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36 Cards in this Set
- Front
- Back
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What is the most common cause of MS?
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Rheumatic heart disease
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What pathological changes are present in the MV in MS?
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Leaflet fibrosis, calcification and fused commissures
Chordae tendinae - fused, thick, fibrous |
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What is the pathogenesis of MS?
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Left ventricular pressure overload is transmitted backward through lung circulation causing hypertension and edema. Left ventricle dilates in response
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How do you measure Left Atrial pressure?
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Swan-Ganz Catheter
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What occurs in the right and left hearts in MS?
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Right heart - RV dilation and backward heart failure (congestion)
Left heart - LV underfilled and forward heart failure (Low CO) |
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What is the normal MR valve area?
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3-5cm
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List the 1) mean gradient (wedge pressure) 2) valve area and 3) symptom status in mild, moderate and severe MR
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Mild - <5mmHg, >1.5cm, with vigorous exertion
Moderate - 5-10mmHg, 1-1.5cm, with activity Severe - >10mmHg, <1cm, with minimal activity |
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What are complications of MS? (4)
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Pulmonary edema and hemoptysis
Atrial fivrillation and cardioembolism Right heart failure Endocarditis |
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What type of murmer is heard in MS?
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Opening snap followed by diastolic rumble and presystolic accentuation (atrial kick)
(smaller S2-OS interval = bad) |
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What ECG findings are there in MS?
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Left atrial enlargement
Right ventricular hypertrophy with strain pattern Atrial fibrillation |
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What do you see on CXR in MS?
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Splayed carina
Straight left heart border Pulmonary venous congestion |
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How do you manage MS with medications?
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Diuretics
Anti-arryhthmics Anticoagulation Endocarditis prevention |
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What are the NYHA functional classes?
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NYHA I - no limitation
NYHA II - slight limitations, symptoms with normal activity NYHA III - marked limitation, symptoms with less than normal activity NYHA IV - symptoms at rest or with any activity |
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What are indications for surgery in MS? (definite, highly probable, probable)
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Definite: NYHA III-IV and valve area <1.5cm
Highley probable: NYHA I-II, severe pulmonary hypertension, severe mitral stenosis (<1cm) Probable - NYHA I, moderate stenosis (<1.5cm), new onset atrial fibrillation |
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What are the different types of surgeries for MS?
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Percutaneous balloon valvuloplasty
Valve replacement |
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What is the etiology of MR? (3 major classes with examples)
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Leaflet/chordae problem: myxomatous, rheumatic, endocarditis, congenital
Annulus problem: Left ventricular dilation Papillary muscle problem: ischemia or infact (rupture) |
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What occurs to preload, afterload and contractility in acute MR and what is the result?
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Preload increases, afterload decreases, contractility increases to compensate - result is decreased CO and pulmonary edema
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What changes occur in the heart during chronic MF?
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Dilation of LV and LA (volume overload)
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What are clinical features of MR?
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Fatigue (reduced cardiac output)
Dyspnea, orthopnea, edema, PND (congestion) Palpitations (atrial arrhythmias) |
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What does a murmer sound like in MR?
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Pansystolic, high pitched
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What are the findings on cardiac exam in MR (other than murmer)?
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Displaced apex
Thrill S3 |
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What ECG findings are there for MR?
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Left atrial enlargement, left ventricular hypertrophy, atrial arryhthmias
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What are CXR findings for MR?
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Cardiomegaly, atrial dilation, pulmonary edema
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How do you treat MR medically?
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Afterload reduction (ACEi)
Preload reduction (diuretics, nitrates) Endocarditis prophylaxis Anti-arrhythmics Anti-coagulants |
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What surgical options are there for MR?
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Valve repair (only for myxomatous cause)
Valve replacemnt (mechanical or bioprosthetic) |
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What are the definite indications for surgery in MR?
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Acute symptomatic mitral regurgitation
NYHA II-IV with normal ejection fraction Symptomatic or not with reduced ejection fraction |
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What two factors do you need to get endocarditis?
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Exposure to bacteria and a predisposition
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What are vascular stigmata of endocarditis?
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arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival/nailbed hemorrhages, Janeway lesions(painless)
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What are immunologic stigmata of endocarditis?
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glomerulonephritis, roth spots, positive RF, osler's nodes(painful)
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What is the basic structure of the Duke Criteria for diagnosing endocarditis?
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In total there are 2 major and 5 minor criteria
Need: 2 major OR 1 major+3 minor OR 5 minor |
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How do you treat endocarditis?
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Eliminate portal of entry
Narrow spectrum, intensive, synergisitc antibiotics (ex-ampicillin and gentamycin) Valve surgery (if indicated) |
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What are the indications for valve surgery in endocarditis? (5)
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Hemodynamic compromise
Recurrent embolism Large and highly mobile vegetations Prosthetic valve endocarditis Fungal endocarditis |
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What are new indications for endocarditis prophylaxis? (3)
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Prosthetic heart valve
Previous endocarditis Unrepaired complex congenital heart disease |
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What is a common error in managing MR?
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Failure to recognize (and treat) asymptomatic LV dysfunction
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What is a common error in managing rheumatic MS?
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Not anticoagulating for atrial fibrillation emboli
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What is a common error when doing surgery on someone with a mechanical valve?
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Failure to give bridging anticoagulation (ie-heparin)
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