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69 Cards in this Set

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  • Back
Systole: systemic valves are ___. AV valves are _____.
open, closed
Diastole: systemic valves are ____. AV valves are ____.
closed, open
You hear a systolic murmer in the aortic valve, most likely due to ?
stenosis
You hear a systolic murmur in the mitral valve, most likely due to ?
regurgitation
You hear a diastolic murmur in aortic valve, most likely due to ?
regurgitation
You hear a diastolic murmur in the mitral valve most likely due to ?
stenosis
Increase in wall thickness and decrease in ventricular chamber.
concentric hypertropy
Decrease in wall thickness with an increase in ventricular chamber.
eccentric hypertrophy
Valve stenosis leads to ____ hypertropy which if not fixed will lead to ____ hypertrophy.
concentric, eccentric
Valve incompetence leads to ____ hypertrophy.
eccentric
Most common valvular condition seen clinically.
Aortic Stenosis
If you see supravalvular or subvalvular obstruction in the aortic valve, you are mostly likely examining a ____ patient.
pediatric
The younger the patient the more likely that this is the cause of aortic stenosis.
bicuspid aortic valve (congenital)
What are three causes of AS?
valve degeneration, bicuspid aortic valve, inflammatory changes
Three symptoms of AS?
angina, syncope, and SOB
Pulse is delayed and narrowed. Arterial pulse rises slowly and takes longer to reach its peak, w/ peak itself being diminished in amplitude.
pulsus parvus et tardus
Pulsus parvus et tardus is seen w/
AS
Four physical findings in AS
pulsus parvus et tardus, carotid thrill, fourth heart sound (S4), ejection murmur that peaks late in systole w/ musical quality
You hear an ejection murmur that peaks late in systole and has a musical quality. You should think?
AS
Preferred method screening and follow-up for AS?
Echo
Two ways to measure AS severity:
Aortic valve area (AVA) < 1.0 - severe
AVA < 0.7 critical
Mean gradient across the valve
What is the life expectancy of patient w/ symptoms of AS?
angina - 5 years
syncope - 3 years
CHF - 2 years
What is pharmaceutical therapy for a patient w/ AS?
trick question... none
What is a bridging procedure that can be done for patients with AS who are to severe for surgery to get them to the point where surgery is possible?
valvuloplasty
Most cases of aoric regurgitation are caused by ____ due to ____ or ____.
aortic root dilation; Marfan's, HTN
What is the main problem with AR?
volume overload leading to ventricular dilation
Chronic AR has very high ____ pressure with low ____ pressure.
systolic, diastolic
Symptoms of AR?
fatigue, weakness, angina, DOE
Bobbing of head in synch w/ HR b/c pressure is so high and then so low.
de Mussett's sign
"Pistol shot" like sound heard over femoral artery b/c brisk flow hits the femoral artery, but then decreases rapidly.
Traube's sign
Diastolic murmur over the femoral artery when it is compressed (to and fro).
Duroziez' sign
Capillary pulsations that can be detected by pressing a glass slide on the patient's lip or transmitting a light through the patient's fingertips
Quincke's pulse
Abrupt distension with a rapid rise and a quick collapse of the arterial pulse
Corrigan's pulse
The essential sign of ____. An early flowing decrescendo diastolic murmur beginning w/ the end of A2. No pause between A2 and murmur.
AR
Why is S1 sometimes soft with AR?
b/c the mitral valve closes due to the AR
Mid-diastolic murmur caused by "funcional mitral stenosis" where blood coming from the aorta back in to the LV closes the MV a little bit. The murmur is the vibration of the anterior leaflet of MV in severe AR.
Austin-Flint murmur
What is the best way to evaluate AR severity?
Echo
The predictor of symptoms in AR is ______.
systolic dysfunction - heart enlarges and EF is supernormal
What is the mortality of symptomatic patients w/ AR?
5 years - 25%
10 years - 50%
Drugs used to slow progression of AR in asymptomatic patients.
Ca channel blockers - nifedipine and amlodipine
Patient is acutely ill with pulmonary edema due to AR. Treat w/ ?
Na nitroprusside - vasodilator
Rule of 55 for AR patients
Surgery needed for patients w/ EF < 55% or LVESD > 55mm.
What is the cause of MS?
rheumatic fever
Patient history of MS?
slowly progressive, from time of rheumatic fever takes 10 years to get MS, ten more years to go from mild to moderate, and so on
Symptoms of MS?
DOE, hemoptysis, systemic emboli, atrial fibrillation
One of the only times you will hear an accentuated S1.
MS
Three physical findings for MS
accenuated S1, diastolic rumble heard at apex w/ bell, opening snap if severe
Correlation between OS and A2?
shorter the distance between A2 and OS, the more severe MS
CXR on MS patient?
dilated LA, dilation of right sided chambers, dilation of PAs and PVs
EKG on MS patient?
common to have atrial fibrillation, huge P waves that are long w/ double hump
Huge P waves that are long w/ double hump. Seen in ?
P mitrale, MS
Classic echo finding for MS.
hockey stick sign
Severity of MS is used by two methods:
mitral valve area (MVA) and LA/LV gradient; MVA < 1 cm^2 is usually severe
Medical mngt of MS
endocarditis prophylaxis. diuretics for pulmonary edema. Beta blocker for tachycardia. Anti coagulants
Most common cause of MR is?
heart failure b/c LV and annulus are dilated
Most common cause of primary MR?
alteration of leaflets due to endocarditis, rheumatic fever
Most common cause of MR in US?
mitral valve prolapse
Symptoms of MR
well tolerated, SOB, PND, pulmonary edema
Hallmark of MR
holosystolic blowing murmur heard at the apex; can radiate to the axilla or to the back
S3 heard with ? b/c of ?
MR, blood flowing in to an LV that is still full of blood
Markers for mitral valve prolapse?
midsystolic clicks
Gold standard for diagnosing MR?
echo
Surgery for MR patients?
EF is falling, progressive dilation of LV, pulmonary HTN
Pulmonary stenosis and insufficiency seen in ?
pediatrics
Prosethic valves are good for ____ but require _____.
lifetime, anticoagulants
Bioprosthetic valves last ?
10-15 years
Bioprosthetic valves are good for ? Why?
elderly (prone to falls) and women who want to get pregnant. BP valves do not require anticoagulant therapy.
INR for MV patients
2.5-3.5
INR for AV patients
2.0-3.0