent asx period
  • MC: functional gradual decline
  • progressive DOE
  • angina
  • transient syncope
  • exercise induced tachycardia
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12
Q

AS pathophys

A
  • LV outflow obstruction ==> incr. EDV and afterload = LVH
  • incr. LVH = dec LV chamber vol = incr LV diastolic pressure = transmitted to LA to pulm system = DOE
  • incr/prolonged ejection phase
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13
Q

AS murmur

A
  • systolic or midsystolic after S1
  • crecendo-decrecendo (diamond shaped)
  • heard over R 2nd ICS at SB
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14
Q

AS special manuvers

A
  • handgrip, standing, and valsalva decr murmur

- intensified when pt sits up and leans forward

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15
Q

AS physical exam

A
  • pulsus parvus et tardus (weak, delayed)
  • paradoxically split S2 heart sound
  • S4 w/ LVH
  • LV heave on PMI d/t LVH
  • carotid a. thrill
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16
Q

AS management

A
  • echo
  • CXR
  • EKG
  • aortic valve replacement
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17
Q

AR pathophys

A

backflow from aorta –> incr LV workload = incr SV and LVH

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18
Q

AR etiologies

A
  • valvular (rheumatic fever, endocarditis, HTN, syphilis)

- root (aortic dissection, HTN, marfans)

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19
Q

AR murmur

A
  • diastolic

- decrecendo

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20
Q

AR presentation

A
  • LV failure
  • CAD
  • musset sign
  • duroziez sign
  • quincke pulses
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21
Q

define musset sign

A
  • head bob with pulse in AR
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22
Q

define duroziez sign

A
  • back and forth murmur over partially compressed peripheral a. (i.e. femoral)
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23
Q

define quincke pulse

A

nailbed capillary pulsation

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24
Q

AR management

A
  • echo
  • EKG
  • CXR
  • MRI/CT
  • surgery
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25
Q

When is surgery indicated in AR?

A

abnormal LV function and/or appearance of sx dramatically increases risk of mortality

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26
Q

etiology/epidem mitral stenosis (MS)

A
  • MC: rheumatic fever but incidence is decr d/t strep tx
  • congenital
  • SLE
  • RA
  • infective endocarditis
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27
Q

T/F: MS is less common in females than males.

A
  • false, 3x more
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28
Q

MS pathophys

A
  • rheumatic chronic inflam leads to:
    = valve leaflet thickening + fibrous/calcific deposits
    = mitral commissures + chordae shortening
    = close papillary muscles
    = rigid valve cusps
  • hallmark
    = decr mitral valve diameter ==> change in pressure gradient b/t LA + LV ==> decr pulm compliance ==> DOE
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29
Q

MS presentation

A
  • DOE, fatigued
  • orthopnea, PND
  • palpitations, chest pains
  • a. fib d/t LA dilatation
  • hemoptysis d/t incr LV press + incr rupture of sm. bronchial v.
  • thromboembolism (incr turbulence)
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30
Q

What are the two clinical syndromes of MS?

A
  • mild/moderate

- severe

31
Q

Describe the presentation of each of the two clinical MS syndromes

A
  • mild/severe: asx or sx ONLY w/ extreme exertion

- severe: pulm HTN d/t decr pulm vascular compliance ==? decr CO + R heart failure ==> ascites, edema, hepatomegaly, JVD

32
Q

What is the first sign of MS?

A

JVD

33
Q

physical exam of MS

A
  • “opening snap” followed by diastolic, “low-pitched, rumbling decrescendo”
  • heard best at apex in L lat. decubitus position
34
Q

diagnostics for MS

A
  • echo
  • catheritazation for pts w/ CAD
  • CXR, shows LA enlargement
35
Q

treatment of MS

A
  • mitral valve replacement
  • warfarin for a. fib
  • refer
36
Q

define MR

A
  • d/o of mitral valve closure
37
Q

etiology of MR

A
  • acute (i.e. trauma, ruptured chordae tendinae, rheumatic fever, endocarditis, flail cusps, myxomatous dz)
  • chronic (i.e. marfans, degenerative, endocarditis, rheumatic fever, SLE, drugs, congenital leaflet)
38
Q

pathophysiology of MR

A
  • backflow of LV transmits to LA causes LV + LA enlarge leading to increased EF d/t LVH as compensation
  • overtime decr EF d/t persistant incr vol overload and decreased contractile function leads to heart failure, pulm HTN and edema, a. fib, sudden death
39
Q

presentation of acute MR

A
  • pulm edema d/t increased LA + pulm v. pressures
40
Q

presentation of chronic MR

A
  • LA enlarges slowly leading to DOE which leads to incr. LA/LV pressure ending in a. fib and L heart failure
41
Q

physical exam of MR

A
  • murmur = pansystolic w/ prominent S3 (kentucky) best heard over apex + radiates to axilla
  • brisk upstroke of carotid pulse
42
Q

diagnostics of MR

A
  • echo
  • trnasthoracic esophageal echo
  • BNP
  • cardiac catherization
43
Q

treatment of MR

A
  • surgery

- refer

44
Q

who are candidates for surgical tx of MR?

