Busy. Please wait.
Log in with Clever

show password
Forgot Password?

Don't have an account?  Sign up 
Sign up using Clever

Username is available taken
show password

Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
Your email address is only used to allow you to reset your password. See our Privacy Policy and Terms of Service.

Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.
Didn't know it?
click below
Knew it?
click below
Don't Know
Remaining cards (0)
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

Valvular Disease


Constant, sharp CP worse lying down, better sitting up and leaning forward Pericarditis
Electrical alternans, narrow pulse pressure, pulsus paradoxus = Pericardial effusion/tamponade
JVD, hypotension, muffled heart sounds are sxs of: Pericardial effusion/tamponade (Beck triad)
Pericarditis post open heart surgery Dressler’s syndrome; tx w/ ASA or colchicine
Lateral displaced PMI, Canon “a” waves, Quincke pulse, Corrigan pulse, Austin flint murmur, deMusset sx, water hammer pulse Aortic Regurgitation/ Insufficiency
Peds w/ leg pain after physical activity, abnormal heart sounds, unequal UE & LE pulses, rib notching Coarctation of aorta
Young female (<30yo), palpitations, long arms & fingers, pectus excavatum, ectopic lentis, flexible joints = Marfan Syndrome: MVP, aortic regurgitation, aortic dissection, aortic root dilatation, ectopic lentis
CHD shunts R to L: cyanotic; L to R: acyanotic (ASD, VSD, PDA)
Eisenmenger triad: Systemic to pulmonary connection, pulmonary vascular dz, hypoxemia
Jones criteria are used to diagnose: rheumatic heart disease (2 major OR 1 major and 2 minor criteria to dx)
Types of myocardial dz Cardiomyopathy; myocarditis
3 types of myocarditis infectious; toxic; autoimmune/idiopathic
3 types of pericardial dz Pericarditis; Pericardial effusion / tamponade; Pericardial constriction
Quincke pulse = subungual capillary pulsation (Aortic regurg)
Corrigan pulse = rapid rise and fall (Aortic regurg)
Austin Flint murmur = low pitch mid-diastolic murmur at apex (Aortic regurg)
Pericarditis Exam: Beck triad, fever, friction rub sitting/leaning forward (pain less); pulsus paradoxus
Beck triad = low arterial blood pressure, distended neck veins, and distant, muffled heart sounds.
Roth spots = Small, white, exudative, edematous spots on retina surrounded by hemorrhage
Osler nodes = tender, violaceous subcutaneous nodules on finger/toes fat pads (= immune complex deposition); often SBE
Janeway lesions = painless red macular, blanching lesions on palms & soles (2/2 infected microemboli)
Acute bacterial endocarditis: common bugs = STAPH AUREUS, Strep, H flu, Pneumococcus, N gono, Enterococcus
Duke criteria = 2+ pos BC (drawn 12h apart) or 3 of 4 separate BC; TTE/TEE evidence; RF heart condition or IVDU; T >38C (100.4); vascular sxs; immune sxs; microbiological evidence (not meeting major criteria)
Initial Abx tx for infectious endocarditis PCN & ceftriaxone (vs old tx: nafcillin & gentamicin)
Most common cause of LV OT obstruction Aortic stenosis (pathogenesis assoc with genetics (NOTCH1) and atherosclerosis)
Aortic stenosis 2 types Subvalvular (d/t: thin membrane (most common), thick fibromx ridge, diffuse tunnel-like obstruction, HCM); Supravalvular (hourglass deformity (60-75%) or more diffuse narrowing along ascending aorta)
Aortic stenosis Etiology US: lipid accumulation, inflammation, CALCIFICATION ; Elsewhere: rheumatic valve dz (fusion of the commissures between the leaflets, with a small central orifice)
Aortic stenosis Sx/Sx: triad w/exertion: HF, syncope, angina; Other: DOE (diastolic ventric dysfn); A-fib, V-arrhythmia, IE, Pulsus parvus et tardus
Aortic stenosis: echo valve opening <3cm2; antegrade velocity across valve >2.6m/sec; progressive concentric hypertrophy
