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45 Cards in this Set
- Front
- Back
Causes of Mitral Stenosis
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Immune-mediated damage, usually caused by RHEUMATIC HEART DISEASE, leads to scarring and narrowing of orifice
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How does Mitral Stenosis lead to Pulmonary Congestion?
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Mitral stenosis leads to elevated left atrial and pulmonary venous pressure
*Can eventually lead to pulmonary HTN and right ventricular failure *Long-standing mitral stenosis can also cause A-fib |
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Clinical features of Mitral Stenosis
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1) Exertion dyspnea, orthopnea, PND
2) Palpitations, chest pain 3) HEMOPTYSIS - 2/2 ruptured anastomoses of small bronchial veins 4) Thromboembolism |
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Murmur of Mitral Stenosis
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1) Opening snap
2) Low-pitched diastolic rumble |
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Treatment of Mitral Stenosis
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1) Diuretics (pulmonary congestion and edema)
2) INFECTIVE ENDOCARDITIS PROPHYLAXIS 3) Chronic anticoagulation with WARFARIN 4) Percutaneous balloon valvulopasty (or open commissurotomy or mitral valve replacement) |
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Causes of Aortic Stenosis
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1) Calcification of bicuspid aortic valve
2) Calcification of tricuspid aortic valve in elderly 3) Congenital unileaflet valve 4) RHEUMATIC FEVER |
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How can Aortic Stenosis lead to Mitral Regurgitation?
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Over time, AS causes LVH, which can pull the mitral valve annulus apart and cause mitral regurg
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Clinical features of Aortic Stenosis
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1) Asymptomatic for years
2) Angina, exertional syncope, heart failure symptoms |
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Murmur of Aortic Stenosis
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1) Harsh crescendo-decrescendo SYSTOLIC murmur
2) Radiates to CAROTID ARTERIES 3) Heard best in 2nd right intercostal space |
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Diagnosis of Aortic Stenosis
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1) CXR: calcified aortic valve
2) ECG: LVH, LA abnormality 3) Echo 4) Cardiac catheterization |
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Indicated treatment in all patients with symptomatic Aortic Stenosis
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Aortic valve replacement
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Causes of Aortic Regurgitation
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Acute:
1) INFECTIVE ENDOCARDITIS 2) Trauma 3) Aortic dissection Chronic: 1) Valvular, MARFAN'S, EHLERS-DANLOS, Ankylosing spondylitis, SLE 2) Aortic root disease: BEHCET'S, REITER'S, HTN |
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Murmur of Aortic Regurgitation
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Diastolic decrescendo murmur best heard at left sternal border
*WIDENED PULSE PRESSURE - markedly increased systolic BP, with decreased diastolic BP |
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Treatment of Aortic Regurgitation
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1) Conservative if asymptomatic: diuretics, salt-restriction, digoxin
2) Aortic valve replacement - definitive tx 3) Endocarditis prophylaxis before dental and GI/GU procedures |
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Pathophysiology of Mitral Regurgitation
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Abrupt elevation of left atrial pressure in setting of normal atrial size and compliance --> backflow into pulmonary circulation --> pulmonary edema
*Hypotension and shock can occur 2/2 decreased cardiac output |
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Causes of Mitral Regurgitation
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Acute:
1) ENDOCARDITIS (S. aureus MC) 2) Papillary muscle rupture (post-infarction) or dysfunction (2/2 ischemia) Chronic: 1) RHEUMATIC FEVER 2) Marfan's syndrome 3) Cardiomyopathy |
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Murmur of Mitral Regurgitation
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1) HOLOSYSTOLIC MURMUR at apex
2) Radiation to the back or clavicular area *A-fib is a common finding |
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Treatment of Mitral Regurgitation
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1) Afterload reduction (vasodilators, salt reduction, diuretics, digoxin)
2) Chronic anticoagulation (if A-fib) 3) Mitral valve repair/replacement |
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Causes of Tricuspid Regurgitation
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1) Right ventricular dilatation
2) TRICUSPID ENDOCARDITIS (IVDA) 3) Epstein's anomaly - downward displacement of tricuspid valve into RV 4) Carcinoid syndrome, SLE, myxomatous valve degeneration |
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Murmur of Tricuspid Regurgitation
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1) Blowing holosystolic murmur
2) Left lower sternal border 3) INTENSIFIED with INSPIRATION (decreased with expiration or Valsalva) |
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Clinical features of Tricuspid Regurgitation
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1) Right ventricular failure (ascites, hepatomegaly, edema, JVD)
2) PULSATILE LIVER 3) A-fib usually present |
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Surgical treatment of Tricuspid Regurgitation
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1) Native valve repair
2) Valvuloplasty of tricuspid ring 3) Valve replacement surgery - rarely performed |
