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30 Cards in this Set

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394. Tx of AS?
a. Medical therapy has a limited role.
b. Surgical therapy: Aortic valve replacement is the tx of choice.
i. It is indicated in all symptomatic pts.
395. Note: Management of aortic stenosis is straightforward:
a. If asymptomatic: no tx.
b. If symptomatic: surgery (aortic valve replacement)
396. Can Percutaneous balloon valvuloplasty be used for AS?
a. Has produced poor results.
b. “Restenosis is a common problem”
397. Pathophys of Aortic Regurg?
a. Regurgitant blood flow increases left ventricular and diastolic volume.
b. LV dilation and hypertrophy occur in response in order to maintain stroke volume and prevent diastolic pressure from increasing excessively.
c. Over time, these compensatory mechanisms fail, leading to increased left-sided and pulmonary pressures.
d. The resulting left ventricular EF is usually normal until advanced disease.
398. Course of Aortic Regurg?
a. For chronic aortic regurgitation, survival is 75% at 5 yrs.
i. After the development of angina, death usually occurs w/in 4 yrs.
ii. After the development of heart disease, death usually occurs w/in 2 yrs.
b. For acute aortic regurgitation, mortality is particularly high w/out surgical repair.
399. Causes of Acute Aortic regurg?
a. Infective endocarditis
b. Trauma
c. Aortica dissection
400. Chronic Aortic regurg?
a. Primary valvular: rheumatic fever, bicuspid aortic valve, Marfan’s syndrome, Ehlers-Danlos syndrome, ankylosing spondylitis, SLE.
b. Aortic root: syphilitic aortitis, osteogenesis imperfecta, aortic dissection, Behcet’s syndrome, Reiter’s syndrome, System HTN.
401. Symptoms Aortic Regurg?
a. Dyspnea on exertion, PND, orthopnea
b. Palpitations
c. Angina
d. Cyanosis and shock in acute aortic regurg (medical emergency).
402. Physical exam presentation of Aortic regurgitation?
a. Widened pulse pressure?!? Markedly increased systolic BP, w/decreased diastolic BP.
b. Diastolic decrescendo murmur best heard at left sternal border.
c. Corrigan’s pulse (water-hammer pulse)
d. Austin-flint murmur.
403. Corrigan’s pulse (water-hammer)?
a. Associated w/Aortic regurg
b. Rapidly increasing pulse that collapses suddenly as arterial pressure decreases rapidly in late systole and diastole.
c. Can be palpated at wrist or femoral arteries.
404. Austin-Flint murmur?
a. W/mitral regurg?
b. Low-pitched diastolic rumble due to narrowing of mitral valve orifice by aortic regurg, resulting in relative mitral stenosis.
c. Displaced PMI (down and to the left) and S3 may also be present
405. Diagnosis of Aortic Regurg?
a. CXR: LVH, dilated aorta
b. ECG: LVH
c. Echo- Perform serially in chronic, stable pts to assess need for surgery.
1. Assess LV size and function
2. Look for dilated aortic root and reversal of blood flow in aorta.
3. In acute aortic regurg, look for early closure of mitral valve.
4. Cardiac cath: to assess severity of aortic regurg and degree of LV dysfunction.
406. Tx of Aortic Regurg?
a. Conservative if stable and asymptomatic: salt restriction, diuretics, vasodilators, digoxin, afterload reduction (i.e., ACE inhibitors or arterial dilators), and restriction on strenuous activity.
b. Endocarditis prophylaxis before dental and GI/genitourinary procedures.
407. Definitive option for tx of Aortic Regurg?
a. Aortic valve replacement. This should be considered in symptomatic pts, or in those w/significant LV dysfunction on echocardiogram.
b. Acute AR (e.g., post-MI): Medical emergency- Perform aortic valve replacement.
c. Endocarditis prophylaxis before dental and GI/genitourinary procedures.
408. Mitral Regurgitation (MR) Pathophys?
a. Abrupt elevation of left atrial pressure in setting of normal LA size and compliance, causing backflow into pulmonary circulation w/resultant pulmonary edema.
b. Cardiac output decreases because of decreased forward flow, so hypotension and shock can occur.
409. Other physical findings of Aortic insufficiency?
a. De Musset’s sign: head bobbing (rhythmical jerking of head)
b. Muller’s sign: Uvula bobs
c. Duroziez’s sign: pistol-shot sound heard over the femoral arteries.
410. Pathophys of chronic mitral regurg?
a. Gradual elevation of left atrial pressure in setting of dilated LA and LV (w/increased left atrial compliance)
b. LV dysfunction occurs due to dilatation
c. Pulmonary HTN can result from chronic backflow into pulmonary vasculature.
411. Causes of acute MR?
a. Endocarditis (most often A. aureus)
b. Papillary muscle rupture (from infarction) or dysfunction (from ischaemia)
412. Cause of chronic MR?
a. Rheumatic fever
b. Marfan’s syndrome
c. Cardiomyopathy
413. Prognosis of MR?
a. Acute form is associated w/much higher mortality
b. Survival is related to extent to LV cavity dilatation.
414. Symptoms of MR?
a. Dyspnea on exertion, PND, orthopnea
b. Palpitations
c. Pulmonary edema
414. Symptoms of MR?
a. Dyspnea on exertion, PND, orthopnea
b. Palpitations
c. Pulmonary edema
415. Signs of MR?
a. Holosystolic murmur (starts w/S1 and continues through S2 at the apex which radiates to the back of clavicular area, depending on which leaflet is involved.
b. Afib is a common finding.
c. Other findings: S3 gallop; lateral displaced PMI; loud, palpable P2.
415. Signs of MR?
a. Holosystolic murmur (starts w/S1 and continues through S2 at the apex which radiates to the back of clavicular area, depending on which leaflet is involved.
b. Afib is a common finding.
c. Other findings: S3 gallop; lateral displaced PMI; loud, palpable P2.
416. Diagnosis of MR?
a. CXR: dilated LV, pulmonary edema.
b. Echo: MR; dilated LA and LV; decreased LV function.
416. Diagnosis of MR?
a. CXR: dilated LV, pulmonary edema.
b. Echo: MR; dilated LA and LV; decreased LV function.
417. Medical Tx of MR?
a. Afterload reduction w/vasodilators; also salt reduction, diuretics, digoxin, and antiarrhythmics.
b. Chronic anticoagulation is pt has atrial fibrillation.
c. IABP as bridge to surgery for acute MR.
417. Medical Tx of MR?
a. Afterload reduction w/vasodilators; also salt reduction, diuretics, digoxin, and antiarrhythmics.
b. Chronic anticoagulation is pt has atrial fibrillation.
c. IABP as bridge to surgery for acute MR.
418. Surgical tx of MR?
a. Mitral valve repair or replacement
b. Must be performed before left ventricular function is too severely compromised
418. Surgical tx of MR?
a. Mitral valve repair or replacement
b. Must be performed before left ventricular function is too severely compromised