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44 Cards in this Set

  • Front
  • Back
What are the most common symptoms of valvular disorders?
dyspnea and chest pain
What is the pathophysiology of aortic stenosis?
• obstruction of the left ventricular outflow
• leads to left ventricular hypertrophy
What are the 3 cardinal signs and symptoms of aortic stenosis?
• angina
• syncope
• dyspnea
What are some late findings of aortic stenosis?
• left ventricular failure
• severe pulmonary hypertension
• resultant rightheart failure
On physical exam, what are some findings of a patient with aortic stenosis?
• lower B/P with narrowed pulse pressure
• delayed and diminshed pulses
• prominent "a-wave"
• palpable S4 with non-displaced, sustained PMI
• thrill at the base
Describe the murmur of aortic stenosis upon auscultation
• "diamond-shaped" murmur (crescendo-decrescendo) at the 2nd intercostal space at the left sternal border
• low pitch murmur at the base radiating to the carotids
• paradoxically S2 split from constant late A2 (P2-A2 instead of normal A2-P2)
What are some EKG findings of a patient with aortic stenosis?
• left ventricular hypertrophy and left axis deviation
• possible atrial fibrillation
• left bundle branch block
• left atrial enlargement
What is the treatment of symptomatic patient with aortic stenosis?
surgery (valve repair or replacement)
What 2 types of medical therapy would you give to a patient who had a mechanical valve replacement?
• endocarditis prophylaxis
• anticoagulation therapy
What is the area of the aortic valve with significant stenosis?
less than 1.0 cm2
What are some characteristics of aortic insufficiency?
• increased left ventricular end-diastolic volume
• chamber thickens and dilates to accommodate the regurgitant volume
• evntually the left ventricle fails, causing pulmonary hypertension and right venticular failure
What are some etiologies for aortic regurgitation?
• infectious - from endocarditis or syphilitic)
• inflammatory - rheumatic, ankylosing spondylitis, Lupus)
• Congenital - bicuspid aortic valve, prolaspe associated with ventricular septal defect, congenital fenestration
• Degenerative - Marfan's, cystic medial necrosis
• Traumatic
True/False: Patients with aortic regurgitation usually are asymptomatic until middle age
The correct answer is: True
What are some findings upon physical exam of a patient with aortic regurgitation?
• wide pulse pressure
• physical findings of Marfan's
• displaced PMI (due to left ventricular hypertrophy) with palpable S3 and S4
• possible pulmonary congestion
• diastolic "blowing" murmur along left sternal border
What part of the cardiac cycle would you hear the murmur of aortic regurgitation?
• during diastole
• high pitched decrescendo diastolic murmur heard best by sitting up and leaning forward
What is an Austin-Flint murmur?
• a rumbling apical diastolic murmur heard with aortic regurgitation
• regurgitant blood flow hits the mitral valve
What murmurs are heard during systole?
• aortic stenosis and mitral regurgitation
• also mitral valve prolapse
What murmurs are heard during diastole?
aortic regurgitation and mitral stenosis
What are some findings on chest xray with aortic regurgitation?
• enlarged heart, if chronic, with signs of pulmonary congestion
• possible calcified aortic valve
• enlarged aorta with connective tissue disorders
What are some EKG findings with aortic regurgitation?
• left ventricular hypertrophy and left axis deviation
• ST depression and T wave inversion (ischemic changes)
• widened QRS (due to fibrosis)
What is the medical treatment for aortic regurg?
• vasodilators
• ACE inhibitors (reduces regurg)
• beta blockers in Marfans
• diuretics (to reduce preload)
• digoxin (to improve inotropy)
• antiarrhythmics
• SBE prophalaxis, penicillin for syphillis, and anticoagulation (if necessary)
When is surgery indicated in aortic regurg?
• when the patient is symptomatic
• Ejection fraction < 55%
• annulus > 5.0 cm
What are etiologies for mitral regurg?
•. degenerative - myxomas (cardiac tumors), Marfan's, calcified annulus
• infectious - infective endocarditis
• structural - ruptured chorae tendineae, papillary muscle dysfunction
Why is acute mitral regurg worse that chronic mitral regurg?
• with chronic mitral regurg, the left ventricle and atria can accommodate the regurgitant flow; less blood flow goes to the lungs
• with acute mitral regurg, the normal-sized left atria cannot accommodate the regurgitant flow and blood flows into the lungs
Describe the murmur of mitral regurg
holosystolic (or pansystolic) murmur at apex radiating to the axillae
What is the difference between acute and chronic mitral regurg on Xray?
• with chronic mitral regurg, you would see left atrial, left ventricular, and right ventricular enlargement
• with acute mitral regurg, you would see pulmonary edema without chamber enlargement
What is the first line therapy in patients with mitral regurg?
ACE inhibitors
What is the treatment for acute mitral regurg?
surgery is the only option with acute mitral regurg
What are the 2 syndromes associated with mitral stenosis?
• moderate - pulmonary edema
• severe- pulmonary HTN, and low cardiac output
What are the 2 major causes of mitral stenosis?
• rheumatic fever
• congential disease
How do you distinguish strep throat from a viral sore throat?
strep has:
• exudates
• fever
• lymphadenopathy
• absence of cough
What is the pathophysiology of rheumatic fever?
• antibodies form in response to the strep antigen
• antibodies mistakenly attack host tissue (have an affinity for connective tissue, like valve collagen)
• causes fibrous thickening and adhesion of valve
What is the criteria for a diagnosis of rheumatic fever?
• evidence of previous strep pharyngitis
• need two major criteria OR 1 major and 2 minor
What are the major points of the Jones Criteria?
• migratory arthritis
• carditis
• sub-cutaneous nodules
• erythema marginatum (redness with a margin)
• Sydenham's chorea (shakes)
What are the minor points of the Jones Criteria?
• fever
• elevated sed rate/C-reactive protein
• arthralgias (sore joints)
• increased PR interval
• prior rheumatic fever or rheumatic heart disease
List the valves that affected by rheumatic heart disease (from most common to least common)
Mitral > aortic > tricuspid (almost never pulmonic)
What is the difference between rheumatic fever and rheumatic heart disease?
Rheumatic heart disease is when there is residual evidence of cardiac impairment long after the acute illness has passed
Describe the murmur of mitral stenosis
diastolic "thrill" at the left apex in the left lateral decubitus position
What a Graham-Steell murmur?
murmur of pulmonic insufficiency secondary to severe pulmonary hypertension
Why is important to maintain sinus rhythm with a patient with mitral stenosis?
if the patient had A-fib with mitral stenosis, they do not have the atrial kick to open the stenotic valve
What is the most common cause of mitral stenosis?
rheumatic fever from group A beta-hemolytic strep
Why can patient with mitral regurg have hoarseness?
the left atria and pulmonary artery enlarges and compresses the laryngeal nerve
What does mitral valve prolapse sound like upon auscultation?
• midsystolic click and late systolic murmur
• late systolic murmur is due to mitral regurg
What are some complications of mitral valve prolapse?
• mitral regurg
• infective endocarditis
• atrial fibrillation
• stroke
• sudden cardiac death