Cv: Test 2: 22. Takubo: Valvular Heart Disease

Front 1

what heart sound is heard as "Kentucky"

when does it occur

Back 1

S3

right after S2

Front 2

What causes a S3 gallop? 2 examples?

Back 2

overloaded ventricle

CHF, 3rd trimester pregnancy

Front 3

Is S3 variant normal in kids?

Back 3

YES

Front 4

Is S3 variant normal in 40+?

Back 4

NO especially not with decreased left heart function

Front 5

what gallop sounds just like "Tennessee"

Back 5

S4

Front 6

when does an S4 gallop occur

Back 6

just before S1

Front 7

what causes a S4 gallop?

2 examples?

Back 7

Stiff ventricle

HCM and LVH

Front 8

Please grade murmurs

Back 8

Grade I – Less intense than S1, S2
Grade II – Same intensity as S1, S2
Grade III – More intense than S1/S2 but without a palpable thrill
***Grade IV – Grade III intensity but with palpable thrill
Grade V – Can be heard through a solid medium
Grade VI – Can be heard without a stethoscope

Front 9

The intensity of most murmurs _____ as you _____ flow across the valve.

Back 9

increase

increase

Front 10

what are the 2 murmurs that decrease with increased preload?

Back 10

MVP

HCM

Front 11

standing and valsalva increase/decrease preload?

Back 11

decrease!

Front 12

sustained 30 second handgrip will soften what murmur? why?

Back 12

HCM

Handgrip increases afterload which dilates the aortic outflow tract and softens the m

Front 13

what will Sustained 30 second handgrip do to MVP (mitral valve prolapse)?

Back 13

NOTHING or it can increase it


but should soften the murmur with HCM! (Handgrip increases afterload which widens the outflow tract)

Front 14

right sided murmurs will increase with ______

Back 14

inspiration

Front 15

Left sided murmurs increase with _____

Back 15

expiration

Front 16

In what position should you have your patient to best hear S3 and S4 gallops?

Back 16

lateral recumbent

Front 17

What is a fixed split S2 associated with?

Back 17

ASD

Front 18

if you see L atrial pressure go through the roof during ventricular contraction...what are you thinking?

Back 18

that you have regurgitation of the mitral valve

Front 19

what is the most common congenital valve disorder?

Back 19

aortic stenosis with a bicuspid valve is the most common

Front 20

patient has syncope with exercise....what do they likely have?

Back 20

aortic stenosis

Front 21

pulsus tardus is associated with what problem? what kind of murmur do you get with this? where can you best auscultate this

Back 21

aoritc stenosis

systolic

right upper sternal boarder

Front 22

how can you tell the difference between a carotid bruit and radiation from aortic stenosis?

Back 22

a carotid bruit will be much louder as you move up the neck!

Front 23

what has the worst prognosis of all valve lesions?

Back 23

Aortic Stenosis

Front 24

When do you fix aortic stenosis

Back 24

when it becomes symptomatic...

Front 25

what must you use extreme caution in using when a pt has aortic stenosis? 2

Back 25

Vasodilators and diuretics (ventricle needs excess volume to overcome pressure of stenotic valve)

Front 26

is medical management effective in aortic stenosis?

Back 26

NO

only surgery when symptoms pop up help

Front 27

You are the physician on call. You are called for a 72 year old male with a hx of HTN, hyperlipidemia and severe AS who has fallen at home and now has an intertrochanteric hip fx. Which do you have fixed first, the AS or the hip fx?

Back 27

Aortic Stenosis

Front 28

What are three indications to replace an aortic valve that is regurgitant?

Back 28

Symptoms at rest****

LVES dimension >5.5cm^2

EF decreases during exercise MUGA scan by >10%

Front 29

dyspnea, hemoptysis, and frequently causing atrial fib are symptoms of what

Back 29

Mitral Stenosis

Front 30

why do you get hemoptysis during mitral stenosis?

Back 30

pressure backs up into the lungs, and swells pulmonary capillaries

Hemoptysis caused because of increased pulmonary vascular pressure. May be severe, streaky, frothy.

Front 31

pregnant females with mitral stenosis may present with what? 2

Back 31

pulmonary edema and a fib

Front 32

what are the 3 types of rupture that can happen in the heart after MI?

Back 32

VSD (septal wall rupture)

Free wall rupture (creates acute tampanode, leaks into pericadium)

Papillary muscle rupture (get acute mitral regurg)

Front 33

when do ruptures occur?

Back 33

3-5 days post MI

Front 34

A 56 year old woman, who has had a cardiac murmur since childhood, now presents with increasing hypoxia and dyspnea 4 days following an anterior wall MI. You are consulted because of increased leg swelling and abdominal tenderness over the RUQ. On physical exam, her bp is 98/52. Jugular venous are distended. Precordial palpation shows a nondisplaced apical impulse and a left parasternal systollic thrill. The S1 is normal but the S2 shows a fixed split. There is a grade 4/6 harsh, holosystollic murmur which is loudest at the fifth left intercostal space with radiation to the right. No diastollic component is heard. Her EKG shows RVH by criteria. The remainder of the exam is significant for +3 peripheral edema. The CXR is normal. What does she have?

Mitral regurgitation
Aortic stenosis
Pulmonic stenosis
Atrial septal defect
Ventricular septal defect

Back 34

Ventricular septal defect

Front 35

how common are right sided valvular lesions?

Back 35

RARE

Front 36

do you replace diseased right sided valves?

Back 36

NO because of the low pressure

Front 37

what normally causes tricuspid stenosis? 3

Back 37

usually secondary to rheumatic heart disease, staph endocarditis (IV drug abusers) or carcinoid syndrome.

Front 38

if you see a really big "a" wave (giant or cannon) on the EKG what should you be thinking

Back 38

tricuspid stenosis

Front 39

what causes tricuspid regurgitation? 3

what is it secondary to?

Back 39

rheumatic heart dz, staph endocarditis or carcinoid

secondary to LHF with increased PAH

Front 40

if you see cannon v waves, what should you be thinking

Back 40

tricuspid regurgitation

Front 41

what are the 7 causes of large R wave in V1

not orange...not sure why I included this

Back 41

RVH – R>S in V1

RBBB – rsR

Posterior Wall MI – mirror sign

Misplaced leads – misplaced r wave progression

Muscular Dystrophy - Hx

Dextrocardia – CXR

WPW – delta wave in lateral precordial leads

Front 42

for tricuspid regurg do you treat the underlying disease or valve replace?

Back 42

treat the disease

valve replacement never done

Front 43

when do you replace left heart valves?

Back 43

Consider replacement when patient first becomes symptomatic, especially at rest

Front 44

when do you replace right heart valves?

Back 44

never replaced, consider valvuloplasty if symptoms severe

Front 45

when do you use Porcine valves?

Back 45

if older than 60

female wanting to give birth (because you can't give anti-coagulants to these women, and they are required for these valves)

Front 46

what is the lifespan of a porcine valve?

Back 46

10-15 years

Front 47

what is the exception to the rule that you should give antibiotic prophylaxis for congenital cardiac malformations?

Back 47

isolated secundum atrial septal defects

Front 48

most valve replacements require anticoagulation...what type DO NOT?

what population(s) would this be good in

Back 48

Porcine valves

good for: Females of child bearing age or others with anticoagulation contraindication