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44 Cards in this Set
- Front
- Back
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What are the most common symptoms of valvular disorders?
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dyspnea and chest pain
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What is the pathophysiology of aortic stenosis?
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• obstruction of the left ventricular outflow
• leads to left ventricular hypertrophy |
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What are the 3 cardinal signs and symptoms of aortic stenosis?
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• angina
• syncope • dyspnea |
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What are some late findings of aortic stenosis?
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• left ventricular failure
• severe pulmonary hypertension • resultant rightheart failure |
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On physical exam, what are some findings of a patient with aortic stenosis?
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• 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 |
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Describe the murmur of aortic stenosis upon auscultation
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• "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) |
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What are some EKG findings of a patient with aortic stenosis?
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• left ventricular hypertrophy and left axis deviation
• possible atrial fibrillation • left bundle branch block • left atrial enlargement |
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What is the treatment of symptomatic patient with aortic stenosis?
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surgery (valve repair or replacement)
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What 2 types of medical therapy would you give to a patient who had a mechanical valve replacement?
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• endocarditis prophylaxis
• anticoagulation therapy |
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What is the area of the aortic valve with significant stenosis?
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less than 1.0 cm2
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What are some characteristics of aortic insufficiency?
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• 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 |
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What are some etiologies for aortic regurgitation?
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• 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 |
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True/False: Patients with aortic regurgitation usually are asymptomatic until middle age
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The correct answer is: True
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What are some findings upon physical exam of a patient with aortic regurgitation?
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• 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 |
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What part of the cardiac cycle would you hear the murmur of aortic regurgitation?
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• during diastole
• high pitched decrescendo diastolic murmur heard best by sitting up and leaning forward |
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What is an Austin-Flint murmur?
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• a rumbling apical diastolic murmur heard with aortic regurgitation
• regurgitant blood flow hits the mitral valve |
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What murmurs are heard during systole?
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• aortic stenosis and mitral regurgitation
• also mitral valve prolapse |
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What murmurs are heard during diastole?
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aortic regurgitation and mitral stenosis
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What are some findings on chest xray with aortic regurgitation?
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• enlarged heart, if chronic, with signs of pulmonary congestion
• possible calcified aortic valve • enlarged aorta with connective tissue disorders |
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What are some EKG findings with aortic regurgitation?
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• left ventricular hypertrophy and left axis deviation
• ST depression and T wave inversion (ischemic changes) • widened QRS (due to fibrosis) |
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What is the medical treatment for aortic regurg?
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• 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) |
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When is surgery indicated in aortic regurg?
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• when the patient is symptomatic
• Ejection fraction < 55% • annulus > 5.0 cm |
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What are etiologies for mitral regurg?
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•. degenerative - myxomas (cardiac tumors), Marfan's, calcified annulus
• infectious - infective endocarditis • structural - ruptured chorae tendineae, papillary muscle dysfunction |
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Why is acute mitral regurg worse that chronic mitral regurg?
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• 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 |
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Describe the murmur of mitral regurg
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holosystolic (or pansystolic) murmur at apex radiating to the axillae
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What is the difference between acute and chronic mitral regurg on Xray?
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• 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 |
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What is the first line therapy in patients with mitral regurg?
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ACE inhibitors
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What is the treatment for acute mitral regurg?
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surgery is the only option with acute mitral regurg
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What are the 2 syndromes associated with mitral stenosis?
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• moderate - pulmonary edema
• severe- pulmonary HTN, and low cardiac output |
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What are the 2 major causes of mitral stenosis?
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• rheumatic fever
• congential disease |
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How do you distinguish strep throat from a viral sore throat?
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strep has:
• exudates • fever • lymphadenopathy • absence of cough |
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What is the pathophysiology of rheumatic fever?
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• 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 |
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What is the criteria for a diagnosis of rheumatic fever?
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• evidence of previous strep pharyngitis
• need two major criteria OR 1 major and 2 minor |
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What are the major points of the Jones Criteria?
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• migratory arthritis
• carditis • sub-cutaneous nodules • erythema marginatum (redness with a margin) • Sydenham's chorea (shakes) |
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What are the minor points of the Jones Criteria?
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• fever
• elevated sed rate/C-reactive protein • arthralgias (sore joints) • increased PR interval • prior rheumatic fever or rheumatic heart disease |
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List the valves that affected by rheumatic heart disease (from most common to least common)
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Mitral > aortic > tricuspid (almost never pulmonic)
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What is the difference between rheumatic fever and rheumatic heart disease?
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Rheumatic heart disease is when there is residual evidence of cardiac impairment long after the acute illness has passed
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Describe the murmur of mitral stenosis
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diastolic "thrill" at the left apex in the left lateral decubitus position
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What a Graham-Steell murmur?
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murmur of pulmonic insufficiency secondary to severe pulmonary hypertension
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Why is important to maintain sinus rhythm with a patient with mitral stenosis?
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if the patient had A-fib with mitral stenosis, they do not have the atrial kick to open the stenotic valve
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What is the most common cause of mitral stenosis?
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rheumatic fever from group A beta-hemolytic strep
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Why can patient with mitral regurg have hoarseness?
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the left atria and pulmonary artery enlarges and compresses the laryngeal nerve
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What does mitral valve prolapse sound like upon auscultation?
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• midsystolic click and late systolic murmur
• late systolic murmur is due to mitral regurg |
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What are some complications of mitral valve prolapse?
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• mitral regurg
• infective endocarditis • atrial fibrillation • stroke • sudden cardiac death |
