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clinical medicine II > Valvular heart disease > Flashcards

Valvular heart disease Flashcards

1
Q

what grade of murmurs is loud, and associated with a thrill

A

Grade 4/6

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2
Q

function of echocardiography

A
  • evaluate chamber size and valve abnormalities, including pressure gradients
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3
Q

function of angiography

A
  • provides detailed info preoperatively
  • evaluate for CAD
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4
Q

aortic stenosis

A

narrowing of aortic outflow tract

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5
Q

aortic stenosis can occur at what 3 levels

A
  • aortic valve: 75% of cases
  • supravalvular: congenital or post-operative
  • subvalvular: congenital or hypertrophic cardiomyopathy
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6
Q

etiology of aortic stenosis below age 30

A

congential, unicuspid valve

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7
Q

etiology of aortic stenosis age 30-65

A
  • congenital bicuspid valve which becomes calcified and stenotic
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8
Q

rheumatic valve disease account for what percentage of aortic stenosis between ages 30-70

A

6-27%

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9
Q

etiology of aortic stenosis over age 65

A

degeneration of sclerosis of valve

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10
Q

when does mortality become significant in patients with aortic stenosis

A
  • after symptoms develop
  • average survival without valve replacement is 2-3 years with a high risk of sudden death
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11
Q

early symptoms of aortic stenosis

A
  • dyspnea on exertion
  • fatigue
  • decreased exercise tolerance
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12
Q

later symptoms of aortic stenosis

A
  • dyspnea with normal activity
  • angina
  • syncope
  • heart failure
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13
Q

aortic stenosis is associated with what murmur? where would you hear the murmur

A
  • systolic ejection murmur
    • high pressure to high pressure
  • 2nd RICS or apex
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14
Q

what type of pulse pressure indicates severe aortic stenosis disease

A

small pulse pressure

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15
Q

CXR findings of aortic stenosis

A
  • LVH
  • calcification may be seen in valve
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16
Q

management of mild asymptomatic aortic stenosis

A
  • follow, educate regarding sxs
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17
Q

management of moderate asymptomatic aortic stenosis

A
  • annual ECG, echo, cxr
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18
Q

management of severe asymptomatic aortic stenosis

A
  • cardiolgoy evaluation and f/u
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19
Q

patient education regarding aortic stenosis

A
  • avoid strenuous physical activity
  • avoid dehydration
  • signs of worsening disease
    • exertional dizziness, dyspnea, palpitations
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20
Q

what is the definitive technique for evaluating severity and site of stenosis

A

cardiac catheterization

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21
Q

normal aortic valve area

A

3-4 cm2

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22
Q

classification of severe aortic stenosis

A

severe < 1.0

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23
Q

which patients with aortic stenosis are candidates for valve replacement

A
  • severe, symptomatic aortic stenosis
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24
Q

differentiate clinically between prosthetic valves and tissue valves (in aortic vavle replacement)

A
  • prosthetic valves last longer but require lifelong anticoagulation
    • warfarin
  • tissue valves do not last as long but do not require lifelong anticoagulation
25
Q

hypertrophic cardiomyopathy

A
  • a form of subvalvular aortic stenosis
  • disease of cardiac muscle characterized by severe myocardial hypertroph, in the absense of a cause for secondary hypertrophy (HBP, AS)
  • familial, inherited in 60% of cases
26
Q

hypertrophic cardiomyopathy’s murmur compared to AS

A
  • murmur is similar except it is louder if patient stands or valsalvas (opposite of valvular AS)
27
Q

treatment for hypertrophic cardiomyopathy

A
  • calcium channel blocker
  • beta blocker
28
Q

aortic regurgitation (insufficiency)

A
  • leakage of blood back through aortic valve during diastole
29
Q

primary etiologies of aortic regurgitation (insufficiency)

A
  • rheumatic valvular disease (29%)
  • bicuspid aortic valve (12%)
  • dilated aortic root (12%)
    • acutely dissecting aortic aneurysm
30
Q

acute causes of aortic regurgitation (insufficiency)

A
  • aortic dissection
  • infective endocarditis
31
Q

treatment of acute aortic regurgitation (insufficiency)

A

urgent cardiology consult for medication and consideration of valve replacement

32
Q

clinical presentation

  • LV overload and gradual dilation and hypertrophy
  • patients may be asymptomatic for 20+ years, then develop only mild DOE
  • eventually develop signs of heart failure
A

chronic aortic regurgitation

33
Q

murmur associated with aortic regurgitation (insufficiency). where is it best heard

