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Mitral stenosis tx

Drugs that slow the heart rate (beta-blockers, CCB's) to increase LV filling time, anticoagulants to decrease thromboembolytic risk.

Pharmacotherapeutic tx for CHRONIC (but not acute) Mitral Regurgitation or Aortic Insufficiency

IV vasodilators (reduce peripheral vascular resistance and favour forward flow.

Four right-to-left shunts in Congenital Heart Disease

Tetralogy of Fallot, Transposition of great arteries, Truncus arteriosus, Tricuspid valve atresia

Tricuspid Valve Atresia

Complete absence of the tricuspid valve w/ undersized or absent right ventricle

Ventricular Septal Defects

Wall between the L & R ventricles defective, allowing blood to move left to right

Atrial Septal Defects

Wall between the L & R atria defective, allowing blood to move left to right

ASD & VSD effects

Volume & Pressure overloads on R heart

Acute rheumatic fever findings

Fever, arthritis, acute carditis, erythema marginatum

Most common causes of mitral stenosis

Calcification of valve or chronic rheumatic disease is the etiology

Associated w/ dental work in pt w/ cardiac deformity

Bacterial endocarditis

Mitral valve prolapse dx

Midsystolic click, palpitations, panic attacks, depression

Four etiologies of vegetative endocarditis

Rheumatic fever, Lupus, Bacterial Ix, Thrombotic dz

Most common benign cardiac tumor in adults

Atrial myxoma

Most common benign cardiac tumor in ped.s


Three measurements of aortic stenosis

Flow rate, cross-sectional area, pressure

Acute mitral regurgitation progression

MR --> High LV EDV --> CHF

Aortic valvular insufficiency progression

LV Volume overload --> LV Pressure overload -->LVH --> LCHF

Mitral Stenosis progression

Left atrial enlargement --> pulmonary edema --> RVH

Cardiac defects resulting in A-fib

All valvular disease --> Left Atrial Enlargement --> A-fib

Aortic stenosis worst case

Sudden death (LVH --> V-fib --> MI)

Most common cause of Mitral Regurgitation

Mitral valve prolapse

Mitral valve prolapse anatomical indicator

Hollow at the lower part of the breastbone, called pectus excavatum

Clinical presentations of Aortic Stenosis

SAD + 1 Angina, syncope, dyspnea & CHF

Auscultation of Aortic Stenosis

Slurred upstroke, delayed peak

An S4 gallop may indicate these 3 diseases


Disease associated with sudden cardiac death in athletes

Hypertrophic obstructive cardiomyopathy (HOCM)

An S3 gallop may indicate this

Decompensated CHF

Cardiac pressure effects of Mitral Regurgitation & Aortic Stenosis

Aorta: down, LA: up, LV: up, Systemic BP: down

Chronic Aortic insufficiency pulse findings

Bounding pulse, wide pulse pressure.

Auscultatory findings in Mitral Stenosis

Opening snap, then a rumbling diastolic murmur ending with presystolic crescendo

Three clinical presentations of HCM & AS

SAD: Syncope, Angina, & Dyspnea

Common etiologies of acute aortic insufficiency

Dissection, syphilis

Common etiologies of chronic aortic insufficiency

Marfan's, congenital bicuspid aortic valve, chronic rheumatic heart dz

Atrial septal defects induce what overloads on which side of the heart, and with what result?

Both volume & Pressure on the right--> RVH & pulmonary edema--> CHF

Site of 90% of VSDs

Membranous septum

Complications associated with VSD's

Unrepaired: Aortic insufficiency/CHF, Repaired: RBBB

Ventricular, systemic & pulmonary BP effects of VSDs

LV: increased preload, RV: pressure overload, Systemic BP drops, pulmonary BP rises

Four defects in Tetralogy of Fallot

Pulmonary trunk stenosis, Overriding aorta, VSD & RVH

Truncus Arteriosus

A single artery from the two ventricles gives rise to both the aorta and pulmonary trunk

Tricuspid Valve Atresia

Complete absence of tricuspid valve w/ undersized or absent right ventricle

Failure of coronary circulation to supply adequate circulation to cardiac muscle

CAD: Coronary Artery Disease --> CHD Coronary Heart Disease

Aortic insufficiency signs and symptoms

SAD, also Bounding pulse, low diastolic pressure and increased pulse pressure, De Musset's sign (head nodding in time with the heart beat), Quincke's sign (pulsation of the capillary bed in the nail)

Coronary Heart Disease s/s

STAR: ST depression, angina, response to nitro

Tetralogy of Fallot dx

"Coeur-en-sabot" (boot-like) heart on X-ray, low blood O2 saturation, cyanosis

Tricuspid valve atresia dx maneuver

Carvallo's Maneuver : Deep inhalation increases right ventricle filling, prolonging ejection time

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