1
Q
aortic stenosis
A
- PRESSURE overload
- CONCENTRIC hypertrophy
- angina (O2 supply mismatch)
- CHF (filling pressure backs up into lungs)
- delayed carotid upstroke
- LATE PEAKING SYSTOLIC AORTIC MURMUR
- absent A2
2
Q
aortic regurgitation
A
- VOLUME overload
- ECCENTRIC hypertrophy
- dilatation to normalize stress
- increased EDV
- increased SV
- LONG LOUD DIASTOLIC MURMUR along sternal border
- austin flint murmur
- bounding pulses (lare SV)
- wide pulse pressure
- Rx tx: reduce afterload with CCB, ACEi
3
Q
mitral stenosis
A
- RHEUMATIC FEVER if in adults
- increased LA pressure
- enlarged LA
- pulm HTN, edema
- calcification + stiffening
- afib (stretched atrium)
- LOUD S1, opening snap
- low diastolic rumble
- HF cells
- diuretics to decr LA pressure
- B blockers to decr HR
4
Q
mitral regurgitation
A
- VOLUME overload
- LA dilation
- pulm HTN, RV failure
- afib
- HOLOSYSTOLIC murmur, radiates to AXILLA
- decreased S1
- diuretics to decrease afterload
5
Q
calcific aortic stenosis
A
- congenital bicuspid, or developed senile
- concentric LVH, ischemia
- triad: chest pain, HF, syncope
- angina, DOE
6
Q
mitral valve prolapse
A
- young females, Marfan’s
- floppy enlargement/ballooning of mitral leaflets
- myxoid, mucus-y center
- alcian blue stain
- MIDSYSTOLIC CLICK
- mitral regurgitation
7
Q
rheumatic fever
A
- B hemolytic strep infection of pharynx
- licks joints, bites the heart
- usually mitral valve
- fibrinous pericarditis, endocarditis, mitral valve stenosis/fish mouth
- ASCHOFF NODULES: lymphocytes, histiocytes, ANITSCHKOW catepillar cells
- vegetations on CLOSURE LINES of cusps
JONES criteria Joints, polyarthritis <3 carditis Nodules, subcutaneous Erythema marginatum (truncal rash) Sydenham chorea
8
Q
infective endocarditis
A
- infection of valves
- bulky, friable vegetations
- ANYWHERE on valve (except closure)
- usually L sided, but can be on R esp with IV drug users
- fibrin, PMNs, bacterial colonies
- fibrosis, calcifications
- septic emboli
-alpha hemolytic strep, staph aureus, enterococci/HACEK, staph epidermidis, fungi
9
Q
nonbacterial thrombotic endocarditis
A
NBTE
- risk factors: hypercoaguable states, malignancy
- vegetations on CLOSURE LINES of valves
10
Q
Libman Sacks Endocarditis
A
SLE
- mitral and tricuspid valves
- STERILE vegetations
- UNDERSURFACE of valves
- hematoxyphil bodies