A
  • high-pitched diastolic decrescendo murmur
  • aortic area and left sternal border
34
Q

austin flint murmur

A
  • soft, low-pitched diastolic murmur at the apex which sounds like a diastolic mitral stenosis murmur
  • may be associated with aortic regurgitation (insufficiency)
35
Q

wide pulse pressure is seen in which condition

A

aortic regurgitation (insufficiency) due to increased systolic and decreased diastolic pressures -> “water hammer” or “corrigan pulse”

36
Q

CXR findings of aortic regurgitation (insufficiency)

A
  • normal if acute
  • LVH if chronic, possible CHF/pulmonary edema
37
Q

treatment of chronic aortic regurgitation (insufficiency)

A
  • if asymptomatic, f/u q 6-12 months (ECG, echo, CXR)
  • vasodilators reduce regurgitant volume and increase EF
    • ACE inhibitors are most helpful
  • valve replacement is available if symptomatic
38
Q

mitral regurgitation

A
  • leakage of blood from LV into left atrium
  • may develop due to abnormality of
    • valve leaflets
    • chordae tendinae
    • papillary muscles
    • valve annulus
39
Q

etiologies of mitral regurgitation

A
  • papillary muscle necrosis secondary to ischemic heart disease
  • inherited
    • mitral valve prolapse
    • marfans
  • rheumatic heart disease (5-15% cases)
  • congenital
40
Q

causes of acute mitral regurgitation

A
  • papillary muscle necrosis from ischemia
  • endocarditis
  • ***poorly tolerated and often required emergent surgery
41
Q

explain what happens in chronic mitral regurgitation

A
  • LV adapts to larger blood volume by enlarging and increasing SV
  • heart may compensate for years with normal CO but eventually it is unable to keep up with demands and CHF develops
  • A-Fib frequently develops due to left atrial enlargement
  • pulmonary HTN and RVH may also develop
42
Q

what often develops with chronic mitral regurgitation

A

A-Fib due to left atrial enlargement

43
Q

murmur associated with mitral regurgitation. where is heard best

A
  • high pitched, pansystolic murmur
  • loudest at apex
  • later stages, S3 develops (early passive rapid filling of the ventricles with blood from atria)
44
Q

CXR findings common in mitral regurgitation

A
  • left atrial enlargement
  • LVH
45
Q

treatment of chronic mitral regurgitation

A
  • afterload reduction: ACE inhibitors and vasodilators
  • sodium restriction and diuretics (Reduce preload)
  • anticoagulation for A-Fib
  • surgery:
    • repair valve vs valve replacement
46
Q

mitral valve prolapse

A

due to ballooning of mitral leaflets into the left atrium during systole

47
Q

heart sounds associated with mitral valve prolapse

A
  • mid-late systolic clicks
  • mitral regurgitation may also occur with late systolic murmur
48
Q

prevelance of mitral valve prolapse

A
  • 5% of general population
  • usually benign
49
Q

diagnostic study for mitral valve prolapse

A

echocardiogram

50
Q

management of mitral valve prolapse associated with palpitations or arrhythmias

A
  • B-blockers may be helpful
  • if symptomatic or worsening, follow as with other patients with MR
51
Q

pathophysiology of mitral stenosis

A
  • narrowing of mitral valve
  • obstructs flow from LA to LV
  • increases LA pressure
  • increase pulmonary vascular pressure
52
Q

most common cause of mitral stenosis

A

rheumatic heart disease

53
Q

rheumatic heart disease

A
  • spectrum including acute rheumatic fever, pericarditis, myocarditis, and valvular lesions
  • delayed sequela following group A steptococcus pharyngitis
54
Q

signs and symptoms expected in mitral stenosis

A
  • usually due to pulmonary congestion
    • dyspnea, orthopnea, PND, fatigue
    • pulmonary edema with hemoptysis
    • pulmonary HTN -> RHF
  • A-Fib in 40-50%
  • 20% have systemic emboli, usually to brain
55
Q

40-50% of patients with mitral stenosis have what conditions

A

AFIB

56
Q

murmur associated with mitral stenosis. where is it best heard

A
  • Loud S1 with opening snap
  • mid diastolic rumbling murmur
  • apex with patient in left lateral decubitus position, with bell
57
Q

CXR findings with mitral stenosis

A
  • Left atrial enlargement
  • later, pulmonary congestion and RVH
  • kerley B lines
58
Q

management of mitral stenosis

A
  • mild symptoms: diuretics and sodium restriction
  • anticoags for A-Fib
  • valve sx for progressive symptoms
59
Q

who needs antibiotic prophylaxis

A
  • prosthetic cardiac valve or prosthetic material used for cardiac valve repair
  • previous infectious endocarditis

clinical medicine II (8 decks)

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