Aortic stenosis Tx prevention of dz progression (statin, ?ACEI, HTN tx, IE Ppx); valve replacement (esp concurrently w/CABG); Survival = 2-3 yrs w/o valve replacement; balloon valvuloplasty
Mitral stenosis Pathophysiology symmetric oval orifice & doming of the leaflets in diastole (2/2 fusion of leaflet tips); leaflet thickening / calcification 2/2 chronic turbulent flow thru deformed valve -> leaflet fusion & thickening -> obstructed LA-to-LV blood flow
Mitral stenosis Sx/Sx A-fib (in 80%); pulmo HTN; dyspnea, hemoptysis, orthopnea, PND, CP, VTE, IE, right HF, hoarse; Graham Steell murmur
Mitral stenosis EKG P-mitrale: broad notched P wave
Mitral stenosis Tx exercise; loop diuretic if pulmo art congestion; digoxin, beta; VTE ppx, IE ppx
Mitral Regurgitation Pathophysiology increases preload but reduces afterload
Mitral regurgitation Sx/Sx Asx for yrs; poss left HF; exercise intolerance, dyspnea
Mitral regurgitation Tx serial monitoring; tx A-fib or LA enlargement (poss vasodilators); surg if LV EF<60% or echo LV end sys diameter >4cm
Bacterial endocarditis pathophysiology SA, Viridans strep & Strep bovis; Enterococci; HACEK group; Rheumatic; bicuspid valve
Bacterial endocarditis general Sx/Sx Fever; regurgitant murmurs/sx of HF; small and large emboli in fundi, conjunctivae, skin, digits: petechiae, splinter hemorrhages (nonblanching, linear reddish-brown lesions found under the nail bed)
Bacterial endocarditis Sx/Sx (SA) SA: more rapidly progressive & destructive infxn (acute febrile illness, early embolization, valvular regurg, myocardial abscess).
Bacterial endocarditis Dx studies 3 sets blood cx; CXR, EKG; TTE & TEE: evidence of vegetation; high ESR/CRP, normo/normo anemia
Bacterial endocarditis Tx Vanc 1 gm q12h IV + ceftriaxone 2gm q24h (vs staph/strep/enterococci); or Unasyn plus aminoglycoside
Acute rheumatic fever pathophysiology Post-GABHS infxn; strep strains with M protein (shares epitope w/myosin, thus may cause anti-myosin Ab rxn -> fibroblasts/macrophages); perivascular granulomatous rxn w/vasculitis
rheumatic fever sequelae include: arthritis, carditis (pericarditis, cardiomeg, CHF), chorea, subcutaneous nodules, erythema marginatum; abd pain, facial tics, epistaxis
rheumatic fever DDx RA, osteomyelitis, IE, chronic meningococcemia, SLE, Lyme, SCD
Jones criteria: major criteria = Carditis (pericarditis, cardiomegaly, CHF), erythema marginatum, sydenham chorea (late finding; face, tongue, UE), polyarthritis, subcutaneous nodules
rheumatic fever: non-Jones high ASO & anti-DNAse B to dx recent infxn
rheumatic fever Tx bedrest, salicylates, PCN, csteroids for joint sxs
Aortic regurgitation Sx/Sx Asx for decades; wide pulse pressure; S3; water hammer pulse, Corrigan pulse (pulse collapse in carotid);
Aortic regurgitation Signs: deMusset' (head bob), Duroziez (bruit when femoral art is partially compressed), Quincke (capillary pulsations in fingertips); apical impulse laterally displaced
Aortic regurgitation Tx serial monitoring; ACEI, CCB; surgery/valve replacement if EF <55%
Acute Pericarditis symptoms: sharp stabbing precordial or retrosternal CP; may radiate to back (L trapezial ridge), neck, shoulder, arm; worse with inspiration
Pericarditis pain is most severe when: pt is supine; relieved when pt leans forward while sitting
Acute Pericarditis exam: most common/important: pericardial friction rub (best heard at LLSB or apex when pt sitting forward)
Acute Pericarditis: viral causes: COXSACKIE B, echo, Flu A/B, adeno, MMRV, EBV, HSV1, Enterovirus, parainfluenza 2, RSV, HIV
Acute Pericarditis: bacterial causes: STREP PNEUMO; Staph / Strep, GNR: Proteus, E coli, Pseudo, Klebs, Sal/Shigella, N meningitidis, H flu. Less common: Legionella, Nocardia, tickborne, Myco, TB
Best test for pericarditis / pericardial effusion = TTE / TEE
Acute pericarditis tx: Firstline: NSAIDs (indomethacin / Aspirin) UNLESS 2/2 bacterial (then ABX is firstline); secondline: steroids
