Reading...
Play button
Play button
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;
51 Cards in this Set
- Front
- Back
|
What is the normal surface area of the Aortic Valve?
|
3-4 cm2
|
|
|
When do you start to see hemodynamic change as the area of the aortic valve begins to change? (at rest)
|
When the surface area decreases to 1/3 the size
|
|
|
What is the stats of the aortic valve in mild stenosis?
|
1.5-3cm2 and pressure <10mmhg
|
|
|
What are the stats of the aortic valve in moderate stenosis
|
1.1-1.5 cm2 change in pressure 10-25mmhg
|
|
|
what are the aortic valve stats in severe stenosis?
|
.8-1 cm2, change in pressure 25-50 mmhg
|
|
|
What are the Aortic valve stats in critical stenosis?
|
<.8 cme2, and pressure change 50-100mmhg
|
|
|
What does an aortic murmur sound like?
|
crescendo/decrescendo, harsh, high pitched, ejection sound
|
|
|
What are the physical exam findings of Aortic stenosis?
|
Ejection murmur, carotid pulse delay, apical precordial lift, paradoxic split or single s2, s4
|
|
|
What does a apical precordial lift mean?
|
Left ventricular hypertrophy
|
|
|
What causes paradoxic splitting?
|
Late Aortic valve (A2) closure, anything that delays left ventricular emptying, so it can also be caused by Left BBB
|
|
|
What does the presence of an S4 sound mean?
|
Low compliance of Left ventricle
|
|
|
How do you treat Aortic stenosis pharmacologically?
|
Avoid vasodilators, ACE inh, Use nitrates cautiously for angina, and use diuretics for heart failure
|
|
|
what is hypertension induced Aortic regurgitation called?
|
annuloaortic ectasia
|
|
|
What is the best position to feel an aortic murmur?
|
Sitting, feel left sternal border
|
|
|
What is Corrigans pulse?
|
sharp upstroke with rapid decline of carotid pulse
|
|
|
What is Duroziez's sign?
|
femoral artery systolic and diastolic bruits
|
|
|
What is De mussets sign
|
head bobbing with each heart beat
|
|
|
What is quince's pulse
|
can see your pulse in the red and white margin in the blanched fingernail
|
|
|
Hills sign
|
Increase of femoral systolic pressure 40 mmhg over brachial arterial pressure
|
|
|
How do you treat aortic regurge?
|
Decrease PVR, vasodilators, ACE inhibitors, hydralazine. endocarditis prophylaxis
|
|
|
When should the valve be replaced in aortic regurgitation?
|
when the ejection fraction falls below 40%, or when the left ventricular end dimension becomes > than 55
|
|
|
What is the normal MV area?
|
4-6 cm2,
|
|
|
When do symptoms from mitral valve stenosis begin?
|
<2cm2
|
|
|
When do you have critical Mitral valve stenosis?
|
<1cm2
|
|
|
In what sex is mitral valve disease more common?
|
women
|
|
|
In what sex is aortic valve disease more common?
|
men
|
|
|
What are the progressive symptoms in mitral stenosis?
|
Pulmonary hypertension followed by Right ventricular failure
|
|
|
what are the most common symptoms of mitral stenosis?
|
exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, ascites, and edema
Hoarseness (ortners) syndrome Dysphagia |
|
|
Why do patients get hoarse?
|
LA pressure on recurrent laryngeal nerve
|
|
|
What do you find on a physical exam in mitral stenosis?
|
RV parasternal lift, loud s1, split s2, short s2-opening snap interval
Low pitched diastolic rumble presystolic murmur - atrial contraction pulmonary diastolic blowing murmur(graham steel murmur JVD Ascites Edema |
|
|
What do you see on an EKG in mitral stenosis?
|
a-fib
LA abnormality RVH |
|
|
What is typical pharmacological treatment of Mitral stenosis?
|
control HR with diltiazem or esmolol (iv) or beta blockers or CCB.
Can also use Anticoagulation and cardioversion electively |
|
|
What is the surgical treatment of mitral valve stenosis?
|
balloon valvotomy
mitral comissurotomy (break it open) Mitral valve replacement |
|
|
What is a cause of acute mitral regurgitation
|
papillary muscle or chordae tendinae rupture.
|
|
|
What are the symptoms of acute mitral regurgitation?
|
Increased Left atrial pressure
Increased end diastolic volume of Left ventricle (volume overload) decreased end systolic volume of left ventricle Low cardiac output, LV failure |
|
|
What are the symptoms of chronic compensated mitral regurgitation?
|
LVH
LA enlargement at lower LA pressure Normal cardiac output asymptomatic |
|
|
What are the symptoms of chronic decompensated Mitral regurgitation?
|
Impaired LV contractility
LV dilation increased LVESV mitral annular dilation Increased MR Heart failure |
|
|
What causes and apical lift?
|
left ventricular hypertrophy
|
|
|
What are the symptoms of mitral regurgitation
|
Apical impulse downward and left
apical lift left parasternal area s1 decreased physiologically split s2 s3 - not a gallop, not due to heart failure murmur RV lift, increased p2 if pulmonary hypertension |
|
|
What does a mitral regurgitation murmur sound like?
|
apical, high pitched, holosystolic, radiates to left axilla.
|
|
|
What is the only useful thing the ecg shows in mitral regurge?
|
A fib
|
|
|
What are physical exam findings of mitral valve prolapse?
|
Midsystolic click
Late systolic murmur |
|
|
What do you give to prevent stroke in mitral prolapse?
|
low dose aspirin
|
|
|
How do you treat severe acute MR?
|
surgery
|
|
|
How do you treat chronic compensated MR?
|
no treatment
elective surgical valve repair or replacement |
|
|
How do you treat chronic symptomatic MR?
|
ACE I,
Anticoagulation for atrial fibrillation surgical valve repair or replacement is best surgery for sure for HF symptoms and LV dilation |
|
|
What is the most common cause of right sided endocarditis?
|
IV drug use
|
|
|
How do you diagnose tricuspid regurgitation?
|
usually can be done bedside
JVD with large V-wave Hepatic enlargement and pulsation RV parasternal lift Echo: Shows regurge, tricuspid gradiant |
|
|
How do you treat tricuspid regurgitation?
|
Treat cause such as Right ventricular MI, carcinoid syndrome, etc
Seldom need surgical treatment Diuretics |
|
|
What is the most common cause of pulmonic stenosis?
|
congenital fusion of cusps
|
|
|
What is the most common cause of pulmonary regurgitation?
|
ring dilation due to pulmonary hypertension
|
