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Cardiology > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

All forms of VAlvular Heart disease ass with

A

SOB and CHF

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2
Q

… Heart lesions Increase with inhalation

A

Right-sided( tricuspid and pulmonic valve

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3
Q

Inhalation… venous return to right side

A

Increase

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4
Q

Left-sided lesions( mitral and aortic valve)… with exhalation

A

Increase

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5
Q

… “ squeezes” blood out of lungs into left side

A

Exhalation

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6
Q

Best initial test Valvular heart ds

A

Echocardiogram

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7
Q

Which is more sensitive& specific transesophageal or transthoracic echo

A

Transesophageal . But you shoud do transthoracic 1st

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8
Q

Most accurate test

A

Catheterization

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9
Q
  • Most precise valvular ds

* most exact pressure gradient across valve

A

Catheterization

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10
Q

Ass with fluid overload, benefit from diuretics

A

All forms Valv h ds

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11
Q

Dilated with balloon

A

Mitral stenosis( fibrotic tissue)

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12
Q

Surgical replacement

A

Aortic stenosis( calcifications)

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13
Q

Respond best to vasodilators( ACEi/ ARBs, nifedipine, hydralazine)

A

Regurgitant lesions

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14
Q

Must be done before heart dilates too much

A

Surgical replacement

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15
Q

Valve replacement will not be able to correct decrease in systolic function if

A

If heart dilates excessively( 55 mm LV endsyst diameter for AR, 40 mm for mitral r)

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16
Q

Assess ventricular size based on

A
  • End-systolic diameter
  • Ejection fraction
  • expansion of end-systolic diameter( must replace the valve)
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17
Q

Tx of MS only

A

If symptomatic

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18
Q

Why MS revealed during pregnancy

A
  • 50% increase in plasma volume

* contraction of uterus “squeezes” 500 ml extra into central circulation

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19
Q

Unique feature of MS presentation

A
  • Dysphagia- LA presses on esophagus
  • Hoarseness- LA presses on laryngeal nerve
  • Atrial fibrillation & stroke from enormous LA
  • Hemoptysis
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20
Q

MS physical findings

A
  • Diastolic murmur after opening snap

* Squatting & leg raising increase it

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21
Q

MS. If increase venous return- murmur

A

Increases

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22
Q

MS. Best initial test

A

TTE ( but more accurate TEE)

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23
Q

Most accurate test MS

A

Catheterization

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24
Q

75% of anterior heart

A

RV ( that is why thoracic/ thansesoph for R lesions are equal)

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25
Q

EKG MS

A
  • atrial fibrillation very common

* LA hypertrophy- biphasic P wave: V1 and V2( up/down)

26
Q

MS. Chest X ray

A

Left atrial hypertrophy
• straightening of L heart border
• elevation of L mainstem bronchus
• second “bubble” behind heart

27
Q

MS Tx

A

1) Diuretics& sodium restriction( when fluid overload present)
2) Ballon valvuloplasty( with a catheter)
3) Valve replacement( if a catheter procedure cannot be done or fails)
4) Warfarin( A-fib to INR 2 to 3)
5) Rate control( digoxin, bb, diltiazem/ verapamil

28
Q

Most common presentation AS

A

Angina

29
Q

AS presentation

A
  • Angina
  • Syncope
  • CHF
30
Q

Poorest prognosis( 2 year average survival) AS

A

+ CHF

31
Q

Valsalva& standing…. Venous return to the heart

A

Decrease

32
Q

Valsalva& standing AS

A
  • decrease intensity of murmur

* less venous return= less murmur

33
Q

Handgrip

A

Increase afterload

34
Q

Handgrip AS

A
  • Softens murmur

* Less blood ejected= less murmur

35
Q

Diagnostic tests for AS

A
  • TTE then TEE, then catheterization
  • chest X ray: LVH
  • EKG LVH( S V1+ R V5 > 35 mm)
36
Q

AS Tx

A
  • Replacement( only truly effective)
  • diuretics decrease CHF but don’t tolerate volume depletion well
  • not routine for AS- baloon valvuloplasty( only if unstable/ fragile, if surgery is not an option)
37
Q

What can cause MR

A
  • HTN
  • Endocarditis
  • MI
  • Papillary muscle rupture
  • Any heart dilation
38
Q

MR regurgitation

A
  • Pansystolic ( holosystolic) murmur
  • Obscures S1 and S2
  • Radiates to axilla
39
Q

Handgrip.. MR murmur

A

Worsens murmur( handgrip increases afterload), pushes blood backwards

40
Q

Worsens AR and MR

A

Handgrip

41
Q

Squating& leg raising … MR

A

Worsen( increase venous return to heart)

42
Q

All L-sided murmurs EXCEPT … will increase with expiration

A

Mitral valve prolapse and hypertrophic obstructive cardiomyopathy

43
Q

MR tx even in absence of symptoms

A
  • Vasodilators( ACE or ARBs are best)= decrease rate of progression
  • digoxin & diuretics for symptomatic CHF
44
Q

MR Tx . Valve replacement

A

Indicated when heart dilates. Don’t wait for LV end systolic diameter to become large

45
Q

Replace MV if MR, when

A

LVESD >40 mm or EF < 60%

46
Q

Placing a clip or sutures across valve to tighten

A

Valve repair MR

47
Q

AR etiology

A
  • MI
  • HTN
  • Endocarditis
  • Marfan s or cystic medial necrosis
  • inflammatory ds( ankylosing spondylitis, Reiter syndrome)
  • Syphilis
48
Q

AR presentation

A
  • Wide pulse pressure
  • Water- hammer pulse( wide bounding)
  • Quincke pulse ( pulsations in nail bed)
  • Hill sign ( BP in legs as much as 40 mmHg above arm BP)
  • Head bobbing( de Musset sign)
49
Q

Diastolic, decrescendo murmur. Heard best: lower left sternal border

A

AR

50
Q

AR. Valsalva& standing

A

Softer( less blood less murmur for all Lsided except Mv prolapse and HOCM)

51
Q

AR. Handgrip

A

Worse murmur( increase afterload)

52
Q

AR. Diagnostic tests

A

EKG& cXR: LVH

53
Q

AR Tx med

A
  • ACEi/ARBs or nifedipine: vasodilators, increase forward flow of blood, delay progression.
  • Digoxin& diuretics: little benefit
54
Q

AR surgical tx

A

Surgical valve replacement: acute valve rupture( MI), replace valve before LV dilates excessively, EF< 55%, LVESD > 55 mm

55
Q
  • Common, considered N anatomic variant
  • 2% to 5 % of population
  • particularly in women
  • Marfan or Ehlers-Danlos syndrome
A

Mitral valve prolapse

56
Q

MVP presentation

A
  • Most often asymptomatic
  • Atypical chest pain, palpitations, panick attacks
  • usually absent symptoms of CHF
57
Q

MVP presents with

A
  • Midsystolic click
  • When severe ass with murmur
  • Mitral regurgitation
58
Q

Valsalva & Standing MVP

A

Worsen

59
Q

MVP. If increase return, decrease emptying. Squatting& Handgrip

A

Improve( diminish) murmur

60
Q

MVP diagnostic tests

A
  • Echocardiography

* Catheterization: rarely if ever done

61
Q

Tx MVP

A
  • BB- if symptomatic
  • Valve repair( with catheter, place clip to tighten valve, stitches valve to tighten leaflets) rare
  • Rarely valve replacement

Cardiology (10 decks)

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