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Cardiology > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

Heard during rapid ventricular filling

  • Normal in younger patients
  • In adults may indicate dilated ventricle with tending of chordae tendinae
A

S3

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2
Q

Atrial systole causes ejection of blood into a stiffened ventricle

A

S4

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3
Q

Caused by opening of stenosis aortic or pulmonic valve

A

Ejection Click

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4
Q

Usually seen in mitral stenosis

A

Opening Snap (OS)

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5
Q

Sound generated by turbulent blood flow as a result of structural or hemodynamics changes

A

Murmurs

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6
Q

Generated when there is flow between chambers that have widely different pressures throughout systole

A

Holosystolic/pansystolic murmers

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7
Q

Crescendo-decrescendo murmers that occur when blood is ejected across aortic or pulmonic outflow tracts

A

Midsystolic/systolic ejection

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8
Q

Starts shortly after S1 when ventricular pressure rises enough to open valve

A

Midsystolic/systolic ejection

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9
Q

Begin with S1 and end in mid systole

-Occurs In patients with acute MR

A

Early systolic murmers

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10
Q

High-pitched murmers at the left ventricular apex

-Start after S1 and end before or at S2

A

Mid to late systolic murmurs

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11
Q

Often due to tethering and malcoaptation of the mitral leaflets

A

Mid to late systolic murmurs

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12
Q

Begin with S2, when ventricular pressure drops below that in the aorta or pulmonary artery

-Usually high pitched and decrescendo

A

Diastolic murmurs

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13
Q

Usually originate from the mitral ad tricuspid valves

-Occur early during ventricular filling

A

Mid-diastolic murmurs

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14
Q

A classic example of a mid-diastolic murmur is

A

Mitral Stenosis

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15
Q

Due to a relative disproportion between valve orifice size and diastolic blood flow volume

A

Mid-diastolic murmur

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16
Q

Begin during the period of ventricular filling that follows atrial contraction

  • Occur only in sinus rhythm
  • Usually due to mitral or tricuspid stenosis
A

Presystolic murmurs/Late diastolic murmurs

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17
Q

Begin in systole, peak near S2, and continue into all or part of diastole

A

Continuous murmurs

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18
Q

Can be caused by venous hum, PDA, and AV fistulas

A

Continuous murmurs

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19
Q

Most commonly caused by rheumatic fever

A

Mitral stenosis

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20
Q

Characterized by acute and recurrent inflammation w/ leaflet thickening and calcification

A

Mitral stenosis

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21
Q

In mitral stenosis, narrowing of the valve causes decreased

A

Emptying into LV

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22
Q

Can cause dysphasia/hoarseness from compression of esophagus or left recurrent laryngeal nerve

A

LA enlargement from mitral stenosis

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23
Q

Causes typically higher heart rates as well as a loss of atrial kick

A

Atrial Fibrillation

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24
Q

CO becomes subnormal at rest and fails to increase during exercise in

A

Late/severe MS

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25
Q

Characterized by loud S1 early and soft S1 late

  • Opening snap follows S2
  • Mid-diastolic rumble
A

Mitral stenosis

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26
Q

One exam sign of severe mitral stenosis is a short

A

S2-OS interval

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27
Q

We want to treat with medications that slow the heart rate and thus increase diastolic filling time

A

Mitral Stenosis

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28
Q

One way to treat mitral stenosis is

A

Percutaneous Balloon Mitral Valvuloplasty

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29
Q

Due to structural abnormality related to the valve apparatus, leaflets, chordae tendinae, or papillary muscles

A

Primary Mitral Regurgitation (MR)

-also known as degenerative MR

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30
Q

Due to abnormal computation (closure) of the interval leaflets due to a dilated left ventricle causing dilation of the mitral annulus or pulling apart the chordae and leaflets

A

Secondary Mitral Regurgitation

-Also known as functional MR

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31
Q

A portion of LV stroke volume is ejected back into the LA resulting in increased LA volume and pressure and decreased forward CO

A

Mitral Regurgitation

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32
Q

Caused by an acute change such as papillary muscle rupture or torn chordae tendinae

A

Acute Severe MR

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33
Q

Compensated MR where SV is increased because LA and LV dilate

A

Chronic MR

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34
Q

Volume overload causes sufficient dilation to push the LV onto the downward portion of the Frank-Starling curve

A

Decompensated chronic MR

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35
Q

Results in deterioration of systolic function and symptoms of heart failure

A

Decompensated MR

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36
Q

Characterized by fatigue and dyspnea w/ increased abdominal girth and peripheral edema

A

Chronic MR

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37
Q

On exam, we will hear an apical holosystolic murmur that radiates to the axilla with

A

Chronic MR

38
Q

With chronic MR, the murmur intensifies with maneuvers that increase

A

SVR

39
Q

Due to volume overload of LV seen in chronic MR, we hear an

A

S3 murmur

40
Q

Presents w/ acute shortness of breath and severe respiratory difficulty

A

Acute MR

41
Q

On physical exam, will have a murmur w/ decrescendo quality due to rapid equilibrium between LV and LA pressures

