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33 Cards in this Set

  • Front
  • Back
What is the predominant cause of mitral stenosis?
Rheumatic fever
What is the sex distribution of Px with MS from rheumatic fever?
2/3 are female
What happens to S1 in patients with Rheumatic Fever?
Because of severe thickening of leaflets they may not be able to open or shut, reducing the first heart sound and leading to combined MS and MR
Patients with rheumatic fever can develop MS years after infection. What 5 things may result from MS?
MS can cause:
1. enlargement of the L atrium
2. calcification of the left atrial wall
3. development of mural thrombosis
4. obliteration of pulmonary vascular bed
How is the LV ejection fraction in MS?
It is maintained.
What is the principal symptom of MS? Secondary sympt? (2)
dyspnea from reduced compliance of the lung. Secondary - coughing and wheezing.
What causes pulmonary edema in a Px with MS?
Anything that either increases CO or reduces time for flow of blood to occur (ie preg, infection, sex, A-fib)

Patients with MS are also at risk for thromboembolism - explain.
Thromboembolism results from a-fib that can occur in a px with MS.
How does the symptom of hoarseness occur in a Px with MS?
Because of a dilated left atrium, hoarseness can occur from compression of the L recurrent laryngeal nerve and dilated pulmonary artery.
What heart disease are px with MS predisposed to?
Infective endocarditis because of the distortion of the anatomy of the mitral valve
What is "pressure half time" and how does help diagnose the severity of MS?
Pressure half time is the time in ms from the peak gradient of blood across the mitral valve to half that value.

The larger the number the more sever the mitral stenosis.
Compare and contrast acute and chronic etiologies of mitral regurgitation:
pg6-7 in 11/7
Compare the ventricular functioning in mitral stenosis vs. mitral regurge:
In MS - ventricular function is not impaired, no dilitation occurs

In MR - ventricle is not protected and permanent dilitation occurs from chronic volume overload.
Compare the prognosis of acute MR vs chronic MR:
Acure MR has a better prognosis since valves have incurred as much damage.
What are the three clinical findings of a Px with MR?
1. holosystolic murmur to axilla
2. CXR showing enlarged heart
3. V waves in EKG when you have severe MR
When do symptoms develop in patients with chronic MR?
Symptoms don't develop until left ventricle FAILS!
Compare the development of symptoms in MR vs MS?
MR - development takes longer, often more than two decades

MS - can develop in as short at 2 years (have benefit of "early warning system" since pulmonary symptoms often develop before irreversible damage is done)
In which is pulmonary edema more common, MR or MS?
Two main treatments all patients with MR (acute and chronic) are on:
1. antiboitic prophylaxis
2. afterload reduction (angiotensin inhibitory or oral hydralazine)
What is the best treatment in patients with chronic MR?
MV ring repair with valvular PLASTY (VIP)
What is one indicator of a Px with MR's survival rate post surgery?
Ejection fraction - the better the px's EF was prior to surgery the better the 10y survival
What causes MVP and how bad is it to have?
Cause of MVP: myxomatous degeneration (fibrous thickening of mitral leaflets)

It is most often benign - 90% don't need surgery
Five causes of AS?
AS caused by:
1. congential bicuspid valve but often it does not cause the actually stenosis for decades
2. Rheumatic fever - which causes adhesions and fusions of leaflets as well as calcifications thus these px's usually have AS and AR
3. Degenerative calcific deposits (as in MVP) that cause valves to be immobile. Diabetes and hypercholesterolemia are risk factors for this.
4. Severe atherosclerosis can put sclerotic plaques on the valves (aka aorticsclerosis)
5. congenital unicuspid
What are the three symptoms of AS?
1. syncope
2. CHF
3. angina
What is the main treatment for px with symptomatic AS?
Valve replacement
Four clinical findings of AS?
1. systolic ejection murmur with ejection click
2. late peak of the murmur is muscial and severe
3. Cresendo-decreshendo murmur
4. S2 disappears with severe AS
Where is the best place to listen for an AS?
Suprasternal notch
Why isn't balloon aortic valvuloplasty done in px with AS? What px may still get this?
Since in AS the valves are calcified restenosis usually occurs due to scarring. This is only done in px with severe CHF.
What are the 4 main clinical finding of patient with AR?
1. diastolic murmur that is hard to hear
2. enlarged heart
3. dialated aortic root
4. echo shows diastolic blow
Since timing is key in valve replacement in Px with AR - what are the two criteria for a px to get the surgery before irreversible damage is done?
1. valve must be replaced before EF is lower than 60%
2. and LVESD is 40mm
What is the most common cause of tricuspid regurgitation?
Right ventricular dilatation secondary to pulmonary hypertension.
What is Carvallo's sign? What does it signify?
It's when the intensity of a murmur is increased just following inspiration. This sign translates into a diagnosis of tricuspid regurgitation.
Completely understand MR and AS since they are the most important in his lecture
MR and AS