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52 Cards in this Set

  • Front
  • Back
What sort of Murmurs do all of the following have:
MR (MVP), TR, AS, PS,
VSD
Aortopulmonary Shunts
Systolic

note: for Systolic: OutFlow Stenosis, AV Valvular Regurge
Name the heart defects with Diastolic Murmurs
AR, PR
MS, TS
Atrial Myxoma

-note for Dia: Outflow Regurge, AV Valve Stenosis
What Valvular Dz (VlvDz) has rheumatic etiology, more common in females with thick, fibrous/Calcific leaflets
Mitral Valve Stenosis
--fish mouth valve
What is normal opening for MV oriface?
When mod/severely stenosed?
4-6cm2
mod: 1.7cm2
sev: 1cm2
Systolic murmurs are heard with what
Ventricular (tricuspid) OutFlow Stenoses
& AV Valvular Regurges
What is possible downstream heart problem due to Mitral Stenosis?
MOA
RV Failure--done by Pulm HTN due to backup in lungs from back up in LA due to MV block
For Mitral Stenosis, when/what are:
Sx onset?
Sx?
Onset 4th decade --dyspnea, cough, Pulm Edema, Atrial Arrys, Hemoptysis, PE & Endocarditis
What is Ortner Syndrome
Secondary Sx of MV Stenosis due to impinge of L.Rec. Laryngeal N. by LA and dilated Pulm Artery
--hoarseness
For Mitral Stenosis Phy. Exam:
Skin Appearance?
Auscultation?
Echo?
Malar Flush--ruddy/blue cheeks
S1 increased-opening snap
Diastolic Murmur--rambling
-echo: doming/hockeystick/knee bend
What sort of murmurs go with:
Ventricular (tricuspid) Outflow Regurge
& AV Valve Stenoses
Diastolic
What is Tx for Mitral Stenosis
Prophylaxis for GABHS
Warfarin: for MV Stenosis, PE, & A.Fib
--Valvotomy or Replacement (NYHA III-IV --Pulm HTN, Sys Embolization)
Etiology of Mitral Regurge long term?
Acute?
Chronic Mitral Valve Prolapse--most commone
-Rheumatoid, MAC (Mitral Angular Calcification), LV Dilation
Acute: Pap. mm. rupture, endocarditis or CAD
Along with usual/nonspec fatigue, exertional dysp & orthop, what is another major Sx of Mitral Regurge
Pulmonary backup
--starts by inc. preload in LA-->backsup into lungs
For many valvular Dzs, what sort of atrial enlargement does Pulmonary HTN cause
RAE
--ie, with Left Heart VlvDzs, you have LAE, unless pulm HTN, then RAE too
Phys. Exam for Mitral Regurge:
Left Ventricle?
Ausculations?
LV is Hyperdynamic
-S1 is decreased
-Systolic Murmur, prom at apex and radiates to axilla
Tx for Mitral Regurge
Vasodilator: afterload reduction
--IV nitro

Diuretics, Dig.
ACE--useful in chronic MR
Surgery: Class III/IV Sx
AKA for Systolic 'click murmur syndrome'
MVP
also Barlow's, floppy-valve, billowing MV leaflet Syndrome
Etiology of MVP
Redundant mitral leaflet tissue
inherited: Marfan's, Ehlers-Dahnlos, Osteo imperfecta
Some clinical features of MVP when sympotomatic
Systolic click after S1 (plus Systolic murmur of MR--since its a severe MR)
Arrys: VT, PSVT, PVC,
palpations, dizziness, syncope
Chest Pain
Tx for MVP
Prophy for Infe Endocarditis
-Beta Blockers
-ASAcid
Etiology of Aortic Stenosis
-Degenerative Calcification (most common w/ elderly)
-Rheumatic
-Congenital (ie, congenitally bicuspid)
Other/non-aortic tricuspid valve causes of LV outflow?
1. Hypertrophic cardiomyopathy
2. Subvalvular AS
3. Supravalvular AS
-----2&3 with fiberous tissue above/below
Sx onset for AS?
Change in heart shape?

