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60 Cards in this Set
- Front
- Back
- 3rd side (hint)
Heart valve dz almost always due to Rheumatic Fever
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Mitral Stenosis
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Murmur type:
Dyspnea on Exertion; Cough, rales; signs of RV failure; RV precordial thrust; Hoarse voice |
Mitral Stenosis
(Hoarse voice is from enlarged LA on recurrent laryngeal nerve) |
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Diagnostic results for Mitral Stenosis
- Auscultation - CXR (2) - EKG (3) - Echo |
Auscultation: mid-diastolic low-pitched rumble w/ opening snap;
CXR: large Left atrium and Kerely B lines EKG: LA enlargement; RV hypertrophy; A-fib Echo: abnormal valve |
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Tx for mitral stenosis w/ each grade:
I (4); II (2); III/IV (1) What should always be avoided w/ mitral stenosis tx? |
Grade:
I: Diuretics; B-Blockers; Anticoagulants; Digitalis II: Drugs from I + Balloon valvuloplasty (if drugs dont work) III/IV: Balloon Valvuloplasty Avoid: Inotropic Agents! |
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Etiology of Acute Mitral Regurgitation
(2) |
MI w/ papillary muscle rupture;
Endocarditis |
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Etiology of Chronic Mitral Regurgitation
(3) |
Rheumatic fever;
Mitral Prolapse; LV dilation |
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Diagnostic tests for Mitral Regurgitation
- Auscultation - EKG - Echo |
Auscultation: Loud, holosystolic apical murmur radiating to axilla
EKG: large LA Echo: valve problem |
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Tx for Mitral Regurgitation (6)*
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DAVES Deal:
Diuretics; ACEi; Vasodilators; Endocarditis prophylaxis; Surgery if severe; Digitalis |
DAVES Deal
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Most common valvular disorder
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Mitral prolapse
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Asymptomatic murmur w/ genetic predisopositon, seen most commonly in women
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Mitral Prolapse
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What (2) murmurs are seen in Marfan's syndrome?
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Mitral prolapse
Aortic Regurg |
None
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Tx for mitral prolapse?
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not necessary to tx unless symptomatic
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Mean survival rate for patients w/ Aortic Stenosis and:
1. Angina 2. Syncope 3. Heart failure |
1. 5 years
2. 2 - 3 years 3. 1 - 2 years |
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Etiology of Aortic Stenosis (2)
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- Calcific dz w/ age
- Bicuspid valve (around age 40) |
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Conditions w/ a wide Pulse Pressure
(6)* |
WAH-HA-H-ide pulse pressure:
Wet beri-beri; Aortic Regurgitation; Hyperthyroidism; HTN; Anemia; Hypertrophic Subaortic Stenosis (IHSS) |
WAH-HA-H-ide pulse pressure
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What (2) valve disorders result in severe decompensation to CHF due to the absence of hemodynamic compensation?
How are they treated? |
Mitral Regurg
Aortic Regurg Tx: Emergent surgery |
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Classic triad* of Sx for Aortic Stenosis
(4) other signs |
SAD:
- Syncope; - Angina; - Dyspnea on Exertion Others: - Forceful apex beat - narrow Pulse Pressure - Paradoxical S2 split - heard in carotids |
SAD
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Diagnostic test results for Aortic Stenosis
- Auscultation - EKG - Echo - CXR |
Auscultation: Loud systolic crescendo-decrescendo murmur;
EKG: LV strain CXR: calcifications on valve Echo: diseased valve |
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What is the EKG LV strain pattern seen in aortic stenosis?
(hint: affects 4 leads) |
ST depression + T-wave inversion in I, aVL, V5 and V6
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Tx for aortic stenosis
What should be avoided? (2) |
Valve replacement
- AVOID Afterload reducers (ACEi & beta-blockers) |
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(2) main etiologies for Aortic Regurgitation
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Aortic root dilatation or dissection;
Valvular dz; |
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(3)* causes of Aortic root dilatation thereby causing Aortic Regurg
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Marfan's;
Idiopathic (but inc w/ HTN); Collagen vascular dz |
MIC
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(2) causes of Valvular dz thereby causing Aortic Regurg
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Rheumatic heart dz;
Endocarditis |
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(6)* causes of proximal Aortic root dissection thereby causing Aortic Regurg
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"THE MTS":
Third Trimester Pregnancy; HTN; Ehlers-Danlos; Marphans (Cystic medial necrosis); Turner's syndrome; Syphilis; (Aortic arch is shaped like a mountain) |
THE MTS
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Names of the unique signs of Aortic regurg
(7)* |
Tap Water Quickly Complicates De-Murmur Designs:
1. Traube's sign 2. Water-Hammer pulse 3. Quincke's sign 4. Corrigan's pulse 5. de Musset's sign 6. Muller's sign 7. Duroziez's sign |
Tap Water Quickly Complicates De-Murmur Designs
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Aortic regurg sign:
wide pulse pressure presenting w/forceful arterial pulse upswing w/ rapid falloff |
Water-Hammer pulse
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Aortic regurg sign:
pistol-shot bruit over femoral pulse |
Traube's sign
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Aortic regurg sign:
unusually large carotid pulsations |
Corrigan's pulse
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murmur sign:
pulsatile blanching & reddening of fingernails upon light pressure What murmur? |
Quincke's sign
(Aortic Regurg) |
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Aortic regurg sign:
head bobbing caused by carotid pulsation |
de Musset's sign
(head bobs like listening to "De Mussic") |
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Aortic regurg sign:
pulsatile bobbing of the uvula |
Muller's sign
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Aortic regurg sign:
to-and-fro murmur over femoral artery (heard best w/ mild pressure applied to artery) |
Duroziez's sign
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Murmur presentation:
dyspnea, orthopnea, paroxysmal noctournal dyspnea, angina, LV failure, wide pulse pressure |
Aortic regurg
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Murmur presentation:
starts asymptomatic, then dyspnea, angina, syncope, heart failure |
Aortic stenosis
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Murmur presentation:
mostly asymptomatic, atypical chest pain, SOB, fatigue |
Mitral Prolapse
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Murmur presentation:
dyspnea, fatigue, weakness, cough, A-fib, systemic emboli |
Mitral Regurg
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Murmur presentation:
DOE, rales, cough, hemoptysis, systemic emboli, RV precordial thrust, RV failure, Hoarse voice |
Mitral stenosis
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What is heard on Auscultation for Aortic regurg?
