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32 Cards in this Set
- Front
- Back
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In HOCM, which portion of the heart hypertrophies? Where causes the defect in circulation |
Interventricular septum
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Describe the murmur of HOCM?
What maneuvers decrease/improve the murmur |
1. Systolic ejection murmur, loudest at left sternal border
2. Increasing venous return
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Name the maneuvers that increase preload |
1. Lying down 2. Squatting 3. Hand grip 4. Elevating legs 5. Administering vasoconstrictors |
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Name the maneuvers that decrease preload |
1. Standing 2. Valsalva 3. Nitrates and peripheral vasodilators |
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Decrease in Preload. What will be the effect on:
a) Aortic stenosis |
a) Improve |
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Affect on afterload: a) ACEI b) Handgrip |
a) Reduces afterload b) Increases afterload |
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Affect on Preload: a) Spirinolactone |
a) Reduce preload |
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Tx for symptomatic premature atrial contractions |
BB |
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Harsh holosystolic murmur at lower left sternal border, frequently associated with thrill. |
VSD |
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1.Systolic ejection murmur at 2nd intercostal space at the right sternal border, with a thrill that radiates to the carotids
2. How does it clinically present? |
1. Aortic stenosis
2. Angina, dizziness, Heart failure |
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Increase in afterload. Affect on: 1. Mitral regurg |
1. Worsens the murmur (e.g. handgrip) |
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Decrescendo murmur |
Aortic regurg |
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What will be the effect on afterload? a) Dobutamine b) Hydralazine c) Handgrip |
a) Reduces afterload b) Reduces afterload c) Increases afterload |
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List the negative inotropic agents? |
1. BB CCB |
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Loud, blowing decrescendo diastolic murmur Bounding peripheral pulses Increased pulse pressure (waterhammer pulse) |
Aortic insufficiency/regurg |
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Holosystolic murmur heard at the apex that radiates to the left axilla Loudest over PMI Usually S3 and a mid-systolic click |
Mitral regurg |
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Reasons for Mitral regurg? |
1. Mitral valve prolapse 2. Dilated cardiomyopathy 3. Annular calcification |
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Harsh systolic murmur in the left 2nd-3rd interspaces Radiates to the left shoulder and increases with inspiration |
Pulmonary stenosis |
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What is the presentation of Mitral Stenosis |
Mitral stenosis usually presents in young adult patients: 1. Shortness of breath and CHF is a/w all forms of valvular heart disease 2. Dysphagia from LA pressing on the esophagus - LA Hypertrophy 3. Hoarseness - LA pressing on laryngeal nerve 4. Atrial fib (very common) and stroke from enormous LA 5. Hemoptysis 6. Mid Diastolic murmur - just after opening snap. Increased S1 sound |
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What worsens Mitral Stenosis murmur |
Increase in Preload: e.g. Squatting and leg raising increases intensity due to increased venous return to the heart |
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1. What are the common EKG findings in Mitral Stenosis
2. What are the late findings of MS after pulmonary HTN has indued? |
1. - Atrial rhythm disturbance esp. atrial fibrillation - Left atrial hypertrophy -shows up as biphasic P wave in leads V1 & V2
2. Increased P2 heart sound |
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What decreases intensity of Aortic Stenosis |
Decreasing Preload - because it decreases the volume the LV must eject |
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____ heart sound is a/w Aortic Stenosis |
S4 |
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Most common valvular lesion causing syncope and angina with exercise |
Aortic stenosis |
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What microscopic finding might be seen in AS |
Hemolytic anemia with Schistocytes - an indication for AV replacement |
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_______ presents with increased pulse pressure. |
Aortic regurgitation |
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Presence of ______ murmur is an indication for AV replacement |
Austin Flint murmur - diastolic murmur - Regurg hits the anterior MV leaflet producing functional mitral stenosis |
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Reasons for Tricuspid regurg? |
Functional: - Due to stretching of TV ring E.g: RHF, Pulm HTN, Dilated Cardiomyopathy, RV infarct
Congenital Infective Endocarditis Carcinoid Heart Disease |
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What increases the intensity of Tricuspid regurg? |
Deep inspiration Pressure over liver |
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Pansystolic murmur S3 and S4 heart sounds Increased intensity of deep inspiration |
Tricuspid Regurg |
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Whats the indication for valve replacement in MR |
1. LV End Systolic Diameter (LVESD) above 40 mm 2. EF < 60% |
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Etiology of Aortic regurg |
AR is caused by anything that makes the heart or aorta dilate in size: - MI - HTN - Endocarditis - Marfan syndrome or cystic medial necrosis - Inflammatory disorders e.g. ankylosing spondylitis or Reiter syndrome Tayayasu's - Syphilis - |
