Week 6 Flashcards
What are the systolic murmurs
aortic stenosis pulmonic stenosis mitral regurgitation tricuspid regurgitation mitral valve prolapse ventricular septal defect
Aortic Stenosis
The valve doesn’t open properly.
characteristics include crescendo/decrescendo, mid systolic harsh sound.
located at right sternal border. may radiate to neck and carotids.
sound exacerbates with activity.
Causes LVH (treat with ACE inhibitor)
occurs late in life
what do you treat LVH with?
ACE inhibitors because it remodels
pulmonic stenosis
crescendo/ decrescendo, hard medium pitch,
3rd left intercostal space down the left sternal border to the apex
mitral regurgitation
blowing, pansystolic, heart at the apex, radiating to the axilla.
often seen with a-fib.
causes right sided heart failure
tricuspid regurgitation
in systole, high pitched, heard at left sternal border, may radiate to the right sternal border.
mitral valve prolapese
way more common in young women (15-30) than men.
mid to late systole, honking noise. may have systolic click. sounds can be intermittent.
heard at left lower sternal border
ventricular septal defect (VSD)
pansystolic, loudest in mid systole. heard at left sternal border radiating to the right sternal border. pressure higher on L side of heart. shunting to the right side
diastolic murmurs
aortic regurgitation
pulmonic regurgitation
mitral stenosis
tricuspid stenosis
aortic regurgitation
decrescendo. high pitched, loud “lowing” sound. best heard at Erb’s point, or slightly lower.
may be without symptoms for years.
or could have palpitations, heightened awareness of heartbeat, head pounding.
LVH leads to decreased LVEF. eventually may lead to right sided HF
HF is a late sign of AF and is associated with poor prognosis.
symptoms of right sided heart failure
fatigue, cough, progressive dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea
pulmonic regurgitation
decrescendo, high pitched soft sound. heard best at left upper sternal border. intensity increases with inspiration(have pt take a deep breath).
most common cause is congenital.
mitral stenosis
low pitched, may be observed a-fib.
best heard with the patient lying in the left lateral recumbent position.
tricuspid stenosis
decrescendo, low pitched. heard at left upper sternal border, may be heard down to xiphoid process.
may be seen where there is mitral stenosis.
who should get prophylactic antibiotics?
prosthetic heart valve, past valve repair, hx of infectious endocarditis, congenital heart disease, hx of surgery or procedures affecting the heart.
grade I heart murmur
very faint, heart with intent listening. may not be heard in all position
grade II heart murmur
quiet. heard immediately after placing the stethoscope on the chest
grade III heart murmur
moderately loud
grade IV heart murmur
loud. palpable thrill
grade V heart murmur
very loud with thrill.may be heard when stethoscope is partly off the chest
grade VI heart murmur
very loud with thrill. may be heard with stethoscope entirely off the chest
What time frame does the patient start taking abx before procedure
30-60 minutes before dental, oral, respiratory tract procedures
what is standard prophylaxis abx for dental procedures
amoxicillin (2g PO) for adult
ampicillin (2g PO) for adult
OR
cefazolin or ceftriaxone 1g IV
what is standard prophylaxis abx for dental procedures for those allergic to penicillin
cephalexin (2g PO)
cindamycin (600 mg PO)
azithromycin / clarithromycin (500 mg PO)
what is standard prophylaxis abx for dental procedures for those allergic to penicillin or unable to tolerate PO anx
cefazolin or ceftriaxone (1g IV)
OR
clindamycin (600 mg IC)
acyanotic congenital heart diseases
"LEFT TO RIGHT" VSD/ASD PDA coarctation of the aorta aortic stenosis pulmonic stenosis
VSD/ASD
mixing of the oxygenated blood (from the left ) and unoxygenated blood (from the right).
left to right shunt. lungs are getting oxygenated blood. (not a bad thing)
ASD- left to right atrium
VSA- left to right ventricle
patent ductus arteriosis (PDA)
usually closes within 24 to 72 hours.
pulmonary artery carries deoxygenated blood
refer pt to cardiologist
coarctation of the aorta
results in decreased perfusion to the abdominal organs and lower periphery.
