Valvular heart disease (5/6)

Question 1

Aortic stenosis sx

Answer 1

Dyspnea on exertion, syncope, CP, CHF, narrow pulse pressure, arryhthmias and sudden death common
significant sx when down to 0.8cm
long sx free period w rapid deterioration

Question 2

Aortic stenosis diagnostics

Answer 2

CXR
EKG=Left axis deviation, atrial enlargment, AV conduction delay
Echo=thickened LV wall
Cath=^pressure gradient in systole, ^LV and end diastolic pressure

Question 3

Aortic mgmt

Answer 3

percutanous cath valve implantation for pts w ^surgery risk

AVR for severe sx, biprosthetics prefferred in elderly

Question 4

Aortic regurgitation

Answer 4

LV failure sx, peripheral edema, flushed skin, men
s3, wide pulse pressure, abrupt rise and fall of carotid upstroke, sustained thrusting apical pulse, palpitations, dyspnea, orthopnea, PND, syncop

Question 5

Aortic regurgitation diagnostics

Answer 5

CXR-av dilation, LV enlargment, ascending aorta dilation
EKG-LVH, ^HR, PVCs
Echo-aortic root and LA enlargement, early closure of mitral valve, diastolic av fluttering
Cath-vAortic diastolic pressure, ^LVEDP, vRegurg flow, reflux thru AV

Question 6

Aortic regurgitation mgmt

Answer 6

control htn-nifedipine, hydralazine, ACE
digitalis
diuretics for sx
AV replacement -for acute/severe w HF/hemodynamic instability
chronic w onset of HF EF<50% or LV end systolic dimension >5.5

Question 7

Mitral stenosis sx

Answer 7

dyspnea, orthopnea, PND, diaphoresis, cyanosis, JVD, edema

abdominal respirations, anxiety, ^liver, crackles

Question 8

Mitral stenosis diagnostics

Answer 8

CXR-L atrial enlarged, calcified mitral valve
EKG-L atrial enlargement, right axis deviation
Echo-quantifies MS, thickening of mitral cusps

Question 9

Mitral stenosis mgmt

Answer 9

diuretics and Na restriction to vBV and pulm and systemic venous pressures
anticoag (afib), hx of embolism, or enlarged LA
antiarhythmic amiodorone or ca channel blocker if in afib

Question 10

mitral stenosis surgical mgmt

Answer 10

mitral commissurotomy

balloon valvuloplasty, MV replacement

Question 11

Mitral regurgitation sx

Answer 11

CP precordium/substernal , dyspnea, syncope, light headed, migraine, HA, exercise intolerance, panic attacks

Question 12

Mitral regurgitation PE findings

Answer 12

thoracic deformities, laterally displaced apical pulse, brisk carotid upstroke

Question 13

Mitral regurgitation diagnostics

Answer 13

CXR-LV enlarged
EKG-LVH, afib
Echo-^velocity jet in LA during systole, severity=distance from valve and jet and size of LA

Question 14

Mitral regurgitation mgmt

Answer 14

vasodilators=vVentricular filling, vSystemic vascular resistance
Diltiazem and anticoags to control vent rate and vEmbolu if in afib
Sodium restriction and diuretics for sx of HF
Mitral valve replacement

Question 15

Mitral valve prolapse PE
can develop regurgitation
may=thrombi/endocarditis

Answer 15

Scoliosis, pectus excavatum, connective tissue disorder
widely split s2 and RV heave
CHF
exertional dyspnea

Question 16

Mitral prolapse diagnostics

Answer 16

EKG-flattened or inverted T waves in inferior leads (2,3,AVF)
Echo-possible MR

Question 17

Mitral prolapse mgmt

Answer 17

B-blockers for palpitations, echos periodically
Valve replacement if severe
Abx prophylaxis only if prosthetic valve, hx of IE, echo evidence of leaflet pathology and regurgitation