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48 Cards in this Set
- Front
- Back
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Buzzwords for endocarditis
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Janeway lesions
Roth spots splinter hemrrahge Olsers nodes mucucutaneous petechiae |
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Pulsus paradoxus
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tamponade
pericardial disease |
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Pulsus bisiferens
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aortic regurg
HCM |
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Pulsus alternanas
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PVC
LV disease |
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Pulsus tardus
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AS
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Asymmetrical pluses
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aortic dissection
PVD vasculitis suclavian steal |
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Poor/absent pulse
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PVD
acute arterial thrombosis |
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S3 indicates
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overloaded ventricle (CHF, pregnancy)
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S4 indicates
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stiff ventricle (LVH, HCM)
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Grade 1 murmur
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less intense than S1, S2
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Grade 2
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same intensity as S1, S2
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Grade 3
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more intense than S1, S2 but without a palpable thrill
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Grade 4
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more intense than S1, S2 but with a palpable thrill
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Grade 5
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can be hear through a solid medium
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Grade 6
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can be heard without a stethoscope
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How to decrease preload
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standing
valsalva exhale |
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How to increase preload
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lying down
squatting rasing legs inhale |
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Two murmurs that decrease with increased preload
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HCM
MVP |
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How sustained handgrip affects HCM and MVP murmurs
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softens the murmur of HCM
does not affect MVP murmur |
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Fixed split S2
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ASD
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Best position for hearing S3, S4?
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lateral recumbent
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Right sided murmurs increase with
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inspirtion (except PS)
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Left sided murmurs increase with
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expiration
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Right side large a wave
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Tricuspid atresia
severe PR stiff RV |
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Right side large v wave
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Tricuspid regurg
septal rupture |
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Left side large a wave
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MS
severe AS complete heart block |
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Left side large v wave
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Mitral regurg
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Most common congenital valve disorder
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bicuspid vavle
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Aortic stenosis murmur
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RUSB, radiates into carotids
S4 secondary to LVH and then becomes S3 pulsus tardus ejection click |
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Which valvular stenosis has the worst prognosis?
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AS
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Tx for AS
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sugery
as soon as patient is symptomatic be very careful with vasodilators and diurectis |
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Aortic regurg
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pulsus bisiferiens
high pitched Diastolic murmur LLSB (if secondary to valve dz) RLSB (if secondary to root dz--marfans) |
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Aortic regr Tx
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diurectics (no obstruction so okay)
ACE inhibitors |
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When to replace valve if have aortic regurg
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symptoms at rest
LVES dimension >5.5cm2 EF decreases during exercise MUGA scan by 10% unless acute then emergent valve replacement |
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Mirtal stenosis murmur
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diastolic "rumble"
LAH on EKG see in pregnant females with acute plumonary edma and Afib |
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Mitral regurg murmur
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radiates into axilla
pansystolic wide split S2 LAH on EKG |
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Mitral Valve Prolapse
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very common
mid systolic murmur unaffected by sustained hand grip |
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Tx of MVP with a murmur
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antibiotics prophylaxis
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Right sided vavlular lesions
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very rare because of low pressure
so diseased valves are rarely removed and NEVER replaced |
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Tricuspid stenosis
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usually secondary to
RF, stach ednocarditis (IV drug abusers) or carcinoid syndrome Giant a wave, diastilic murmur RAH without RVH |
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Tricuspid regurg
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secondary to LHF
caused by RF, staph endocarditis, or carcinoid holosystolic murmur @ LLSB JVD big v waves |
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7 causes of larg R wave in lead v1
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RVH
RBBB Posteior wall MI misplace leads Muscular Dystrophy Dextrocardia WPW |
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Pulmonic Stenosis
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alway congenital and rarely progresses
RVH and RAH a waves |
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When to replace Left heart vavles
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when patient first becomes symptomatic, especially at rest
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When to replace Right heart vavles
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NEVER
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Who gets a porcine vavle?
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if >65 yrs old
cannot be on anticoags femal of child bearing age |
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When to give antibiotic prophylaxis
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prosthetic heart valves
Hx of infective endocarditis acquired valvular dysfunction HCM MVP with mitral regurg |
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What does not get antibiotics?
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ASD
PDA VSD MVP without mitral regurg CAD RF or Kawaski without valve involvement pacemakers and internal defibrillators innocent heart murmurs |
