Valvular disorders - Newman Flashcards Preview

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Flashcards in Valvular disorders - Newman Deck (40)
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1
Q

3 major symptoms of Aortic Stenosis

A
  1. Heart failure/dyspnea
  2. Angina
  3. Syncope
2
Q

Murmur heard with aortic stenosis best described as what?

A

Sounds like someone clearing their throat in between S1 and S2
S1 (Lub) - “Clear your throat” - S2(Dub)

3
Q

Will an EKG show aortic stenosis?

A

Yes

4
Q

Why is a cardiac cath done to establish aortic stenosis?

A

Done to establish gradient

5
Q

What 2 variables are important in determining if stenotic valve needs replacement

A
  1. Cardiac output (flow)

2. Gradient (difference in pressure on both sides of valve)

6
Q

3 most common causes of mitral regurgitation? Which is most common?

A
  1. Mitral valve prolapse (most common)
  2. MI (resulting in papillary muscle rupture)
  3. Left ventricular dilation (due to left heart failure)
    Know the other causes (rheumatic fever, bacterial endocarditis)
7
Q

Normal aortic valve opening size? When is it considered stenotic?

A
Normal = 3 cm^2 (pathoma says 4)
Stenotic = .5 cm^2 (pathoma says 1)
8
Q

Besides 3 common causes of mitral regurgitation, what are other causes?

A

Rheumatic fever, bacterial (infective) endocarditis

9
Q

2 requirements for bacterial endocarditis?

A
  1. Bacteria in the blood

2. Damaged heart valve

10
Q

2 complications of bacterial endocarditis?

A
  1. Pulmonary embolism

2. Damaged/destroyed heart valve

11
Q

Aortic regurgitation is leakage of blood from where to where?

A

Aorta to left ventricle (upstream)

12
Q

Mitral regurgation is leakage of blood from where to where

A

Left ventricle to Left atrium (upstream)

13
Q

Stenosis requires what cardiac adaptation?

A

Concentric hypertrophy = increased thickness (mass); normal volume and chamber size
- Hypertrophy required to overcome PRESSURE OVERLOAD

14
Q

Regurgitation requires what cardiac adaptation?

A
Eccentric hypertrophy (aka dilated ventricle)  = enlarged chamber; normal mass and thickness
-Dilatation required to overcome VOLUME OVERLOAD
15
Q

Interventricular septum normal size?

A

1 cm thick

16
Q

3 key features of ACUTE regurgitation?

A
  1. Murmur
  2. No adaptation (hypertrophy)
  3. Sudden increase in pressure upstream (i.e. if aortic regurg, increase in LV diastolic pressure)
17
Q

Chest pain is most notable in what valvular disorder? Why?

A

Aortic stenosis, Normal left systolic blood pressure is 120 mm Hg. With stenotic valve, require increased systolic blood pressure (250-300) to pump out now. causes chest pain

18
Q

Mitral regurgitation, what defining feature heard on murmur?

A

Holosystolic, high-pitched “Blowing murmur”

Lub - Newman blowing (don’t pass out) - dub

19
Q

1st heart sound (S1) correlates with what pulse?

A

Carotid pulse

20
Q

Aortic regurgitation, systolic or diastolic murmur?

A

Diastolic murmur, S1—–S2-“blowing”

21
Q

Valvular disorder(s) during diastole?

A

Aortic regurgitation

22
Q

Valvular disorder(s) during systole?

A

Aortic stenosis

Mitral regurgitation

23
Q

Relationship between loudness(intensity) of murmur and severity of valvular disorder?

A

There is no relationship, can have severe valve disorder with quiet murmur.

24
Q

Concentric ventricular hypertrophy is a risk factor for?

A

coronary disease

25
Q

Echocardiogram tells you what 3 features?

A
  1. Diseased valves
  2. Hypertrophy
  3. study flow of blood
26
Q

Angina refresh. What are the 2 main precipitating events of Angina?

A
  1. increased myocardial O2 demand

2. decreased O2 supply

27
Q

Eccentric hypertrophy seen in?

A

Acute cor pulmonale, regurgitation

28
Q

Describe EF in stages of aortic/mitral regurgitation?

A

Initially, increased preload due to (normal flow + extra flow due to valve regurge) in left ventricle, causing EF to increase to 75-80% or so. Over time, hypertrophy/fibrosis of ventricle ensues and EF will start dropping.

29
Q

Mitral stenosis most common cause?

A

Rheumatic fever

30
Q

Complications of mitral stenosis?

A

Left atrium dilation followed by pulmonary congestion>hypertension> eventual right sided heart failure (with ascites). Also atrial fibrillation with increased risk of mural thrombi

31
Q

Mitral stenosis can causee atrial fibrillation, increasing risk for?

A

Mural thrombus

32
Q

Ascites = how many liters of fluid

A

30L

33
Q

Jugular venous distention = how many liters of fluid?

A

3 L

34
Q

Mitral regurgitation can result in what 3 findings?

A
  1. Diseases affecting supporting structures
  2. Diseases affecting leaflets
  3. Dilation of annulus
35
Q

Features of Chronic mitral regurgitation?

A
  1. Dilation of Left ventricle and atrium
  2. Less HTN upstream than mitral stenosis
  3. Increased Preload, Decreased Afterload, Increased Stroke volume and ejection fraction
36
Q

Features of Acute mitral regurgitation?

A
  1. Sudden rise in atrial pressure
  2. no hypertrophy
  3. Murmur
37
Q

Causes of acute mitral regurgitation?

A

Infection, ischemia

38
Q

Delayed arterial pulse = ?

A

Tardus

39
Q

Weakened arterial pulse = ?

A

Parvus

40
Q

Aortic regurgitation causes widening or narrowing of pulse pressure?

A

Widening in pulse pressure (i.e. 200/40) due to increased preload + “venting” of aorta (lower afterload)