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103 Cards in this Set
- Front
- Back
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what is the most common cause of atrial stenosis worldwide?
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rheumatic
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what is the most common cause of atrial stenosis in the US?
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calcific/degenerative
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when is calcification induced in aortic stenosis?
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when uni- or bicuspid valve functions decrease and create turbulence
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what pressure is high in aortic stenosis?
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LV filling pressure
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what function is preserved until late in aortic stenosis?
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systolic function
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what fills the LV in aortic stenosis?
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atrial contraction rather than passive filling
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when does the peak ejection occur in late aortic stenosis?
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it is delayed later into systole (instead of the beginning like normal)
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what are the triad of symptoms in aortic stenosis?
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chest pain
exertional syncope or near syncope dyspnea or orthopnea |
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why does exertional syncope occur during aortic stenosis?
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because blood goes to the muscles and sacrifices blood pressure, leading the brain to lose blood
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how long until the chest pain symptoms occur in aortic stenosis until death?
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5 years
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how long from when exertional syncope develops in aortic stenosis until death?
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3 years
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how long form when dyspnea develops in aortic stenosis until death?
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18 months
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why may aortic stenosis murmur decrease with standing?
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because blood will pool in the legs and there will be less blood to push through the stuck valve
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how will the carotid pulse present in aortic stenosis?
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delayed and weakened carotid upstroke ("pulsus tardis et parvis")
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what will the aortic stenosis mumur sound like?
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late crescendo/decrescendo murmur at base with radiation to carotids
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what is one of the best markers for the severity of aortic stenosis?
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soft or absent S2 (i.e. it's not closing very well because it's not opening very well)
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what heart sound will you hear at the apex of the heart in aortic stenosis?
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S4
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what heart sound will be paradoxic in aortic stenosis and why?
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paradoxically split S2
normally S2 splits with inspiration because you're sucking more blood into the venous side; with critical aortic stenosis the split happens when you're not inspiring and when you breathe in there is no split because normally the aortic is longer than the pulmonic so when you breath in, it increases the pulmonic component to match the aortic |
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what is a rare by unique association for aortic stenosis?
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GI bleeds
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what 2 diagnostic tests are most important for aortic stenosis and why?
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Doppler - quantifies the gradient and calculates the valve area
2D echo - structure and mobility of valve leaflets, thickness and function of ventricular wall |
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what will the EKG of aortic stenosis show?
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simply left ventricular hypertrophy
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what is the most approprate intervention fr aortic stenosis?
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surgert
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at what point will you perform surgery for aortic stenosis?
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when the valve area has been reduced to 0.75cm2
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what is the problem with balloon valvuloplasty and when would you use it for aortic stenosis?
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the initial success rate is excellent, but most patients restenosis within 6 months
therefore, it is only used as a "bridge" to surgery in patients with other transient co-morbid illnesses |
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what is an alternative to surgery in aortic stenosis that is technically difficult?
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transcutaneous valvular surgery
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what are 5 causes of aortic regurgitation?
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endocarditits
rheumatic fever calcific degeneration trauma aortic root disease |
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what causes the simultaneous dilation and hypertrophy in aortic regurgitation?
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blood leaks back into the ventricle from the aorta at 5-7x greater pressure than that from the atrium
the high pressure increases causes hypertrophy and the increased volume causes dilation |
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what is cor bovinum and what disease is it associated with?
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large, thick walled heavy hearts (sometimes big enough to fill half the chest) seen in aortic regurg
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what allows people to go on for so long asymptomatically with aortic regurg?
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the simultaneous hypertrophy and dilations
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when do aortic regurg symptoms arise?
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when myocardial compensation outstrips vascular supply
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what function is preserved in aortic regurgitation?
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systolic function
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what will pulses be like in aortic regurg?
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bounding central pulses
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what is corrigan's or water hammer pulses?
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the bounding central pulses seen in aortic regurg
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what will the murmur be like in aortic regurg?
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diastolic decrescendo murmur at 2nd interspace right, radiating to apex, heard best in end expiration when patient is leaning forward
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what is austin flint murmur and what disease is it associated with?
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the jet of regurgitation hitting the mitral valve during diastole to close it
heard in aortic regurg |
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what are quincke's pulses and what disease is it associated with?
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nailbed capillary pulsations associated with aortic regurg
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what is duroziez's sign and what disease is it associated with?
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to and fro murmuer over femoral artery associated with aortic regurg
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what will you find on the echo in aortic regurg? (3)
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LV chamber dimension, wall thickness, and motion
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what will you find on the doppler in aortic regurg? (1)
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quantification of regurgitant flow
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wht will you find on the CXR in aortic regurg?
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cardiomegaly
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what will you find on the EKG in aortic regurg?
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left ventricular hypertrophy
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what happens if aortic regurg is not corrected?
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acute AR leads rapidly to pulmonary edema and death
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what is the 1st thing you should do when treating aortic regurg?
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afterload reduction
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what can be prescribed prophylactically with aortic regurg?
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antibiotics
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when should you perform surgery in aortic regurg?
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at onset of symptoms or if functional capacity falls
LV end systolic dimension = 5cm or LV end diastolic dimension = 7cm |
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what is the most common cause of mitral stenosis and when does it manifest?
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rheumatic fever
manifests 2-10 years after acute infection |
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what is the normal mitral orifice and what is its size during stenosis?
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normal orifice = 4-6cm
critical stenosis <1cm |
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what develops that is of greatest concern with mitral stenosis?
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pulmonary hypertension
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what pressure remains normal with mitral stenosis and why?