A
  • all symptomatic pts especially w/ pulm HTN
  • asx with less than 60% EF + LV dilatation
  • emergency for life threatening situation
45
Q

define MVP

A
  • mitral valve prolapse (aka floppy-valve syndrome + systolic click syndrome)
  • mitral valve flops up into atria during systole
46
Q

etiology of MVP

A
  • idiopathic by can be genetically linked

- incr risk in thin pts w/ MSK deformities

47
Q

pathophysiology of MVP

A
  • prolapse mitral leaflets into LA w/ systole
48
Q

causes of MVP

A
  • ruptured chordae tendinae (flail leaflets)
  • progressive annula dilataion
  • disease progression as part of aging process
49
Q

presentation of MVP

A
  • usually asx

- can have non-specific chest pain, dyspnea, fatigue, palpitations

50
Q

physical exam of MVP

A
  • murmur = mid-systolic clicks followed by late systolic murmur
  • prolonged murmur = holosystolic = d/t increased prolapse
51
Q

diagnostics of MVP

A

echo

52
Q

treatment of MVP

A
  • beta-blockers
  • surgery
  • refer
53
Q

T/F: TS is less common than MS, but also associated with MS.

A

true

54
Q

TS pathophysiology

A
  • change in diastolic pressure gradient b/t RA and RV d/t narrowed tricuspid valve
  • incr RA pressure leads to systemic venous congestion
  • block at R AV leads to RA hypertrophy which leads to hepatomegaly, ascites, edema, and palpable presystolic liver pulsation
55
Q

TS physical exam

A

diastolic rumble murmur heard best at LSB that increases with inspiration

56
Q

TS diagnostics

A
  • EKG
  • CXR
  • echo/cath
57
Q

TS treatment

A
  • diuretics

- tricuspid valve replacement

58
Q

TR pathophysiology

A
  • backflow of blood from RV to RA d/t:
    1. RV dilatation, caused most commonly by LV failure, opens tricuspid valve
    2. RV volume overload leads to pulm a. HTN
    3. pacemaker injures the valve (iatrogenic)
    4. dilated cardiomyopathy
59
Q

TR presentation

A

same as R heart failure (i.e. venous side backs up)

60
Q

TR physical exam

A
  • murmur: blowing, holosystolic heard at LSB and incr w/ inspiration and decr w/ expiration/valsalva
  • audible S3
61
Q

TR diagnostics

A
  • echo/doppler
  • CXR
  • cath
  • EKG
62
Q

TR treatment

A
  • valve replacement and anticoagulants

- diuretics for edema

63
Q

PS etiology

A

congenital

64
Q

PS pathophysiology

A
  • systolic pressure gradient b/t RV and RA
  • RVH d/t resistance and prolonged systolic ejection
  • resistance leads to decr. pulm blood flow ==> cyanosis
65
Q

PS presentation

A
  • mild: asx
  • mod/severe: DOE, fatigue, syncope, angina, eventual RV failure
  • murmur: loud, harsh crescendo-decrescendo that radiates to shoulder and incr. with inspiration (similar to AS since they are both semilunar valves)
  • palpable thrill
66
Q

PS diagnostics

A
  • echo
  • EKG
  • CXR
67
Q

PS treatment

A
  • all sx pts
  • all w/ pressure gradients > 60mmHg, regardless of sx
  • diuretics
  • valve replacement
68
Q

PR types

A
  • high pressure

- low pressure

69
Q

describe high pressure PR overview

A
  • d/t pulm HTN

- decrescendo, diastolic murmur

70
Q

describe low pressure PR overview

A
  • d/t valvular dz

- no murmur

71
Q

PR pathophysiology

A
  • leads to RV enlargement + hypertrophy ==> incr. pre + afterload
  • w/ incr RV pressure, RV + RA enlarge w/ JVD ==> decr. pulm blood flow
72
Q

PR presentation

A
  • most: asx
  • some have RHF d/t RV overload
  • RV heave/lift
  • S2 split
  • systolic click
  • decrescendo, diastolic murmur
    (same S+S of R heart failure)
73
Q

PR diagnostics

A
  • echo
  • EKG
  • CXR
74
Q

PR treatment

A
  • decr. pulm a. HTN via vasodilator + diuretics

- surgery

Clin Med - Cardio Exam #1 (7 decks)

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