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Cardiovascular 2 > Valvular Heart Disease - Johnston > Flashcards

Valvular Heart Disease - Johnston Flashcards

1
Q

Stenosis leads to ____

A

Hypertrophy

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2
Q

Regurg/Insufficiency leads to ____

A

Dilation

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3
Q

Mitral Stenosis

A

Rheumatic heart disease

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4
Q

Major Jones Criteria for RHD

A
  • Carditis (myo, peri)
  • Migratory polyarthritis
  • SubQ nodules
  • Sydenham’s chorea
  • Erythema marginatum
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5
Q

Jones minor criteria for RHD

A
  • Fever
  • Arthralgia
  • Increased sed rate or CRP
  • Leukocytosis
  • Prolonged PR interval
  • Elevated ASO or anti-DNase B
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6
Q

How to Dx RHD

A

2 major

1 major and 2 minor

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7
Q

Pathophysiology of aortic stenosis (results of it)

A
  • LV pressure –> LVH –> diastolic LV dysfunction –> syncope, HF
  • Reduced coronary flow –> angina
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8
Q

Symptoms of aortic stenosis

A
  • Angina
  • Syncope
  • Exertional dyspnea
  • Heart failure
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9
Q

Exam findings for aortic stenosis

A
  • Systolic ejection murmur radiating to suprasternal notch and carotids (2nd ICS RSB)
  • Narrow pulse pressure
  • Delayed pulses (carotid, peripheral)
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10
Q

ECG - aortic stenosis

A
  • Left atrial enlargement

- LVH (w/ strain)

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11
Q

Pharma therapy for aortic stenosis

Avoid what?

A
  • Digitalis, diuretics, nitroglycerin

- Avoid vasodilators (increased pre-load)

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12
Q

Surgical treatment for AS

A
  • Percutaneous balloon valvuloplasty, temporary valve replacement
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13
Q

Causes of aortic regurgitation (7)

A
  • HTN (increased aortic pressure)
  • Endocarditis
  • Marfan’s (aortic root dilation)
  • Ankylosing spondylitis
  • Aortic dissection
  • Syphilis (aortic root dilation)
  • Collagen vascular disease
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14
Q

Pathophysiology (results) of ACUTE aortic regurgitation

A

High diastolic LV pressure –> premature mitral closure –> LV ischemia and failure

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15
Q

Pathophysiology (results) of CHRONIC aortic regurgitation

A

Decreased SV over time –> hyperdynamic (overloaded) circulation –> systolic HTN –> pressure/volume overload –> concentric LVH

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16
Q

Symptoms of aortic regurg.

A
  • Dyspnea
  • Orthopnea
  • Paroxysmal nocturnal dyspnea
  • Angina
  • Syncope
17
Q

Exam findings for aortic regurg

A
  • Diastolic blowing murmur (2-3 ICS LSB)
  • HTN
  • Wide pulse pressure
  • Displaced PMI
  • Rhythmic movement of head w/ heart beats (DE MUSSET SIGN)
  • Decreased breath sounds
  • Kyphosis and decreased lumbar ROM
18
Q

Why do you want a chest X-ray is suspected aortic regurg?

A

To check for aortic dilation

19
Q
  • Prominent A wave in jugular venous pressure graph
  • Hepatomegaly
  • Diastolic murmur (LSB) that increases with inspiration
A

Tricuspid stenosis

20
Q

Prominent V wave in JVP graph, blowing systolic murmur (LSB) that increases with inspiration

A

Tricuspid regurgitation

21
Q

Tricuspid regurg. is associated with what causes?

A
  • Pulmonary HTN
  • RV infarction
  • Others
22
Q

Pulmonary HTN, diastolic blowing murmur (2nd LSB)

A

Pulmonic regurgitation

23
Q
  • Systolic murmur with ejection click (2-3 ICS LSB) that radiates to L shoulder and increases on inspiration
  • Angina, syncope
A

Pulmonary stenosis

24
Q

Causes of mitral stenosis

A
  • RHD

- Annular calcification

25
Q

Pathophysiology (results) of MS

A
  • Increased LA pressure, decreased LV output (looks like LV failure) –> volume overload + sympathetic response
  • Increased RV pressure + pulmonary HTN –> SYMPTOMS –> RVH
26
Q

Symptoms of mitral stenosis

A
  • Dyspnea
  • Orthopnea
  • Paroxysmal nocturnal dyspnea
  • Hemoptysis
  • Hoarseness
  • Edema
  • Ascites
  • MALAR RASH
27
Q

Exam findings for mitral stenosis

A
  • Diastolic rumble after an opening snap (apex)
  • Loud S1
  • LAE on EKG (P-mitrale)
28
Q

Chest X-ray findings for mitral stenosis

A
  • Straight left heart border
  • Thick right heart border
  • Kerley B lines (lungs)
  • Enlarged pulmonary arteries
29
Q

Pharma treatment for mitral stenosis

A
  • Diuretics (volume overload)
  • Anticoagulation for A. fib
  • Digitalis, BB, or CCB for rate control (sympathetic response)
30
Q

Causes of mitral regurg.

A
  • MVP
  • Ruptured chordae
  • Endocarditis
  • Ischemic papillary muscle (MI)
  • Collagen disease
  • Other
31
Q

Pathophysiology (results) of mitral regurg.

A
  • LV volume overload –> LV dilation –> LV dysfunction (volume overload)
32
Q

Symptoms of mitral regurg.

A
  • Dyspnea
  • Orthopnea
  • PND
33
Q

Exam findings for mitral regurg.

A
  • Holosystolic apical murmur radiating to axilla
  • S3
  • Displaced PMI
34
Q

Pharma treatment for ACUTE mitral regurg.

A

Vasodilators

Cardiovascular 2 (20 decks)

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