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Cardiovascular Med II Final > Valvular Heart Diseases - Johnston > Flashcards

Valvular Heart Diseases - Johnston Flashcards

1
Q

Name symptoms of mitral stenosis (MS)

A
  • DOE
  • Cough orthopne,
  • PND, pulmonary edema
  • hemoptysis, arterial emboli, a fib
  • ortner syndrome: hoarseness d/+ compression of left recurrent laryngeal nerve due to LA enlargement
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2
Q

what are some exam findings of MS?

A
  • malar flush (ruddy cheeks, blue facies.
  • increase S1; opening shape after S2
  • rumbling diastolic murmur - low pitched; best heart at apex using bell of stet
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3
Q

How is MS treated?

A
  • anticoagulant if in afib
  • percutaneous balloon valvuloplasty MVR (replacement)
  • diuretics
  • digitalis, BB, or CCB for rate control
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4
Q

Pts with MS are at increased risk of RVF why?

A

Pts can develop increased LA pressure, pulm HTN, pulm edema, hepatomegalia, ascites, peripheral edema

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5
Q

what are some CXR findings for MS

A
  • straight left heart border
  • Thick right heart border
  • Kerley B lines (lungs)
  • Enlarged pulmonary arteries
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6
Q

what are some causes of Mitral regurg?

A
  • MVP (most common) and mitral annular calcification
  • ruptured chordae
  • endocarditis
  • ischemic papillary muscle
  • collagen disease
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7
Q

explain the pathophys of mitral regurg

A

LV volume overload –> LV dilation –> LV dysfunction (volume overload)

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8
Q

what are some signs and symptoms of mitral regurg

A
  • dyspnea
  • orthopnea
  • PND
  • usually asymptomatic for years
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9
Q

what are some physical findings of mitral regurg?

A

systolic murmur (blowing, prominent at apex; radiates into left axilla)

  • loudness of murmur correlates with severity
  • decreased S1 or normal; may have a systolic click
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10
Q

How is Mitral regurg treated?

A
  • vasodilators - afterload reduction
  • decrease resistance to flow
  • ACEI - chronic MR
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11
Q

what are some symptoms of MVP and how is it treated?

A

asymptomatic to arrhythmias (SVT, PVC, VT) chest pain, syncope
- systolic murmur; may have systolic click

Rx: If hyper adrenergic state (anxious, palpitations; consider BB)
- valve repair favored over replacement

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12
Q

If a pt presents with signs and symptoms of MVP, what must you rule out first?

A
  • hyperthyroid

- collagen abnormalities

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13
Q

Explain the pathyophys of aortic stenosis (AS)

A

Obstruction leads to pressure overload; LVH, increased LVED pressure–> dystollic LV dysfunction –> syncope, HF
- reduced coronary flow –> angina

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14
Q

Symptoms of AS

A
  • angina
  • exertional dyspnea
  • syncope
  • HF
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15
Q

What are some physical findings of AS?

A
  • narrow pulse pressure; decreased SV and systolic pressure
  • delayed pulses - Parvis/tardus
  • systolic murmur, harsh, 2nd ICS RSB; radiate into supra sternal notch/carotids
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16
Q

what are you likely to see on EKG with AS?

A

Left atrial enlargement

- Left Ventricle hypertrophy (w/strain)

17
Q

How is AS treated?

A
  • percutaneous balloon valvuloplasty - temporary AVR
  • Drugs: digitalis, diuretics, nitroglycerin
    Avoid vasodilators (increased preload)
18
Q

what are some causes of aortic regurg?

A
  • HTN
  • endocarditis
  • Marfans
  • Anklyosing spondylitis
  • aortic dissection
  • syphilis
  • collagen
19
Q

explain the pathophys of acute aortic regurg

A
  • high diastolic LV pressure –> premature mitral closer –> LV ischemia and failure
20
Q

explain the pathophys of chronic aortic regurg

A
  • decreased SV over time –> hyperdynamic (overload) circulation –> systolic HTN–> presure/volume overload –> concentric LVH
21
Q

what are some symptoms of aortic regurg

A
  • dyspnea
  • orthopnea
  • paroxysmal nocturnal dyspnea
  • angina
  • syncope
22
Q

what are some physical findings associated with aortic regurg?

A
  • diastolic decrescendo blowing murmur at 2-3 iCS LSB)
  • Austin flint murmur
  • HTN
  • wide pulse pressure
  • displaced PMI
  • head-bobbing with heart beats (de musset sign)
  • corrigan’s pulse: carotid pulse iwth rapid rise and fall
  • water hamer pulse
  • femoral fbruits
23
Q

How is aortic regurg treated?

A
  • ARB: decrease afterload to decrease regurg volume

- surgery AoVR when symptomatic or EF < 55%

24
Q

WHy is a CT of chest performed in patients with aortic regurg

A

To check for aortic dilation

25
Q

pt with hepatomegaly, diastolic murmur at LSB that increase with inspiration (carvallo’s sign) and decrease with expiration and valsalva. Prominent A wave in jugular venous pressure graph. Most likely valvular disease involved _

A

tricuspid stenosis

26
Q

Pt with pulmonary HTN, hx of MI/RV infarction. Promient V wave in JVP. on PE blowing systolic murmur at LSB that increase with inspiration. most likely diagnosis

A

tricuspid regurg

Cardiovascular Med II Final (9 decks)

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