Myocarditis: relation to viral syndromes >50% of pts have antecedent viral syndrome; cardiac-specific sxs appear in subacute virus-clearing phase (2 wks after acute viremia).
Myocarditis: sx/sx Fever in 20% of patients; 35% have CP (pleuritic, sharp, stabbing precordial). DOE, palps, tachypnea, tachycardia out of proportion to fever
Severe myocarditis: sx/sx Sxs of LV failure: JVD, bibasilar crackles, ascites, peripheral edema
Most common infectious cause of myocarditis; Viral acute
More than half of myocarditis cases due to: Coxsackie-adenovirus: CA receptor protein is target of coxsackievirus B (Enterovirus) and adnovirus serotypes 2 & 5
Most common drug hypersensitivity reactions causing acute myocarditis: PCN, ampicillin, HCTZ, methyldopa, sulfonamides.
Medications causing acute myocarditis include: lithium, cocaine, numerous catecholamines, APAP, zidovudine (AZT), doxorubicin
Autoimmune causes of acute myocarditis: SLE, RA, Kawasaki, sarcoid, giant cell arteritis
Acute myocarditis tx: Diuresis (furosemide); ACEI
Mitral stenosis: most common cause = rheumatic heart disease (sxs follow latency period of 20-40 years after initial rheumatic fever episode)
Rheumatic heart disease: causes damage to which valves? 1. mitral valve; 2. aortic valve; 3. tricuspid
Rheumatic heart disease: peak incidence: 5-15 y.o.
Jones criteria: minor criteria = Fever >101, polyarthralgia, long PR interval, high ESR / CRP, high WBC, +ASO titer, A-fib
Angina pectoris: how common in severe aortic stenosis? 30-40% [old: 50-70%]
Aortic regurgitation exam: Wide pulse pressure (inc SBP & dec DBP); Korotkoff sounds to zero; Traube sign (pistol shot sounds over femoral artery)
Mitral regurgitation dx studies TTE, ECG (L atrial enlargement, AF), CXR (LA / LV enlargement & inc pulmo markings)
Stages of mitral regurgitation: compensated, transitional, decompensated (EF decreases)
Mitral regurgitation etiology MVP (most common: 45%); rheumatic fever; IE; trauma / chordae tendinae rupture; mitral annulus calcification, CHD/Marfan, DCM
MVP can lead to: flail MV regurg
Bulging / billowing MV leaflets into LA during systole, +/- mitral regurgitation = MVP
MVP etiology Primary: genetic (AD); Marfan; connective tissue dz (Ehlers-Danlos); Graves dz. Secondary: to CAD, rheumatic HD, or CM
MVP exam Hypotension/orthostasis, dizziness, palpitations; anxiety/panic. Seen w/scoliosis, pectus excavatum, military spine
Narrowing of pulmonic valve -> RVOT obstruction and right sided HF = pulmonic stenosis
Pulmonic stenosis etiology: Usually congenital & dz of the young; rheumatic HD, carcinoid; severe dz presents as HF in neonates; also Rubella embryopathy
Pulmonic stenosis exam: RV heave at epigastrium; thrill w/loud murmur (IV/VI); pulmonic ejection sound; wide split S2 w/soft delayed P2; S4; JVD; ascites/HJR in Rt HF
Pulmonic regurgitation etiology: pHTN from left VHD or pulmo dz; congenital; Fallot tet surgery complication; IE
Pulmonic regurgitation sx/sx: usually asx. Possible exercise tolerance
Tricuspid stenosis etiology: Rheumatic fever (most common), often with mitral & aortic lesions; RA myxoma; carcinoid; endomyocardial fibroelastosis; IE (bacterial)
Endomyocardial fibroelastosis is associated with what valvular disorder? Tricuspid stenosis
Tricuspid stenosis mgmt: Na restriction, diuretics, valvotomy, CT surg if severe progressive disease
Tricuspid regurgitation pathophysiology: Dilatation of annulus 2/2 functional RV dilation; TVP; chronic RV volume overload -> right CHF
Pulsation or fluttering sensation in neck can be due to: Tricuspid stenosis or regurgitation
Tricuspid regurgitation exam: abd bloating/pain; right HF; parasternal lift; RV S3; AF rhythm; JVD/pulsatile; palpable pulsating liver; HJR/ascites; edema
SBE bugs = Strep viridans and S bovis (most common), Enterococcus, SA, HACEK
