Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
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
|