Cv-Valvular Heart Disease

Front 1

What are some s/s of right-sided heart congestion?

Back 1

1. JVD
2. ascites
3. peripheral edema
4. cardiac cirrhosis

Front 2

What are some skin findings in endocarditis?

Back 2

1. roth spots
2. splinter hemorrhage
3. janeway lesions
4. osler's nodes
5. mucocutaneous petechiae

Front 3

A murmur is heard with the pulse: is this a systolic or diastolic murmur?

Back 3

systolic

Front 4

When BP lowers upon inhalation, what is this called?

Back 4

pulsus paradoxus

Front 5

A two-peak pulse is called what?

Back 5

pulsus bisiferens

Front 6

A long pulse that drops is called what?

Back 6

pulsus tardus

Front 7

S3 gallop indicates what?

Back 7

overloaded ventricle

Front 8

An S3 gallop has a poor prognosis when?

Back 8

when patient is >40y/o with decreased left heart function (normal in kids and pregnancy)

Front 9

An S4 gallop indicates what?

Back 9

stiff ventricle

Front 10

Grade I-III murmur sounds are compared with what sounds?

Back 10

S1 and S2

Front 11

Which murmurs will demonstrate a palpable thrill?

Back 11

IV-VI

Front 12

Most murmurs will increase sound with increased flow across the valve. What 2 conditions are exceptions?

Back 12

MVP and HCM

Front 13

How will the handgrip test lessen the sound of an HCM-related murmur?

Back 13

isotonic contraction constricts arterioles->constricts arteries->increases afterload->pressure wave hits aorta->outflow tract is opened wider->lessened murmur intensity

Front 14

Will the 30 second handgrip test increase or decrease the intensity of an MVP murmur?

Back 14

increase (or remain unchanged)

Front 15

Right-sided murmurs increase with inspiration or expiration? What about left-sided murmurs?

Back 15

1. rIght=Inspiration
2. lEft=Expiration

Front 16

S3 and S4 murmurs are best heard in what position?

Back 16

left lateral recumbent position

Front 17

Fixed split S2 is associated with what condition?

Back 17

ASD

Front 18

If a DVT embolized and caused a stroke instead of pulmonary edema, what condition might the patient have?

Back 18

ASD

Front 19

What condition is best heard at the RUSB? LLSB? LLSB->RLSB? Left axilla?

Back 19

1. aortic stenosis
2. aortic regurgitation and mitral stenosis
3. large VSD
4. mitral regurgitation

Front 20

What is the most common congenital valve disorder?

Back 20

bicuspid aortic valve (instead of 3 flaps)

Front 21

T or F: aortic stenosis is directly related to age.

Back 21

true

Front 22

What pulse is present in aortic stenosis?

Back 22

pulsus tardus (blood takes longer to squeeze through constricted vessel)

Front 23

What are 2 key features seen in severe aortic stenosis?

Back 23

1. pressure gradient >70 (should be equal across all chambers)
2. valve area<0.7 cm2

Front 24

Which valvular disorder has the worse prognosis of all valvular disorders?

Back 24

aortic stenosis

Front 25

What is best treatment available for aortic stenosis?

Back 25

surgery once they are asymptomatic (medical management is ineffective)

Front 26

What drugs must be used with extreme caution in aortic stenosis?

Back 26

vasodilators and diuretics (pressure outflow is what is keeping constricted aortic valve at least partially open)

Front 27

If you hear "aortic root dilatation" as seen in aortic regurgitation what cause should you think of?

Back 27

marfan's syndrome

Front 28

What pulse is present in chronic aortic regurgitation?

Back 28

pulsus bisiferens

Front 29

What is the major indicator to replace the aortic valve in aortic regurgitation?

Back 29

symptoms at rest

Front 30

Mitral stenosis is most often secondary to what disease?

Back 30

rheumatic heart disease

Front 31

What are 2 major symptoms of mitral stenosis?

Back 31

1. hemoptysis
2. dyspnea

Front 32

Pregnant females with mitral stenosis may present with what s/s?

Back 32

1. pulmonary edema
2. a-fib

Front 33

What causes the hemoptysis seen in mitral stenosis?

Back 33

pressure to pulmonary vasculature causes vessels to pop

Front 34

Where are the following lesions located: janeway, osler, splinter hemorrhages?

Back 34

1. palms
2. finger pads
3. nailbeds

Front 35

What non-surgical treatment can be used for mitral stenosis? When is surgery indicated?

Back 35

1. diuretics
2. pulmonary arterial pressure >70mm/hg

Front 36

What murmur is seen in mitral regurgitation?

Back 36

pansystolic murmur with radiation to axilla

Front 37

What should you know about right sided valvular lesions?

Back 37

1. never replaced
2. rare
3. not commonly associated with pathology

Front 38

Tricuspid stenosis is usually secondary to what? How common is this?

Back 38

1. rheumatic heart disease, staph endocarditis (IV drug abusers), or carcinoid syndrome
2. rare

Front 39

What pressure wave will show a large increase in size in tricuspid stenosis?

Back 39

a wave

Front 40

What do tricuspid stenosis and tricuspid regurgitation have in common?

Back 40

both are caused by rheumatic heart disease, staph endocarditis, (think IV drug abusers) or carcinoid syndrome

Front 41

Pulmonic regurgitation is almost always secondary to what?

Back 41

PAH

Front 42

When should you replace left heart valves?

Back 42

when they become symptomatic

Front 43

What are the indications for using porcine valves instead of mechanical valves for replacement?

Back 43

use porcine if:
1. >65y/o
2. anticoagulants are contraindicated
3. female of child-bearing age

Front 44

When would you not give antibiotics with regard to valvular pathologies?

Back 44

isolated secundum atrial septal defects