IE NOT related to IVDU most often involves which valve: mitral / aorta
IE bugs (in IVDU): Staph aureus (SBE bug); Staph epi, Candida, Aspergillus, Strep viridans, Enterococcus
Early vs late prosthetic valve endocarditis = before vs after 60 days post-implantation
IE risk factors: Prosthetic valves & other devices; congenital anomalies; prior IE; rheumatic heart dz; valvular dz; HCM; dental/surg; IVDU
Fever in IE ABE: 102-105; SBE: 99-100
IE exam: Triad (fever, murmur, pos blood cx), conjunctival hemorrhage, petechiae, splinter hemorrhage, Janeway, Roth, Osler, friction rub, JVD, rales, gallups, cold extremity & focal neuro sxs if septic emboli
Duke criteria: vascular sxs = major arterial emboli, septic pulmo infarcts, mycotic aneurysm, ICH, conjunctival hemorrhage, Janeway
Duke criteria: immunologic sxs = Glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor
IE lab studies BC, high WBC, ESR / CRP, micro hematuria, anemia (SBE), positive RF (SBE), immune complexes (dec C3 & C4)
IE on CXR: infiltrates, pleural effusion
IE mgmt Abx x4-6 weeks: Pen G for S viridans, others guided by C&S; valve surg if severe; PPx
Dental procedure prophylaxis for IE is indicated for patients with: prosthetic cardiac valves, prior IE, transplant pt who develops VHD; CHD
Pre-procedure prophylaxis: which Abx in which procedures? For dental, oral, respiratory tract, infected soft tissue, & esophageal procedures: 2gm amoxicillin 1 hr prior and 1gm 2hrs after (Alt: ampicillin, clinda, CTX)
Most common acquired valve stenosis = aortic stenosis
In patient with hemodynamic sensitivity & syncope with nitrates, consider: aortic stenosis
Aortic regurgitation etiology: 80% idiopathic; HTN; rheumatic fever; IE; SLE; RA / ankylosing spondylosis; Marfan. ?SSRIs?
Most common valvular lesion: 1) aortic stenosis; 2) mitral regurgitation
Type of CAD/ACS most often associated with mitral regurgitation: inferior MI
MVP mgmt Beta blocker (eg, atenolol); consider dental prophylaxis
Tricuspid regurgitation etiology: pulmonary HTN (2/2 COPD); rheumatic fever; CHD; myxoma; carcinoid; SBE (esp in IVDU); Phen-fen; Ebstein is most common congenital form
Most accurate dx test for mitral stenosis = left heart catheterization
Test of choice for mitral stenosis = TEE
Most diagnostic finding for pericarditis ST elevation in all leads
In infective endocarditis, IVDU most commonly affects which valve? Tricuspid
Patients with this condition may have higher incidence of NTG-induced syncope Aortic stenosis
Most common cause of valve replacement in US chronic rheumatic heart disease (usually mitral valve)
Non-IVDU SBE/ABE bug Strep viridans
If endocarditis in prosthetic valve: May add rifampin (to vanc/gent/cefepime or carbapenem); usually added after BCx have cleared
Created by: Abarnard
Popular Medical sets




Use these flashcards to help memorize information. Look at the large card and try to recall what is on the other side. Then click the card to flip it. If you knew the answer, click the green Know box. Otherwise, click the red Don't know box.

When you've placed seven or more cards in the Don't know box, click "retry" to try those cards again.

If you've accidentally put the card in the wrong box, just click on the card to take it out of the box.

You can also use your keyboard to move the cards as follows:

If you are logged in to your account, this website will remember which cards you know and don't know so that they are in the same box the next time you log in.

When you need a break, try one of the other activities listed below the flashcards like Matching, Snowman, or Hungry Bug. Although it may feel like you're playing a game, your brain is still making more connections with the information to help you out.

To see how well you know the information, try the Quiz or Test activity.

Pass complete!
"Know" box contains:
Time elapsed:
restart all cards