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X Clin Med II Exam 1 > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What is seen in HCM that is not in aortic stenosis?

A

Aortic valve not calcified
Similar murmur but louder if pts stands or valsalvas (decrease venous return)
Similar ejections sounds and sxs

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2
Q

Etiologies of aortic regurgitation

A

Rheumatic valvular disease (most), bicuspid aortic valve, dilated aortic root, bacterial endocarditis, senile degeneration, RA, Marfans, Ehlers-Danlos

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3
Q

What is an Austin Flint murmur?

A

Soft, low pitched diastolic murmur at the apex that sounds like a mitral stenosis murmur

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4
Q

Management of acute mitral regurgitation

A

Urgent stabilization (IV nitroprusside) and prep for surgery

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5
Q

Describe the murmur of aortic stenosis

A 
Systolic ejection murmur
Grade 3-4/6
Crescendo-decrescendo, blowing
Max intensity at 2nd RICS or apex
Radiates along carotids into neck
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6
Q

Management of mitral valve prolapse

A

Mostly just reassure pt because it is mild (lifestyle changes)
BBs for palpitations
Treat concurrent MR if have

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7
Q

Etiology of aortic stenosis 30-65

A

Congenital bicuspid valve which becomes calcified and stenotic (see about half calcified by age 50, can all see rheumatic valve disease)

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8
Q

Management of acute aortic regurgitation

A

Urgent cardiology consult for meds and maybe valve replacement

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9
Q

Murmur seen in mitral stenosis

A

Loud S1 with opening snap (early diastolic sound of forcing the valve open) followed by a mid diastolic rumbling murmur
Best heart at apex in left lateral decubitus with bell

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10
Q

Other manifestations of mitral valve prolapse

A

Palpitations, DOE, dizziness/syncope, anxiety disorders, numbness/tingling, skeletal abnormalities, abnormal ECGs

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11
Q

When do you start thinking about surgery with regards to valve area in aortic stenosis?

A

<1 cm2 (normal is 3-4)

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12
Q

How does mitral regurgitation happen?

A

Abnormality to any part of apparatus (leaflets, chordae tendinae, papillary muscles, valve annulus)

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13
Q

Most common symptom of mitral valve prolapse

A

Atypical or non-anginal chest pain

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14
Q

Management of chronic aortic regurgitation

A

Asymptomatic and mild: just follow
Vasodilators reduce regurgitant volume and increase EF (ACE-i most helpful) - delay need for replacement
Avoid isometric exercises
Repair when symptomatic/severe or asymptomatic pts with EF<50 at rest

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15
Q

Murmur of aortic regurgitation

A

High pitched diastolic decrescendo murmur heard best at aortic area and left sternal border (where left ventricle is)

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16
Q

General sxs of all valvular diseases

A

Fatigue, dyspnea/orthopnea/PND, angina, syncope, palpitations

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17
Q

Etiologies of mitral regurgitation

A 
Papillary muscle necrosis secondary to ischemic heart disease
Inherited
Rheumatic heart disease
Acquired
Idiopathic
Congenital maldevelopment
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18
Q

Surgical options for chronic mitral regurgitation

A

Valvuloplasty to repair or valve replacement

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19
Q

Sxs of mitral stenosis

A

Usually due to the pulmonary congestion

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20
Q

Sxs of aortic stenosis

A

Early: DOE, fatigue, decreased exercise tolerance
Later: dyspnea with normal activity and triad of angina, syncope and heart failure

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21
Q

What events can precipitate the sxs of mitral stenosis?

A

Sudden exertion, excitement, fever, severe anemia, tachycardia, intercourse, pregnancy, thyrotoxicosis, a fib

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22
Q

Describe the murmur of mitral regurgitation

A

High pitched, pan systolic murmur that is loudest at apex and radiates to axilla

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23
Q

Management of mitral stenosis

A

Anticoagulate for a fib, hx of emboli or significant LAE on echo (Warfarin to 2-3)
Valve surgery for progressive sxs (valvuloplasty, mitral commisurotomy or prosthetic valve)

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24
Q

What might you see on a CXR with aortic regurgitation?

A

Cardiac to thoracic width ratio > 50%

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25
Q

Reasons for acute aortic regurgitation

A

Aortic dissection or infective endocarditis

26
Q

How to manage symptomatic aortic stenosis

A 
Cardiac catheterization (evaluate severity and site of stenosis)
Maybe valve replacement (only when severe by echo and symptomatic)
27
Q

What is mitral valve prolapse?

A

Ballooning of mitral leaflets into the left atrium during systole due to excess mitral valve tissue

28
Q

Management of mild mitral stenosis

A

Diuretics and sodium restriction

29
Q

How do you anticoagulate a pt with a valve replacement?

