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IM > Valvular Heart Diseases > Flashcards

Valvular Heart Diseases Flashcards

1
Q

Hemodynamic hallmark of mitral stenosis (MS)

A

blood can flow from LA to LV only if propelled by an abnormally elevated left atrioventricular pressure gradient (d.t. reduction in mitral orifice area < 2 cm)

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2
Q

The leading cause of mitral stenosis

A

RHD

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3
Q

narrowed mitral orifice <4cm2 with obstruction blood flow from LA to LV

A

MITRAL STENOSIS

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4
Q

MC presenting symptoms of MS

A

dyspnea
fatigue
decreased exercise tolerance

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5
Q

important cause of morbidity and mortality late in the course of MS

A

recurrent pulmonary emboli

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6
Q

Characteristic murmur of MS

A

DIASTOLIC RUMBLING MURMUR PRECEDED BY OPENING SNAP (OS) AT THE APEX

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7
Q

Murmur is usually LOUDER during INSPIRATION and diminishes during forced expiration

A

Carvallo’s sign

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8
Q

High-pitched, diastolic, decrescendo blowing murmur along the left sternal border

A

Graham Steell murmur

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9
Q

SIGNS OF CHF:

A 
jugular venous distention
dullness on chest percussion → pleural effusion
fine rales
hepatomegaly and ascites
pedal or sacral edema
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10
Q

ECG findings in MS

A
  • atrial fibrillation
  • LA hypertrophy
  • RV hypertrophy
  • RA hypertrophy
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11
Q

Chest x-ray in MS

A
  • left atrial enlargement
  • prominent PA
  • dilation of the upper lobe pulmonary veins
  • posterior displacement of the esophagus by an enlarged LA

• Kerley B lines
-result from distention of interlobular septae and lymphatics with edema when resting mean LA pressure exceeds ~20 mmHg

  • pleural effusion and alveolar infiltrates
  • pulmonary edema
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12
Q

Important for at risk patients with rheumatic MS

A

Penicillin prophylaxis

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13
Q

Useful in slowing the ventricular rate of patients w/ AF

A

beta blockers
nonhydropyridine calcium channel blockers
digitalis glycosides

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14
Q

Should be administered indefinitely to patients w/ MS who have AF or a history of thromboembolism

A

warfarin therapy

targeted to an international normalized ratio (INR) of 2-3

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15
Q

Indicated in symptomatic (New York Heart Association [NYHA] Functional Class II–IV) patients with isolated severe MS, whose effective orifice (valve area) is < ~1 cm2/m2 body surface area, or <1.5 cm2 in normal sized adults

A

mitral valvotomy

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16
Q

May be d.t. ACS w/ papillary muscle rupture, chest trauma, endocarditis

A

Acute MR

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17
Q

May be d.t. RHD, MVP, cardiomyopathies

A

Chronic MR

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18
Q

Most prominent symptoms in CHRONIC SEVERE MR

A

fatigue
exertional dyspnea
orthopnea

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19
Q

Characteristic murmur of MR

A

apical holosystolic murmur of at least grade III

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20
Q

Chest X-Ray findings in MR

A

LAE

LVH

21
Q

ECG findings in MR

A

LAE
LVH
atrial fibrillation

22
Q

Frequent finding in heritable CT disease

A

MVP (Floppy syndrome, Barlow’s syndrome)

more common in women 15-30 y/o
more severe in men and > 50 years old

23
Q

Characteristic murmur of MVP

A

apical mid- or late non-ejection systolic murmur preceded by a click

ACCENTUATED BY - standing and strain phase of Valsalva maneuver
DIMINISHED BY - squatting and isometric exercises

24
Q

narrowing of the aortic valve orifice – causes

obstruction to the flow of blood from LV to aorta

A

AORTIC STENOSIS

25
Q

CONGENITAL AORTIC VALVE DISEASE

A

Bicuspid aortic valve (BAV)

  • MC aortic heart defect
  • AD
  • NOTCH1 gene
  • abnormalities in nitric oxide synthase and NKX2.5
26
Q

CALCIFIC AORTIC VALVE DISEASE

A

degenerative

MC cause of AS in adults

27
Q

3 CARDINAL SYMPTOMS of AS

A
  • exertional dyspnea
  • angina pectoris
  • syncope (exertional)
28
Q

Characteristic murmur of AS

A

thrill and harsh CRESCENDO-DECRESCENDO SYSTOLIC murmur at the 2nd R ICS

↓ in valsalva maneuver

29
Q

pulsus parvus et tardus

A
  • carotid arterial pulse rises slowly to a delayed peak

* weak and late-peaking/delayed pulse

30
Q

Gallavardin effect (AS)

A

murmur may transmitted to apex resembling murmur of MR

31
Q

ECG findings in AS

A
  • LV hypertrophy

* ST segment depression and T wave inversion

32
Q

Gold standard for AS diagnosis

A

Cardiac Catheterization

  • determine the status of coronary artery disease
  • coronary angiography is indicated to detect or
  • exclude CAD in patients >45 years old with severe AS who are being considered for operative treatment
33
Q

percutaneous aortic balloon valvuloplasty (PABV)

A

preferable to operation in many children and young adults with congenital, noncalcific AS

NOT commonly used as definitive therapy in adults with severe calcific AS because of a very high restenosis rate

34
Q

transcatheter aortic valve replacement

A

performed with increasing frequency in prohibitive-, high-, and intermediate surgical-risk adult patients worldwide using one of two available systems, a balloon expandable valve and a self-expanding valve, both of which incorporate a pericardial prosthesis

35
Q

Can be caused by primary aortic valve disease or primary aortic root disease

A

AORTIC REGURGITATION

36
Q

Primary Valve Disease

A

RHD
congenital bicuspid aortic valve
endocarditis

37
Q

Primary Aortic Root Disease

A

aortic annular dilation

Marfan’s syndrome

38
Q

Characteristic murmur of AR

A

high pitched blowing DECRESCENDO DIASTOLIC murmur in 3rd ICS left PSB

39
Q

ECG findings in AR

A

LVH w/ ST depression and T wave inversion in I, avL, V5-V6 (lateral leads)

40
Q

Chest x-ray findings in AR

A

apex displaced DOWNWARD and to the LEFT

41
Q

Management of AR

A

diuretics, ACE-I and vasodilators for CHF

Aortic Valve Replacement

42
Q

valve area is < 4cm2 which causes an ↑ in RA pressures with progressive dilatation

A

TRICUSPID STENOSIS

43
Q

Does NOT occur as an isolated lesion and usually associated with MS

almost always accompanied by severe TR

A

TRICUSPID STENOSIS

44
Q

MC cause of TS

A

RHD

45
Q

Carcinoid Syndrome

A

production of substance that stimulates collagen production – fibrosis of the tricuspid valve

46
Q

Symptoms in TS

A

ascites

edema

47
Q

Signs in TS

A

ascites, edema, hepatosplenomegaly - signs or R sided CHF

48
Q

Characteristic murmur of TS

A

DIASTOLIC murmur at lower left PSB

AUGMENTED - inspiration
REDUCED - expiration and Valsalva (strain phase)

IM (66 decks)

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