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Mitral Valve Prolapse
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Excessive or redundant mitral leaflet tissue due to myxomatous degeneration of mitral valve leaflets or chordae tendineae
--> Redundant leaflets prolapse into left atrium during systole *MC in patients with genetic connective tissue disorders (Marfan's, Ehlers-Danlos, osteogenesis imperfecta) |
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Murmur of Mitral Valve Prolapse
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1) Mid-to-late Systolic murmur
2) Midsystolic or late systolic click *STANDING AND VALSALVA MANEUVER INCREASE MURMUR* |
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Sustained hand grip and MVP murmur
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Increases the murmur
*Decreases murmur in Hypertrophic Cardiomyopathy (HCM) |
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Rheumatic Heart Disease
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Immunologically-mediated systemic complication of Streptococcal Pharyngitis (group A strept)
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MC valvular abnormality in Rheumatic Heart Disease
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Mitral stenosis
*Aortic or tricuspid involvement as well |
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Major Criteria of Acute Rheumatic Fever
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1) Migratory polyarthritis
2) Erythema marginatum 3) Cardiac involvement (pericarditis, CHF, valvular dz) 4) Chorea 5) Subcutaneous nodules *Diagnosis requires 2 major criteria or 1 major and 2 minor |
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Minor Criteria of Acute Rheumatic Fever
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1) Fever
2) Elevated ESR 3) Polyarthralgias 4) Prior history of rheumatic fever 5) Prolonged PR interval 6) Evidence of preceding streptococcal infection *Diagnosis requires 2 major criteria or 1 major and 2 minor |
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Treatment of Rheumatic Heart Disease
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1) Treat stept pharyngitis with Penicillin or erythromycin
2) Treat acute rheumatic fever with NSAIDs *C-reactive protein used to monitor tx |
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Acute Infective Endocarditis
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MCC by Staph aureus (virulent)
Occurs on NORMAL heart valve Fatal in less than 6 weeks if untreated |
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Subacute Infective Endocarditis
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Caused by less virulent organisms (Strept viridans, enterococcus)
Occurs on DAMAGED heart valves Fatal if untreated, but takes longer than 6 weeks |
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Organisms of Native Valve Endocarditis
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1) S. VIRIDANS
2) S. aureus 3) S. epidermidis 4) Enterococci 5) HACEK (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella) |
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Organisms of Prosthetic Valve Endocarditis
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Early onset: Staph (epidermidis > aureus)
Late onset: Strep |
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Organisms of IVDA Endocarditis
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MCC: S. AUREUS
*Others: Pseudomonas, enterococci, strept, Candida |
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Complications of Endocarditis
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1) Cardiac failure
2) Myocardial abscess 3) Showered emboli --> solid organ damage 4) Glomerulonephritis |
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Treatment of Endocarditis
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Parenteral antibiotics
*Penicillin (or vancomycin) and aminoglycoside until an organism is isolated |
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Nonbacterial Thrombotic Endocarditis (Marantic Endocarditis)
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Sterile deposits of fibrin and platelets form along closure of cardiac valve leaflets
Vegetations can embolize to brain or periphery *Associated with debilitating diseases (metastatic cancer) |
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Nonbacterial Verrucous Endocarditis (Libman-Sacks Endocarditis)
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Formation of small warty vegetations on BOTH SIDES of valve leaflets (usually aortic)
Can be a source of systematic embolization *Associated with SLE |
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Endocarditis Prophylaxis
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Amoxicillin
Indicated for patients with known valvular heart disease or prosthetic valves prior to oral or GI/GU surgery |
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Duke's Major Criteria for Endocarditis
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1) Sustained Bacteremia (organism known to cause endocarditis)
2) Endocardial involvement (by echo or new valvular regurg) |
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Duke's Minor Criteria for Endocarditis
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1) Predisposing condition
2) Fever 3) Vascular phenomena (Janeway lesions, mycotic aneursyms, septic arterial or pulmonary emboli) 4) Immunologic phenomena (GN, Osler's nodes, Roth spots, RF) 5) Positive blood cultures 6) Positive Echo |
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Janeway Lesions
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Painless erythematous lesions on palms and soles
*Associated with Endocarditis |
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Osler's Nodes
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Painful, raised lesions of fingers, toes, or feet
*Associated with Endocarditis |
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Roth's Spots
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Oval, retinal hemorrhages with clear, pale center
*Associated with Endocarditis |