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LV pressure because the problem is not with getting the blood from the atrium to the ventricle
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what will decrease with tachycardia in mitral stenosis? (2)
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LV filling volume and cardiac output
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what are 3 key clinical presentations of mitral stenosis?
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exertional dypsnea
orthopenea hemoptysis with pulmonary hypertension |
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what will the murmur sound like in mitral stenosis?
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diastolic low pitched apical murmur (consistent rumbling, buzzing sound as opposed to a crescendo/decrescendo)
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what sound will you hear with mitral stenosis and what condition will it only be associated with?
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opening snap after S2 and before the murmur
only seen with rheumatic disease where flaps fuse like a parachute |
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what will mitral stenosis look like on CXR? (4)
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large RV
pulmonary vascular engorgement no LV dilation large left atrium |
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what can you do for acute pulmonary edema in mitral stenosis?
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diuresis
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what will mitral stenosis look like on echo?
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thickened, fused leaflets
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what will mitral stenosis look like on EKG? (2)
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atrial abnormality
RVH |
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what will mitral stenosis look like on doppler?
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gradient and valve area
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what are 4 non-pharmeceutical interventions for mitral stenosis?
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balloon valvuloplasty
open commissurostomy valvular replacement surgery |
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how long to progress from mild to severe disability in mitral stenosis?
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5 years
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how are mitral and aortic regurgitation different?
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in aortic, volume comes back to the ventricle at a high pressure; in mitral the volume comes back at a lower pressure so there is nothing to stimulate hypertrophy
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what are 5 causes of mitral regurgitation?
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leaflet destruction
myxomatous degeneration papillary muscle dysfunction dilater cardimyopathy hypertrophic cardiomyopathy |
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what disease will the left atrial and pulmonary wedge pressure increase?
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mitral regurg
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how is the mitral leak worsened in mitral regurg?
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increased systemic afterload
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what is wedge pressure? what does it indicate when it rises?
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wedge pressure is the resting venous pressure in the lungs
when it rises it indicated pooling |
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what do mitral regurg symptoms depend on?
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severity of leak and time frame
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what are 2 late findings of mitral regurg?
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palpitations with arrhythmia
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what cardiac finding is tolerated better in mitral regurg than mitral stenosis?
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atrial fibrillation
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where is the PMI in mitral regurg?
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lateral and enlarged
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what heart sound is common in mitral regurg?
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S3
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what does the murmur sound like with mitral regurg?
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holosystolic murmuer at the apex (steady sound as opposed to a crescendo)
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does mitral regurgitation get worse or better with movement change?
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no change
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what will a CXR show with mitral regurg? (3)
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LV dilation
LA dilation pulmonary vascular engorgement |
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what will the echo show with mitral regurg? (3)
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LV engorgement
LA engorgement wall motion is normal until late |
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what will the doppler show with mitral regurg?
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identify and quantify regurgitant jet
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what will the EKG show with mitral regurg? (3)
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LAA in >50%
RVH in 15% atrial fibrillation is common |
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what 2 things must first be reduced when treating mitral regurg?
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preload and afterload
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what drugs are helpful in mitral regurg and why? (2)
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ionotropes to improve contractility
antiarrhythmics to control ectopy and maintain sinus |
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what are 4 surgical interventions in mitral regurg?
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annuloplasty (simply sinching the valve to a smaller size)
valvuloplasty valve replacement coronary revascularization |
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when is surgery indicated in mitral regurgitation?
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end diastolic LV dimension = 7cm
end dystolic LV dimension = 5 cm |
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what indicated severe, possibly inopperable LV dysfunction?
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<40%
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what is mitral valve prolapse?
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myxomatous degeneration of the valve (leaflets thicken with material and become too big to function)
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who gets mitral valve prolapse more often but has a milder form?
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women
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who gets mitral valve prolapse less often but has a more severe form?
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men
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what can mitral valvae prolapse degenerate into?
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severe mitral regurg
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what are 4 clinical presentations of mitral valve prolapse?
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chest pain
palpitations exertional dyspnea occasional syncope |
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when will mitral valve prolapse patients present?
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in the 2nd or 3rd decade
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what sound is unique to mitral valve prolapse and when is it worse?
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early to mid systolic click at the apex
worse with maneuvers which decrease LV filling volume (valsalva, nitrates) |
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what type of murmur will be present in MVP and when?
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mid to late systolic murmur but only if mitral regurg is present
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what should you look for when doing an echo for mitral valve prolapse?
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prolapse
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what should you look for when doing a doppler for mitral valve prolapse?
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mitral regurg
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why would you want to do a holter study in mitral valve prolapse?
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to look for arrhythmias
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what is there a small risk for in mitral valve prolapse? (3)
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SBE
embolus arrhythmia |
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what is the best therapy for mitral valve prolapse?
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reassurance
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what 3 diseases are systolic problems?
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mitral regurg
mitral valve prolapse aortic stenosis |
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what 2 diseases are diastolic problems?
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mitral stenosis
aortic regurgitation |
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what disease will have a mid to late systolic murmur?
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mitral valve prolapse if MR is present
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what disease will have a holosystolic murmur at the apex?
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mitral regurgitation
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what disease will have a diastolic, low pitched murmur that is a constant rumbling?
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mitral stenosis
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what disease will have a diastolic decrescendo murmur at the 2nd interspace right and radiating towards the apex?
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aortic regurgitation
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what disease will have a murmur that is best heard in end expiration when the patient is leaning forward?
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aortic regurgitation
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what disease will have a late peaking crescendo/decrescendo murmur at the base with radiation to the carotids?
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aortic stenosis
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what disease will have the murmur decrease with standing?
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aortic stenosis
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