Mystery
A patient presents to the ED 3 weeks after strep throat complaining of SOB. What form of mitral valve disease are you worried about and what protein causes it?
Rheumatic mitral valve stenosis, M-protein
What are 2 of the 3 common symptoms of aortic stenosis
Angina
Syncope
Heart Failure
What treatment is advised for a patient with asymptomatic aortic valve stenosis?
None (just follow up till symptomatic)
What is the name for the muscles attached to the chordae
papillary muscles
What does S1 correspond to?
Closure of the mitral and tricuspid valves
What is claudication and what stage of PAD is it?
"angina of the leg", 2nd stage
Should I be worried if I have a PAD patient with an ABI index of .4?
Yes
What drug class should you avoid with chronic aortic regurgitation?
Beta blockers
How many leaflets are there in the aortic valve?
3
What does S3 correspond to?
S3 represents a transition from rapid to slow ventricular filling in early diastole.
A patient comes in a day after their stent procedure with symptoms of pulmonary edema. What type of valve issue may have caused this?
Acute mitral valve regurgitation due to the stenting
What would we expect to see on the ekg of a PT with mitral stenosis?
Increased R peak, split P wave, afib
Immediate surgery is indicted for type __ but not type __ aortic dissections.
A
Not for B bc of paralysis
Where do the calcifications on the mitral valve form? (ie. what part of the anatomy of the valve)
Along and beneath the annulus
What location would you go to to auscultate the mitral valve?
The mid-clavicular line at the 5th intercostal space
Valve obstruction leads to LV remodeling in aortic stenosis due to increased __ as a result of increased __.
Increased wall stress due to increased pressure
What would you expect to find on the carotid pulse tracing of a PT with aortic stenting?
Slow upstroke and low amplitude
List the complications that could arise following a bioprosthetic valve replacement.
thromboembolism
endocarditis
deterioration of valve
How do insert valves during a TAVR procedure? (ie. run thru the procedure and the mechanical set up)
Attach valve to a stent, then force old valve open by opening stent and let the prosthetic do its job
What does it mean for a heart sound to be holosystolic?
This means it does not crescendo, ie. it is the same intensity
The Austin-Flint murmur is associated with what abnormality?
Aortic regurgitation
A 54 yo man with hx of tobacco abuse presents with CP. EKG shows ST elevations in leads II, II, aVF, and angiography shows a thrombotic occlusion of the RCA which is treated with a stent. 3 days later the PT develops acute onset dyspnea. The PT has a 3/6 holosystolic murmur at the cardiac apex. Which of the following is the cause of the PTs symptoms?
A. ventricular free wall rupture
B. papillary muscle rupture
C. pulmonary embolism
D. thrombus in the LV
B - papillary muscle rupture
What drugs can we use to manage pulmonary edema in patients with mitral valve regurgitation?
diuretics
nitroprusside
Atrial dilation leads to regurgitation through what valve, and via what mechanism?
mitral valve
annulus dilation
A 56 yo PT comes in complaining of SOB. Physical exam shows signs of edema and JVD. PT has a had a prior MI. What heart sound may be abnormally attenuated in this PT?
S3 - dilated cardiomyopathy