Cardinal AS Sx?
Onset in 6th decade
Concentric LV Hypertrophy

Sx: Exertional Dysp, Angina & Syncope
--note sx of LV failure occur later than the above cardinal sxs
Phys. Ex for AS
-Narrow Pulse Pressure
-Decreased: Stroke Volume, Systolic Pressure
Describe the Peripheral Pulses for AS
rise slowly, delayed peak
Parvus--dec Amplitude
Tardus--dec upstroke
Auscultation and palp of heart for AS?
---PMI is laterally displaced with Systolic Thrill in 2nd ICS radiates up to carotids
What is Gallavardin Phenomenon-
radiation of to apex--paradoxical split of S2
radiation of to apex--paradoxical split of S2
CXR for AS
may be normal
may have Post Stenotic dilation of ascending aorta
Tx for AS?
Heart Failure Txs
Surgery: AVR--Aortic Valve Replacement
Ballon Valvuloplasty (not if calcific) if congenital
Etiology of Aortic Regurge
AR or AI?
Infective?
Rheumatic, Congenital Bicuspid, Infective Endo
Syphyilis,
Aortic Root Dx
How does AI contribute to myocardial ischemia?
AI leads to volume overload in LV = LVED volume increase = LVhypertrophy.
LVH has greater 02 demand
Sx of AR?
Acute
Chronic
Acute: pulm edema, cardiogenic shock
Chronic--exertional dysp/paroxysmal nocturnal,
Chest Pain
What is de Musset sign with AR
Bobbing of Head during Systole with Diastolic Murmur
Describe the following pulses for AR
Corrigan's:
Quincke's
Corrs--water hammer pulse- rapid rising with collapse

Quincke's -- capillary pulsation w/ flushing of nail bed
Describe the following pulses for AR:
Traube's sign:
Duroziez sign
Traubes - pistol shot heard over femoral artery

Duroziez -- to and from murmur if femoral artery is compressed
AR Phys Exam:
Arterial Pulse?
Auscultation
Pulse P. is Wide (ie 140/60)
Diastolic decrescendo/blowing murmur. Austin Flint
Tx for AR
LV Failure Drugs + ACE Ibx
Surgery--after onset of LV dysfxn and before severe symptoms
Etiology of Tricuspid Stenosis
Rheumatic... assc with MS and TR
What are findings on jugular pressure tracings for Tricuspid Stenosis
Prominent A wave
Slow Y decent
Sx of Tricuspid Stenosis
Pulm. Congestion, fatigue due to low CO and RVF
hepatic congestion, jaundice, ascites
Describe murmurs for Tricuspid Stenosis
EKG?
CXR?
Diastolic murmur
inc on inspiration/
dec on expiratio & Vlsalva
EKG: RAE
CXR: RAE
Tx for Triscuspid Stenosis
--diagn perhaps by thickened tricuspid on echo
salt restriction
diuretics (they're wet)

Surgery-- if oriface is less than 2.0cm2
Etiology of Tricuspid Regurge
Dilation of Annulus of Right Ventricle enlargement
-inferior MI/RV infarct, cor pulmonale, pul HTN, cardiomyopathy, carcinoid, endocardits, Ebsteins anomyly
With jugular press tracing, what is prominent feature with Tricuspid Regurge
Prominent V waves
History/Findings for Tricuspid Regurge
RV failure, hepatomegaly, ascites, pleural effusions,
Ausculations for Tri Regurge?
Blowing holosystolic murmur inc during inspiration (Carvallo's sign) and decreased during expiration/Valsalva
Jugular venous pressure tracings for Severe TR
decreased CO, NO x-decent, prominent C-V wave with rapid Y descent
Tx for Tri Regurge
isolated TR well tolerated
--if pul HT: surgery often needed
Which VlvDz can Pul HTN cause
Pulmonary Valve Dz
--dilates the Pulm Valve--leads to Pulmonary Regurge into RV
What murmur goes with Pulm Vlv Dz
Graham Steell's murmur --diastolic, high pitched, decrescendo
General Tx for Vlv Dz (non-infected)
Mechanical --anticoagulate as they cause turbulance

Bioprostheitic if surgery
What sort of murmurs do the following cause:
Patent Ductus Arteriosus,
AV fistula
ASD with high L. Atrial Pressure
Coartation
PE
Continuous murmurs