S2: Ch1 Cv 2-7

Front 1

426. Mitral Valve Prolapse?

Back 1

a. MVP is defined as the presence of excessive or redundant mitral leaflet tissue due to myxomatous degeneration of mitral valve leaflets and/or chordae tendinea.
b. The redundant leaflet(s) prolapse toward the L. atrium in systole, which results in the auscultated click and murmur.
c. MVP is common in pts w/genetic connective tissue disorders, such as Marfan’s syndrome, osteogenesis imperfecta, and Ehlers-Danlos syndrome.
d. MR may occur, but it is rare.
e. Arrhythmias and sudden death are very rare.

Front 2

427. Symptoms of MVP?

Back 2

a. Most pts are asymptomatic for their entire lives.
b. Palpitations and atypical chest pain may occur.
c. TIAs due to emboli from mitral valve have been reported, but are very rare.

Front 3

428. Signs of MVP?

Back 3

a. Midsystolic or late systolic click(s).
b. Mid-to-late systolic murmur
c. Some pts have midsystolic click w/out murmur; others may have the murmur w/o the click

Front 4

429. What increases the murmur and click of MVP?

Back 4

a. Standing and the Valsalva maneuver INCREASE murmur and click bc these murmurs reduce LV chamber size, allowing the click and murmur to occur earlier in diastole.

Front 5

430. What decreases the murmur of MVP?

Back 5

a. Squatting decreases the murmur and click because it increases LV chamber size, thus delaying the onset of the click and murmur.

Front 6

431. How does sustained handgrip affect the murmur MVP?

Back 6

a. Increases the murmur.
b. In contrast, it decreases the murmur of hypertrophic cardiomyopathy HCM.

Front 7

432. Dx of MVP?

Back 7

a. Echo is most useful.

Front 8

433. Tx of MVP?

Back 8

a. If pt is asymptomatic; reassurance.
b. I pt has systolic murmur or thickened valve: abx prophylaxis for dental procedures to prevent infective endocarditis.
c. For chest pain, β-blockers have been useful, but they are unlikely to be required.
d. Surgery rarely is required. The condition is generally benign.

Front 9

434. Key signs of MVP?

Back 9

a. Systolic clicks.
b. Midsystolic rumbling murmur that increases w/standing and the Valsalva maneuver and decreases w/squatting.

Front 10

435. Rheumatic heart disease?

Back 10

a. Rheumatic heart disease occurs as a complication of streptococcal pharyngitis (group A streptococcus).
b. Acute rheumatic fever is an immunologically mediated systemic process that may progress to rheumatic heart disease
c. Rheumatic heart disease describes the chronic valvular abnormalities secondary to acute rheumatic fever.
d. The most common valvular abnormality is mitral stenosis, but pts may have aortic or tricuspid involvement as well.

Front 11

436. Diagnosis of acute rheumatic fever?

Back 11

a. Requires 2 major criteria OR 1 major and 2 minor criteria:

Front 12

437. 5 Major criteria dx of acute rheumatic fever?

Back 12

1. Migratory polyarthritis
2. Erythema marginatum
3. Cardiac involvement (e.g., pericarditis, CHF, valve disease)
4. Chorea
5. Subcutaneous nodules

Front 13

438. 6 minor criteria for acute rheumatic fever?

Back 13

1. Fever
2. Elevated ESR
3. Polyarthralgia
4. Prior hx of rheumatic fever
5. Prolonged PR interval
6. Evidence of preceding step

Front 14

439. Tx of acute rheumatic fever?

Back 14

a. Tx strep pharyngitis w/PCN or erythromycin to prevent Rheumatic fever.
b. Acute rheumatic fever is treated w/NSAIDs. C-reactive protein is used to monitor tx.
c. Pts w/a hx of RF should receive abx prophylaxis w/erythromycin or amoxicillin for dental/GI/genitourinary procedures.
d. Tx the valvular pathology of rheumatic heart disease.

Front 15

440. Infective characteristics?

Back 15

a. Infective endocarditis is defined as an infection of the endocardial surface of the heart (usually involves the cusps of the valves).
b. Classifications:
1. Acute
2. Subacute

Front 16

441. Acute endocarditis?

Back 16

a. Most commonly caused by staph aureus (virulent)
b. Occurs on a NORMAL heart valve
c. If untreated, fatal in <6 wks.

Front 17

442. Subacute endocarditis?

Back 17

a. Caused by less virulent organisms, such as strep viridans and enterococcus.
b. Occurs on damaged heart valves
c. If untreated, takes much longer than 6 wks to cause death.

Front 18

443. Most common organism of native valve endocarditis?

Back 18

a. S. viridans.

Front 19

444. Other common organisms of native valve endocarditis?

Back 19

a. Staph species: S. aureus more commonly than S. epidermidis.
b. Enterococci.
c. HACEK group of organisms:
1. Haemophilus
2. Actinobacillus
3. Cardiobacterium
4. Eikenella
5. Kingella.

