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CV II Exam 3 > Valvular Heart Disease II > Flashcards

Valvular Heart Disease II Flashcards

1
Q

CV wave in left atrium

A

mitral regurg

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2
Q

Tx of mitral regurg

A

replace valve - when EF starts to decline (to 60%)
-even asymptomatic pt

or if ERO - effective regurg orifice is 40mm

repair - if no calcification in annulus or valve

chordae cannot be maintinaed - need replacement

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3
Q

anxious 32yo female chest pain and palpitations, mid-systolic click, late systolic murmur, shortens with lying down, handgrip, and squatting

A

mitral valve prolapse

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4
Q

myxomatous

A

prolapsing of mitral valve

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5
Q

standing with mitral regurg**

A

less murmur

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6
Q

standing with mitral valve prolapse**

A

longer murmur

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7
Q

mitral valve prolapse

A

aortic root disease, hyperadrenergic syndrome, myxomatous degeneration (marfans, ehler-danlos)

mid systolic click

murmur lengthens with standing, valsalva, and amyl nitrate

A and V arrhythmias

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8
Q

Tx of mitral valve prolapse

A

beta blockers
mitral valve repair - wedge repair
mitral replacement

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9
Q

ejection sound with diamond shaped harsh systolic murmur at base and high pitched systolic murmur at apex

A

aortic stenosis

decreases with squatting

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10
Q

gallaverdin phenomenon

A

dissociation between the noisy and musical components of the systolic murmur heard in aortic stenosis

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11
Q

path of aortic stenosis

A

bicuspid valve

degeneratie (calcification)

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12
Q

syncope in aortic stenosis

A

peripheral vasodilation
-from high V pressure stimulates baroreceptors in left ventricle

reduced afterload - calls for increased SV which can’t occur
-due to aortic stenosis

BP falls - patient passes out

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13
Q

parvus et tardus

A

aortic stenosis

weak and late pulse

at carotid

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14
Q

EKG with aortic stenosis

A

LVH and LAH

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15
Q

peak doppler gradient

A

measurement of flow through valve orifice squared x4

ex/ 4 flow = 64 gradient

LV failure, angina, or syncope occur when peak valvular gradient reaches 64

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16
Q

critical valve area

A

valve area < 1 cm2

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17
Q

dangers in catheterization

A

crossing aortic valve
can induce cardiogenic shock, PE, stroke, or death

nitrates also dangerous

18
Q

critical aortic stenosis

A

mean gradient > 50
valve area < 0.75

severe calcification density, pulmonary HTN > 50 and elevated C-terminal BNP

19
Q

severe aortic stenosis to have gradient less than 30?

A

low gradient, low flow aortic stenosis with reduced EF

increased afterload or cardiac contractility problem (IHD, MI, fibrosis)

20
Q

diagnosis of low gradient, low flow aortic stenosis

A

dobutamine ECHO

<20% increase in SV indicates no muscle reserve

21
Q

bicuspid aortic valve

A

prone to stenosis, regurg, or both

associated with root dilation and coarctation

22
Q

Tx for aortic stenosis

A

young - valvuloplasty
elderly - pig valve
middle age - mechanical valve plus anticoag

often need CABG as well

transcutaneous aortic valve replacement (TAVR) - associated with strokes

23
Q

squatting and handgrip

A

increased afterload

increases aortic regurg

24
Q

3/6 decrescendo diastolic murmur

A

aortic regurg

increases with squatting and handgrip

decreased with standing or valsalva

25
Q

wide pulse pressure

A

aortic insufficiency

bounding pulse with huge pulse pressure

26
Q

BP of 140/50

A

wide pulse pressure

with aortic insufficiency

27
Q

quinckes sign

A

gentle pressure on fingernail

will blanch and fill alternatively if wide pulse pressure

28
Q

corrigans sign

A

pulse that is forceful then collapses

aortic regurg

29
Q

de mussets sign

A

rhythmic nodding or bobbing of the head in synchrony with the beating of the heart

with aortic regurg

30
Q

causes of aortic regurg

A 
atherosclerosis
AV fistula
thyrotoxicosis
anemia
fever
heart block
31
Q

light house

A

malar flushing with heartbeat

32
Q

hills

A

systolic BP in lower limb greater than upper limb

-by 20 mmHg

33
Q

duroziers

A

diastolic murmur over femoral arter on distal pressure

34
Q

pulsus bisferiens

A

aortic regurg in association with stenosis

35
Q

pulsus alterans

A

alternating strong and weak beats

left ventricular systolic impairment

36
Q

massive hypertrophy of the left ventricle of the heart due to volume overload

A

cor bovinum

37
Q

surgery in aortic regurg

A

symptoms of exertional dyspnea, orthopnea, and PND

LV dysfunction and contractility failure
-EF < 55%

BNP > 130

38
Q

low pitched rumbling murmur heard at apex

midsystolic or presystolic

A

austin flint murmur

aortic regurg

39
Q

absent MI, austin flint murmur, 1/6 diastolic murmur and acute CHF

A 
aortic dissection
endocarditis
HTN
inflammatory disease
seronegative spondyloarthropathy
40
Q

Tx of aortic insufficiency

A

afterload reduction

BNP evaluation

root replacement

CV II Exam 3 (21 decks)

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