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12 Cards in this Set
- Front
- Back
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regurgitation/stenosis is *always* chronic?
Do dz processes of the valve always have hemodynamic Sx? When a pt develops mitral valve dz due to ischemia, it most commonly (5:1) occurs as a result of ____ infarction due to occlusion of the ___. What is the most common regurgitant lesion we'll see? |
stenosis.
No. inferior, RCA Mitral valve. |
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Annular calcification
Myxomatous degeneration (MVP) RHD Endocarditis SAM (hypertrophic cardiomyopathy) Rupture of the Chordae Ten. Endocarditis of Chor.Ten. dysfunction/rupture of pap. mus. left ventricle cavity dilatation ...all can cause what? |
Mitral regurgitation.
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(answer w/ chronic or acute)
v. high LA pressure and pulm edema/dypsnea? Dilated LA w/less elevated pressure, and volume dilated LV? Possible causes of acute mitral regurgitation? |
acute; chronic.
MI, rupture, etc. |
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There are ___ types of systolic murmurs, name 'em and give characteristics.
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Mid-systolic Ejection Murmur
- turbulent flow from semilunar valve into great vessel - murmur (begins after S1 and stops before S2 Holosystolic murmur: - backflow from a high pressure chamber into a lower pressure chamber (Mitral/Triscuspid regurg., or mid ventricular septal defect) - Begins right w/ S1, and can come up to (or thru) S2. |
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What does the LA pressure wave look like in Mitral regurg?
What would a holosystolic creshendo/decreshendo murmur make you think of? More sustained? Can mitral regurg cause S3? |
normal c wave dips but then shows a taller "t-wave" afterwards as a result of the backflow.
acute mitral regurg. chronic mitral regurg. Yes. |
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When we're talking about mitral valve stenosis (obstruction to inflow)... which is the most common etiology?
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RHD
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Characterize a classical mitral stenotic murmur? What changes as the stenosis gets worse?
Is it low or high frequency? Do any of the normal Ht sounds get louder/softer? Is this an early or a late sign? |
Begins sometime after S2 w/ an opening snap (OS - high frequency sound) ---> decreshendo (diastolic murmur)
--silence b/c the gradient is gone--> small creshendo back into S1 (pre-systolic murmur) It's a 'rumble', low freq/amplitude; best appreciated over diaphragm. period of silence gets smaller, eventually there is actually no PSM b/c we get atrial fibrillation as a result of chronically elevated LAP. Yes, S1 can get louder. One of the earliest. |
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What are the directional shifts and magnitudes (physiological) of A2 and P2 during inspiration?
What also moves in paradoxical splitting? |
P2 is moved later b/c negative intrapulmonary pressure lets more blood go into the pulm sys.
Aortic closure can be a little earlier b/c there is can be a little bit of pooling blood in the lungs. P2 shift is much bigger. P2 is still the one moving, it's just that A2 is later b/c of the LBBB. |
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What is often the earliest Sx of mitral stenosis?
As it gets more severe, the pulm pressure rise isn't passive anymore, it's active. Why? Is this later stage as reversible as the earlier stages? What might be the overall effect on the CO? |
Exertional dyspnea.
concentric RVH No. Decreased. |
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____ filling time is compromised as HR increases.
What condition might this be a problem in?? |
Diastolic.
Mitral valve stenosis Exercise i/ mild MVS: LA pressure will go up, PA will go up, and CO will increase. - this becomes more of a problem as the LAP is already increased in later stages. |
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EKG findings in a pt w/ mitral stenosis?
**This is hard to pick up. Don't worry too much about it.** |
increased P-wave amp in V1 (negative)
RAD some evidence of RVH (increased R-wave in V1) |
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What is the standard approach to Tx of MVS when is gets bad enough?
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open the valve w/ a balloon in the cath lab.
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