(it is like a kink in a hose. The kink is below the 3 great vessels on aorta).
Aortic stenosis can cause
LVH
pulmonic stenosis can cause
RVH
may result in re opening of the foramen ovale (can result in stroke)
cyanotic congenital heart diseases
"RIGHT TO LEFT" tetrology of fallot transposition of the great vessels trucuspid atresia truncus arteriosis hypoplastic left heart syndrome
tetrology of fallot
aorta overrides VSD. right ventricular outflow obstruction.
ventricular septal defect can occur. RVH can occur.
not dx or treated in primary care
transposition of the great vessels
aorta rises from the right ventricle. pulmonary artery arises from the left ventricle. (flipped from normal)
VSD is compensatory, Patent foramen ovale or PDA
will be managed by cardiac surgery
tricuspid atresia
blood enters RA but has no way to get to the RV.
VSD compensates.
this requires surgery
truncus arteriosis
single great vessel where both ventricles contribute blood. can lead to RVH
hypoplastic left heart syndrome
short survival rate. found in utero 5 year survival rate. Left ventricle is small. aorta is small. unable to push out alot of blood to the body RV is extremely large
p wave is absent in
a-fib
PR interval is > 0.2 seconds , what is it
1st degree heart block
if there are alot of p waves, it indicates what
3rd degree heart block
q waves are
pathologic. they indicate a prior myocardial injury
delta wave indicates
wolff-parkinson-white syndrome
atrial fibrillation
most common dysrhythmia . quivering atrium, not contracting. pt loses 20% cardiac output.
at increased risk for clot/stroke due to stagnant/pooling blood.
RVR is heart rate >110. (can cause troubled hemodynamics)
there is a relationship with hyperthyroidism that causes it.
perform CHA2DS2 VASc score to determine risk for strroke
treatment for A-fib
beta blockers to control rhythm
abalation if new onset
anticoagulant
amiodarone- can increase risk for pulmonary fibrosis with longterm use.
CHA2DS2 VASc score
afib stroke risk tool CHF HTN Age >75 DIABETES STROKE VASCULAR DISEASE AGE 65-74 SEX (female)
each category is 1 -2 points
CHA2DS2 VASc score of 0
low risk
CHA2DS2 VASc score of 1
moderate risk.
male should be consider starting anticoagulants
CHA2DS2 VASc score of 2
high risk. start on oral anticoagulant
Dx test to assess for structure/ function of valves
echocardiogram
LVD develops in a patient. what other valve disorder would you expect?
aortic stenosis
RVH develops in a patient. what other valve disorder would you expect?
pulmonic stenosis
who would get prescribed a holter monitor?
pt with palpitations
biggest etiology for developing heart valve issues
rheumatic heart disease
palpitations
most common tachyarrhythmia
causes: stress, chemicals, caffeine
dx: event monitor for 14-30 days
or holter monitor for 24 hours
What are 3 red flag symptoms of a heart murmur?
Holosystolic, diastolic, >/= grade 3, increasing intensity when standing, diastolic, a/w new extra heart sound
A 10 month old patient present to the clinic for a potential ear infection. During exam, the provider notes a new onset short, musical, systolic murmur. What should the provider do next?
Urgent referral to cardiology (ANY child < 1 year old should be referred, even if the murmur appears innocent)
Your patient presents with a harsh, holosystolic, murmur that is best heard at the apex and radiates to the axilla. This is most likely what?
mitral regurgitation
How often should patients with Mitral Valve Prolapse should get an echocardiogram?
q 3-5 years
Describe the classic murmur found in hypertrophic cardiomyopathy?
Pansystolic murmur, quieter with squatting/louder when standing
