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Test-4-Clinical Med

Valvular Heart Disease

When you give a patient an volume (IV saline) what in regards to the heart increases? PreLoad
JONES criteria can be used in the Dx of what? Rheumatic Fever - when two of the major criteria or 1 major and 2 minor criteria are present. Joints- Polyarthritis Obvious Carditis('O' as the Heart) Nodules (subcutaneous) Erythrema marginatum Sydenham' s chorea (St Vitus dance)
SOB, Dyspnea, anything to do with pulmonary/lungs, opening snap which is low pitched with diastolic rumble is Diagnostic of what heart problem? Mitral Stenosis -remember diastole is always pathologic - Think about pregnancy- Preg will increase BV 50% therefore stressing right side of heart.
What are two Txs for Mitral Stenosis? 1. Balloonvalvoplasty - Valvoplasty- use balloon to stretch open valve. 2. Valve replacement.
True or False: Mitral Regurgitation (insufficiency) can cause Left Ventricular hypertrophy. True: Heart increases in size to help increase ejection fraction b/c more oxygenated blood is needed systemic side.
IF you are having Mitral Regurg Sx you would replace valve, but what are two other indications that the valve needs to be replaced if patient is not clearly exhibiting Sx? 1. Fix when Ejection Frac less than 60% 2. LV bigger than 4 cm
Why would you do a Cath on these patients before replacing the valve? Want to check coronary arteries and make sure they are all good before cracking the chest. If not you can fix while replacing Mirtral Valve.
You here a murmur in your patient, its a blowing, high-pitched, harsh or musical sound heard through out systole (holosystolic), what is the Dx? Mitral Regurgitation (insufficiency)
What are some causes of Mitral Regurgitation? 1. Pulmonary Stenosis 2. Chordea Tendinea rupture 3. Endocarditis 4. Acute regurgitation with MI
Why should you monitor MVP each year with an echo? To make sure it does not develop into MR
MVP auscultatory findings are subtle but are greatly affected by what that can help increase the audible mid systolic click, followed by a lated systolic murmur? Left ventricular volume
A person with Aortic Stenosis (AS) usually have what other condition? CAD - Coronary Artery Disease
What are the cardinal symptoms associated with AS? Angina CHF Syncope
In order for the LV to push open the rusty doors (aortic semilunar valves) it has to be big and strong. As the LV overcomes the rusty doors and pushes them open what kind of sounds does it make? Harsh, very loud "holosystolic" Whistle is so loud you can hear it in the neck.
What is the Tx for AS? -Fix early - best prognosis is before LV disfunction -Decrease EF -Same as Heart failure
**Coronary artery disease is less common with Aortic Regurgitation or AS? AS
What are some signs and symptoms of AR? -SOB -Dyspnea on Exertion-DOE -Fatigue -Really big LV -Aortic Root Dialated -Water Hammer Pulse - Bounding arterial pulse with quick collapse (forward blood pressure is lost due to regurgitation)
What does the AR murmur sound like and where is it best heard? -Sound - Blowing, Faint, during diastole -Location- Lower left sternal boarder with patient sitting up and leaning forward
What are the Tx protocols for chronic and acute AR? -Chronic - monitor and treat low ejection fraction and end diastolic volume -Acute - Medical emergency - Urgent surgery for valve replacement.
Tricuspid Stenosis and Regurgitation have what kind of symptoms? Right side heart failure
What two things commonly cause Tricuspid Stenosis? 1. M/C rheumatic 2. Carcinoid Tumor
Right Ventricle increases in size in Tricuspid Stenosis or Regurgitation? -Tricuspid Regurgitation
A mechanical Mitral or Aortic valve will have increased risk for blood clots? Mitral Valve- b/c blood does not move passed this valve very fast.
Which last longer a bovine or porcine bio-prosthetic valve? and what is the life expectancy of this valve? -Bovine -10 - 15yrs
Anticoagulation is needed with which replacement valve, bio-prosthetic or mechanical? Mechanical
Created by: cmuox2000