Front 20

445. Prosthetic valve endocarditis?

Back 20

a. Staph are the most common causes of early-onset endocarditis.
b. Sx appear w/in 60 days of surgery (s. epidermidis more commonly than S. aureus).
c. Strep are the most common cause of late-onset endocarditis; symptoms appear 60 days

Front 21

446. Endocarditis in IV drug users?

Back 21

a. Frequently presents w/right-sided endocarditis.
b. S. aureus is the most common cause.
c. Other organisms include enterococci and streptococci.
d. Fungi (mostly candida) and gram-negative rods (mostly pseudomonas) are less common causes.

Front 22

447. Complications of infective endocarditis?

Back 22

a. Cardiac failure
b. Myocardial abscess
c. Various solid organ damage from showered emboli
d. Glomerulonephritis

Front 23

448. Diagnosis of Infective endocarditis?

Back 23

a. Duke’s clinical criteria.
b. 2 major criteria, one major and three minor, or 5 minor criteria.

Front 24

449. Major criteria for infective endocarditis?

Back 24

a. Sustained bacteremia by an organism known to cause endocarditis
b. Endocardial involvement documented by either echo (vegetation, abscess, valve perforation, prosthetic dehiscence) or clearly established new valvular regurg.

Front 25

450. Minor criteria for infective endocarditis?

Back 25

a. Predisposing condition (abnormal valve or abnormal bacteremia).
b. Fever
c. Vascular Phenomena (septic emboli, mycotic aneurysms, intracranial haemorrhage, Janeway lesions.
d. Immune phenomena (glomerulonephritis, Osler’s nodes, Roth’s spots, rheumatic factor.
e. Positive blood cultures not meeting major criteria
f. Positive echo not meeting positive criteria.

Front 26

451. Janeway’s lesions?

Back 26

a. Painless erythematous lesions on palms and soles.

Front 27

452. Osler’s nodes?

Back 27

a. Painful, raised lesions of fingers, toes, or feet.

Front 28

453. Roth’s spots?

Back 28

a. Oval, retinal haemorrhages w/a clear, pale centre.

Front 29

454. Tx of infective endocarditis?

Back 29

a. Parenteral abx based on culture results for 4-6 wks.
b. If cultures are negative but there is high clinical suspicion, tx empirically w/a pcn (or vanco) plus an aminoglycoside until the organism can be isolated.

Front 30

436. Diagnosis of acute rheumatic fever?

Back 30

a. Requires 2 major criteria OR 1 major and 2 minor criteria:

Front 31

437. 5 Major criteria dx of acute rheumatic fever?

Back 31

1. Migratory polyarthritis
2. Erythema marginatum
3. Cardiac involvement (e.g., pericarditis, CHF, valve disease)
4. Chorea
5. Subcutaneous nodules

Front 32

438. 6 minor criteria for acute rheumatic fever?

Back 32

1. Fever
2. Elevated ESR
3. Polyarthralgia
4. Prior hx of rheumatic fever
5. Prolonged PR interval
6. Evidence of preceding step

Front 33

439. Tx of acute rheumatic fever?

Back 33

a. Tx strep pharyngitis w/PCN or erythromycin to prevent Rheumatic fever.
b. Acute rheumatic fever is treated w/NSAIDs. C-reactive protein is used to monitor tx.
c. Pts w/a hx of RF should receive abx prophylaxis w/erythromycin or amoxicillin for dental/GI/genitourinary procedures.
d. Tx the valvular pathology of rheumatic heart disease.

Front 34

440. Infective characteristics?

Back 34

a. Infective endocarditis is defined as an infection of the endocardial surface of the heart (usually involves the cusps of the valves).
b. Classifications:
1. Acute
2. Subacute

Front 35

441. Acute endocarditis?

Back 35

a. Most commonly caused by staph aureus (virulent)
b. Occurs on a NORMAL heart valve
c. If untreated, fatal in <6 wks.

Front 36

442. Subacute endocarditis?

Back 36

a. Caused by less virulent organisms, such as strep viridans and enterococcus.
b. Occurs on damaged heart valves
c. If untreated, takes much longer than 6 wks to cause death.

Front 37

443. Most common organism of native valve endocarditis?

Back 37

a. S. viridans.

Front 38

444. Other common organisms of native valve endocarditis?

Back 38

a. Staph species: S. aureus more commonly than S. epidermidis.
b. Enterococci.
c. HACEK group of organisms:
1. Haemophilus
2. Actinobacillus
3. Cardiobacterium
4. Eikenella
5. Kingella.

Front 39

445. Prosthetic valve endocarditis?

Back 39

a. Staph are the most common causes of early-onset endocarditis.
b. Sx appear w/in 60 days of surgery (s. epidermidis more commonly than S. aureus).
c. Strep are the most common cause of late-onset endocarditis; symptoms appear 60 days