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CPR 2 Exam 1 > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

What does valvular heart disease most commonly arise from?

A

Degenerative senile calcification
Myxomatous degeneration
Congenital bicuspid aortic valve

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2
Q

What is myomatous degeneration?

A

Remodeling of collagen and ECM
Thinning if fibrin
Thickening of valve leaflets

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3
Q

What do murmurs result from?

A

Turbulence across valves and or increase blood flow (anemia, pregnancy)

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4
Q

What is stenosis?

A

Sclerosis, fibrous, calcification

Impedes forward flow

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5
Q

What does stenosis create?

A

Pressure overload

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6
Q

What does regurgitation create?

A

Volume overload

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7
Q

What is regurgitation?

A

Insufficiency, incompetence

Reversal of flow, valve leaks, fails to close

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8
Q

What are the systolic murmurs?

A 
Mitral regurgitation
Tricuspid regurgitation
Aortic stenosis
Pulmonic stenosis
VSD
ASD
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9
Q

What are diastolic murmurs?

A 
Aortic regurgitation
Pulmonic regurgitation
Mitral stenosis
Tricuspid stenosis
Atrial myxoma
PA
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10
Q

What is grade 1 on the murmur scale?

A

Barely audible

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11
Q

What is grade 2 on the murmur scale?

A

Faint, soft

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12
Q

What is grade 3 on the murmur scale?

A

Louder, easily heard

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13
Q

What is grade 4 on the murmur scale?

A

Very loud with palpable thrill

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14
Q

What is grade 5 on the murmur scale?

A

Heard with the stethoscope barely touching the chest with thrill

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15
Q

What is grade 6 on the murmur scale?

A

Can hear without the stethoscope or can hear with stethoscope close to chest: palpable thrill

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16
Q

Which murmur grades do not have a palpable thrill?

A

1-3

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17
Q

What are causes of acute mitral regurgitation?

A 
Ischemic papillary muscle dysfunction
Rupture chordal tendinaeae
Infective endocarditis
Volume overload (LA pressure, pulmonary edema, RVF/LVF cardiogenic shock)
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18
Q

What are the causes of chronic mitral regurgitation?

A

Mitral valve prolapse
Myxomatous degeneration
Mitral annular calcification

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19
Q

Where is mitral regurgitation heard?

A

5th ICS at midclavicular line

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20
Q

What is heard on PE with mitral regurgitation?

A

Systolic murmur
Blowing at apex
Radiates to left axilla
Reduced S1 use diaphragm

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21
Q

What is mitral valve prolapse?

A

One or both leaflets prolapse into the left atrium

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22
Q

Which gender is mitral valve prolapse most common in?

A

Female

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23
Q

What is heard on auscultation with mitral valve prolapse?

A

Systolic murmur at apex

Click/murmur increase with valsalva and standing

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24
Q

What are symptoms of mitral valve prolapse?

A

Chest pain
ST
PVCs
Dyspnea

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25
Q

When does the murmur increase with mitral valve prolapse?

A

Decrease of ventricular volume and chamber size

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26
Q

When does the murmur with mitral valve prolapse decrease?

A

Squatting

Hand grip

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27
Q

How do you treat mitral valve prolapse?

A

Reassure

Symptomatic give beta blocker

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28
Q

Is tricuspid regurgitation symptomatic?

A

No

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29
Q

What is tricuspid regurgitation associated with?

A 
Pulmonary HTN
Lung disease
RV infarction
Inferior wall MI
IE
Pacemaker
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30
Q

What is heard with tricuspid regurgitation?

A

Blowing systolic murmur

4th ICS LSB

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31
Q

When does the tricuspid regurgitation murmur increase?

A

Inspiration

32
Q

What murmur is the Carvallo sign associated with?

A

Tricuspid regurgitaion

33
Q

What is seen on jugular venous pulse with tricuspid regurgitation?

A

Prominent V wave

34
Q

What is the etiology of aortic stenosis?

A

Age related degenerative calcification
Bicuspid aortic valve
Rheumatic heart disease

35
Q

What is the pathology associated with aortic stenosis?

A

Pressure overload

Right ventricular hypertrophy

36
Q

The more severe the aortic stenosis the more narrow the what?

A

Outflow

37
Q

The higher the gradient across the aortic valve the lower the what?

A

Area

38
Q

What are the symptoms of aortic stenosis?

A

Dyspnea
Angina
Syncope

39
Q

What is heard on PE with aortic stenosis?

A 
Systolic murmur
Crescendo-decrescendo
Harsh 2nd ICS
RSB
Radiates into sternal notch/cardotids
40
Q

What heart sound is diminished with aortic stenosis?