A

Prosthetic: last longer than require life long anticoagulation with warfarin (to INR of 2.5-3.5)
Tissue: don’t last as long but don’t require lifelong anticoagulation

30
Q

Other physical exam findings of aortic stenosis

A

Thrill in 2nd RICS or suprasternal notch
Early systolic ejection click
Narrow PP! (severe disease)
May see S4 due to vigorous left atrial contraction

31
Q

Correlation between sxs of aortic stenosis and mortality

A

Mortality is minimal in asymptomatic phase

After they develop, mortality is significant (2-3 yr survival without valve replacement)

32
Q

When does rheumatic heart disease occur?

A

After GAS pharyngitis

33
Q

Management of asymptomatic aortic stenosis

A

Mild: follow, educate about sxs
Moderate: annual ECG/echo/CXR
Moderate-severe: cardio eval and close follow up

34
Q

3 classifications of aortic stenosis

A

Aortic valve (75%)
Supravalvular (congenital or post op)
Subvalvular (congenital or HCM)
*may cause same sxs at any levels

35
Q

What findings might be seen late in the disease?

A

Loud P2 and RV heave (right heart failure)

36
Q

Management for acute aortic regurgitation

A

Urgent: stabilize (diuretics or vasodilators), surgery is usually necessary within 24 hrs of diagnosis

37
Q

Tricuspid and pulmonic valve disorders

A

Usually congenital anomalies in infancy and childhood
Adults: rheumatic scarring or connective tissue disease
Tx: sodium restriction, diuretics, surgery

38
Q

What can develop due to LAE of mitral regurgitation?

A

A fib (may later see pulmonary HTN and RVH)

39
Q

Correlation between mitral stenosis and a fib

A

40-50% pts with MS will have a fib (might also have systemic emboli)

40
Q

What does chronic aortic regurgitation result from?

A

LV overload with gradual dilation and hypertrophy (why asymptomatic for a while and then start developing DOE)

41
Q

What does a late peak of the murmur in aortic stenosis suggest?

A

Severe obstruction

42
Q

Tx for HCM

A

CCBs or BBs

43
Q

What valvular disorders will we see develop acutely?

A

The regurgitations

44
Q

Most common cause of mitral stenosis

A

Rheumatic heart disease

45
Q

Other physical findings of aortic regurgitation

A 
Wide PP (water hammer or corrigan pulse)
May also have harsh systolic ejection murmur (if have aortic stenosis too)
Austin flint murmur
46
Q

Reasons for acute mitral regurgitation

A

Papillary muscle necrosis/rupture from ischemia or endocarditis

47
Q

HCM classified as aortic stenosis

A

Subvalvular

48
Q

Diagnostic results of aortic stenosis

A

ECG: normal until severe, LVH overtime
CXR: normal until late, maybe post-stenotic dilation of aorta, may see calcification
Echo: immobile, calcified leaflets, LVH, aortic gradient and reduced valve area

49
Q

Management of acute mitral regurgitation

A

It is poorly tolerate so pts are miserable and often need emergent surgery

50
Q

Types of prosthetic aortic valves

A

Ball and cage (driven by pressure)

Tilting

51
Q

Etiology of aortic stenosis under age 30

A

Congenitally stenotic or unicuspid valve

52
Q

Acute aortic regurgitation

A

LV pressure rises rapidly
Pulmonary edema or cardiogenic shock may develop rapidly (can’t compensate for vol overload)
Traumatic rupture of valve cusp is rare

53
Q

Etiology of aortic stenosis over age 65

A

Degeneration and sclerosis of valve (accounts for most cases)

54
Q

Medical management of chronic mitral regurgitation

A

Afterload reduction: ACE-i and vasodilators
Preload reduction: sodium restriction and diuretics
Digitalis
Anticoagulation for a fib: warfarin to 2-3
No abx prophylaxis

55
Q

What maneuvers change the aortic stenosis murmur?

A

Louder with squatting (because increase venous return and ventricular filling)

56
Q

What happens between ARF and symptomatic mitral stenosis?

A

20 yrs
Leaflets diffusely thicken because of fibrous tissue/calcium deposits
Become immobilized and rigid so it narrows

57
Q

Pt education for aortic stenosis

A

Avoid strenuous activity
Avoid dehydration
Signs of worsening disease (exertional dizziness, dyspnea, palpitations)
*no abx prophylaxis

58
Q

What does rheumatic heart disease encompass?

A

Acute rheumatic fever, pericarditis, myocarditis and valvular lesions

59
Q

What do you hear on auscultation in mitral valve prolapse?

A

Mid-late systolic click often present

60
Q

Who needs antibiotic prophylaxis?

A

Those with a prosthetic valve or previous infective endocarditis who have dental procedures or invasive procedures that might expose blood

61
Q

Other physical exam findings for mitral regurgitation

A

S3 gallop at later stages
With pulmonary HTN- S4 gallop, loud P2 and RV heave
JVD, hepatomegaly, edema (RV failure)

X Clin Med II Exam 1 (7 decks)

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