(3) |
1. High-pitched, blowing decrescendo diastolic murmur
2. Apical diastolic rumble (mitral stenosis w/o snap) 3. Midsystolic flow murmur at base |
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Tx for Aortic regurg problems
(3) |
Tx LV heart failure;
Endocarditis prophylaxis; Valve replacement |
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Etiology of Tricuspid stenosis (3)*
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CCR:
Congenital; Carcinoid; Rheumatic heart dz |
CCR
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Murmur presentation:
peripheral edema, JVD, hepatomegaly, ascites, jaundice (2) |
Tricuspid stenosis
or Tricuspid Regurg |
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Auscultation results for Tricuspid stenosis?
Tx? |
Diastolic, rumbling low-pitched heard w/ Inspiration
Tx: Repair valve |
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Dx:
Patient w/ DVT has a stroke. He has a fixed S2 split |
Atrial-Septal Defect
(w/ right-to-left emboli) |
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Etiology of Tricuspid Regurg (4)
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Increased pulmonary artery Pressure
(from L-CHF or Mitral stenosis/regurg); R-CHF; Right papillary muscle rupture w/ MI; Tricuspid valve lesions (rheumatic heart or bacterial endocarditis) |
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Holosystolic murmurs
(3)* |
MTV
Mitral Regurg; Tricuspid regurg; Ventricular Septal Defect |
MTV
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Number 1 cause of death in CHF patients
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Arrhythmia
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Diagnostic results for Tricuspid Regurg:
- Auscultation - EKG (2) - Echo |
Auscultation: Holosystolic murmur increasing w/ inspiration
EKG: RV enlargement; A-fib Echo: diseased valve |
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Tx for Tricuspid Regurg
(3)* |
Tricuspid Dying Slowly:
Tx heart failure; Diuresis; Surgical repair of valve |
Tricuspid Dying Slowly
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What is done first if a patient has hyperK and peaked T-waves? Why?
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give Calcium to stabilize cardiac membrane
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Murmur:
Diastolic apical rumble and opening snap |
Mitral stenosis
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Murmur:
Late systolic murmur w/ midsystolic click What is confirming test? |
Mitral Prolapse
Valsalva - click starts earlier, murmur prolonged |
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Murmur:
High-pitched apical blowing holosystolic murmur where does it radiate? |
Mitral Regurg
radiates: Axilla |
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Murmur:
Diastolic rumble louder w/ inspiration |
Tricuspid stenosis
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Murmur:
High-pitched blowing holosystolic murmur heard better w/ inspiration Where is it heard? Where are pulsations seen? |
Tricuspid Regurg
- heard at left sternal border - Jugular pulsations |
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Name sign:
Peripheral pulses that are weak and late compared to heart sounds What murmur? |
Pulsus Parvus et Tardus
Aortic Stenosis |
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Murmur:
midsystolic crescendo-decrescendo murmur Where does it radiate? (2) What heart sound is also heard? |
Aortic stenosis
radiates to: Carotids and Apex - S4 also heard |
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Name sign:
Double-peaked arterial pulse what murmur? |
Pulsus Bisferiens
Aortic regurg |
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Murmur:
Blowing early diastolic, apical diastolic rumble, midsystolic flow murmurs |
Aortic Regurg
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Dx that causes Murmur:
Systolic murmur at apex and left sternal boarder not transmitted to carotids How is it heard better? |
IHSS
heard better w/ standing after squat |
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When during S1-S2 do you hear the "flow murmur" (murmur heard w/ any high flow state)?
What is differential dx? (5)* |
Midsystolic:
Aortic Regurg Atrial-Septal defect (fixed split S2) Anemia Adolescence Pregnancy |
AAAAP
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