A

S2

41
Q

What are the pulses in aortic stenosis?

A

Parvus (weak/small)

Tardus (slow rising, late pulse)

42
Q

Is the pulse pressure wide or narrow with aortic stenosis?

A

Narrow

43
Q

What is seen on the EKG with aortic stenosis?

A 
Left ventricular hypertrophy
Strain pattern (down sloping ST segment-T wave)
44
Q

What is associated with aortic root dilation?

A

Bicuspid aortic valves

45
Q

What do people with bicuspid aortic valves have a predisposition to?

A

Infective endocarditis

46
Q

Where is bicuspid aortic valve most commonly heard?

A

LSB or apex

47
Q

75% of bicuspid aortic valves turn into what?

A

Aortic stenosis

48
Q

What connective tissue disorders is bicuspid aortic valve associated with?

A

Marfans

Turner’s syndrome

49
Q

What is heard with pulmonic stenosis?

A 
Systolic murmur
Crescendo-decrescendo
2-3 ICS
LSB
Radiates to left shoulder-clavicle
50
Q

What conditions is pulmonic stenosis associated wtih?

A 
Tetralogy of Fallot
PS
VSD
RVH
Overriding aorta
51
Q

What is heard with VSD?

A

Holosystolic murmur
Left lower sternal border with thrill
Left-to-right shunt/murmur
Increases with handgrip

52
Q

What is heard with ASD?

A

Systolic murmur
Upper LSB with fixed splitting of S2
Left-to-right shunt

53
Q

What is the etiology of mitral stenosis?

A

Rheumatic heart disease
Group A streptococci
Congenital
Mitral annular calcification

54
Q

What does a decreased MVA area lead to?

A

Pulmonary HTN
AVF
LAE
A fib.

55
Q

What are the symptoms of mitral stenosis?

A

Dyspnea
Orthopnea
Palpitations
Hoarseness (compression of left laryngeal nerve (Ortner’s syndrome)

56
Q

What is Ortner’s syndrome?

A

Compression of left laryngeal nerve seen in mitral stenosis

57
Q

What is heard on PE in mitral stenosis?

A

Diastolic murmur
Low pitch (use bell)
Rumbling at apex
Inc. S1 and S2 followed by opening snap

58
Q

What is seen on ECG in mitral stenosis?

A 
Left atrial enlargement if in sinus rhythm
A. Fib
RVH
RAD if associated with pul HTN
Anticoagulated if in A fib
59
Q

What is the etiology of tricuspid stenosis?

A

Rheumatic disease
Carcinoid syndromes
SLE
Right atrial myxomas

60
Q

What gender is tricuspid stenosis most common in?

A

Females

61
Q

What is heard in tricuspid stenosis?

A

Diastolic murmur
4th ICS
LSB
Increases on inspiration

62
Q

What is seen on jugular wave in tricuspid stenosis?

A

Prominent A wave

63
Q

What is seen on ECG in tricuspid stenosis?

A

Right atrial enlargement (tall peaking of P waves)

64
Q

What are the acute causes of aortic regurgitation?

A

Infective endocarditis
Aortic dissection
Chest trauma

65
Q

What are the chronic causes of aortic regurgitation?

A

Calcific degeneration
Bicuspid aortic root
Rheumatic heart disease

66
Q

What is the pathology associated with aortic regurgitation?

A

Volume overload
LVH
Left heart failure

67
Q

What are the acute symptoms of aortic regurgitation?

A

Pulmonary edema from infective endocarditis

68
Q

What are the chronic symptoms of aortic regurgitation?

A

Dyspnea
Orthopnea
Angina

69
Q

What is heard with aortic regurgitation?

A 
Diastolic decrescendo murmur
2rd ICS
LSD
Can mimic mitral stenosis (Austin Flint)
Soft S2
70
Q

What is seen on PE with aortic regurgitation?

A 
Wide pulse pressure
DeMusset sign
Quincke's sign
Traube sign
Duroziez's sign
71
Q

What is the treatment for aortic regurgitation?

A

ACEi

ARB

72
Q

What is the DeMusset sign?

A

Head bobs with beats

73
Q

What is the Quincke’s sign?

A

Capillary nail pulsation

74
Q

What is the Traube sign?

A

“Pistol shot” (systolic and diastolic) sounds over femoral artery

75
Q

What is Duroziez’s sign?

A

Diastolic murmur over femoral artery when compressed with bell of stethoscope

76
Q

What is heard in pulmonary regurgitation?

A

Diastolic
Decrescendo
2nd ICS
LSD (Graham Steele)

77
Q

What is pulmonary regurgitation associated with?

A

Pulmonary HTN

Increased S2

CPR 2 Exam 1 (20 decks)

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