A

Acute Mitral Regurgitation

42
Q

May have hypotension and may have hypoxia from acute pulmonary edema

A

Acute MR

43
Q

On ECG, mitral regurgitation is characterized by

A

LA enlargement and LVH

44
Q

To treat an acute MR, we want to give

A

Diuretics and vasodilators

45
Q

Relieve pulmonary edema in acute MR

A

Diuretics

46
Q

Reduce SVR and augment forward cardiac output in acute MR

A

Vasodilators

47
Q

Are less useful for treating chronic MR than they are for treating acute MR

A

Vasodilators

48
Q

Systolic billowing of 1 or both mitral leaflets into the LA w/ or w/out MR

A

Mitral Valve Prolapse

49
Q

May be accompanied by connective tissue disease such as Marfan’s Syndrome or Ehlers-Danlos Syndrome

A

Mitral Valve prolapse

50
Q

Mitral Valve prolapse is usually asymptomatic, but we can see palpitations if their are

A

Arrhythmias

51
Q

On exam, presents w/ mid systolic click and late systolic murmur at the apex

A

Mitral Valve Prolapse

52
Q

With mitral valve prolapse, increased venous return causes more traction on the chordae and a later

A

Click and Murmur

53
Q

Most common cause in adults is calcification of a previously normal trileaflet valve

A

Aortic Stenosis

54
Q

Progresses from base of the cusps to the leaflets, eventually causing a reduction in leaflet motion and effective valve area

A

Calcification

55
Q

Due to narrowing of the valve, and thus increased LV pressure is needed to drive blood into the aorta

A

Aortic Stenosis

56
Q

LV undergoes concentric hypertrophy and decreased compliance with

A

Aortic Stenosis

57
Q

On physical exam, presents with a coarse, systolic ejection murmur w/ a weakened or delayed carotid pulse

A

Aortic Stenosis

58
Q

Aortic stenosis causes a stiff LV, which results in an

A

S4 murmur

59
Q

Three symptoms of aortic stenosis are

A
  1. ) Angina
  2. ) Syncope
  3. ) CHF
60
Q

Due to imbalance between myocardial oxygen supply and demand

A

Angina

61
Q

W/ aortic stenosis, the ventricle can not increase CO due to a fixed stenosis valve orifice. Thus, during exertion we see

A

Syncope

62
Q

A classical ECG finding of aortic stenosis is

A

LVH

63
Q

Characterized by blood regurgitation from aorta into LV in diastole

A

Aortic Regurgitation

64
Q

The LV must pump the normal pulmonary venous return plus the regurgitant volume with

A

Aortic Regurgitation

65
Q

Half of the cases of aortic regurgitation are due to

A

Aortic Root Dilation (annuloaortic ectasia)

66
Q

15% of cases of aortic regurgitation are due to

A

Bicuspid aortic valve

67
Q

LV is normal size and non-compliant. Regurgitation volume causes LV diastolic pressure to rise w/

A

Acute Aortic Regurgitation

68
Q

Acute aortic regurgitation is characterized by

A

Dyspnea and pulmonary edema

69
Q

Over time, the LV dilates and hypertrophies w/

A

Chronic Aortic Regurgitation

70
Q

Increases w/ chronic AR, which allows LV to accommodate larger regurgitant volumes

A

Compliance

71
Q

Aortic and systemic diastolic pressures drop, leading to widened pulse pressure and decreased coronary artery perfusion

A

Chronic AR

72
Q

Characterized by dyspnea on exertion, decreased exercise tolerance, and sensation of forceful heart beat

A

Aortic Regurgitation

73
Q

On exam, gives a blowing murmur early in diastole at left eternal border

A

Aortic Regurgitation

74
Q

Has widened pulse pressure leading to bounding pulses

-Characteristic Water-Hammer pulse (Corrigan’s Pulse)

A

Aortic Regurgitation

75
Q

When capillary pulsations are visible at nail beds or lip

-Seen in AR

A

Quince Sign

76
Q

Drop in pressure in mid systole due to Venturi effect. So you feel a double pulsation

-Feature of AR

A

Pulses Bisferiens

77
Q

A low frequency, mid-diastolic rumble due to flow across the mitral valve, heard at the apex

-Feature of AR

A

Austin Flint Murmur

78
Q

With AR, we can see bobbing of the head w/ each heart beat. This is called

A

De Mussets Sign

79
Q

Visible pulsations of the uvula seen in AR

A

Muller’s Sign

80
Q

Systolic and diastolic sounds heard over the femoral artery in AR

A

Traube’s Sign (“Pistol Shots”)

81
Q

In AR, we can see popliteal BP be higher than Brachial Systolic BP by more than 60 mmHg. This is called

A

Hill’s Sign

82
Q

We can treat AR by targeting

A

Afterload reduction (Ca2+ blockers and ACE inhibitors)

83
Q

Most commonly rheumatic in origin and has an opening snap and diastolic rumble that increases w/ respiration

A

Tricuspid Stenosis

84
Q

We see a large a wave on neck veins with

A

Tricuspid Stenosis

85
Q

Usually functional and is from a dilated RV

A

Tricuspid Regurgitation

86
Q

Presents w/ symptoms of right heart failure

A

Tricuspid Regurgitation

87
Q

On physical exam, presents w/ prominent v waves on JVP and a holosystolic murmur that increases w/ inspiration

A

Tricuspid Stenosis

88
Q

We can also see a pulsating liver w/

A

Tricuspid stenosis

89
Q

Rare and usually congenital

A

Pulmonic Stenosis

90
Q

Usually due to severe pulmonary hypertension

A

Pulmonic Regurgitation

91
Q

Characterized by a high-pitched decrescendo murmur along the left eternal border

A

Pulmonic Regurgitation

Cardiology (27 decks)

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