Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
29 Cards in this Set
- Front
- Back
effect of standing from seated position or valsalva maneuver
|
acutely reduces cardiac preload; shortens duration between S1 and MV click in MVP; differentiates dynamic LV outflow obstruction from fixed stenosis (if fixed, result in decreased intensity of systolic murmur)
|
|
effect of isometric handgrip
|
acute increase in arterial afterload, increases intensity of MR murmur
|
|
the most common cause of aortic stenosis
|
Calcific degeneration of a trileaflet aortic valve
|
|
the second most common cause of aortic stenosis
|
Congenital bicuspid aortic valve
|
|
NOTE: No pharmacologic therapies, including statins,
|
have been shown to reduce or delay the progression of aortic stenosis.
|
|
the most common congenital heart lesion
|
bicuspid aortic valve
|
|
when is surgery for dilated ascending aorta indicated during AVR?
|
At the time of AVR, replace ascending aorta if diameter >4.5 cm [likelihood of progressive dilation]; or if >5cm regardless of valve function
|
|
when is IABP contraindicated in aortic regurgitation?
|
moderate or severe AR [will increase diastolic flow and regurgitant volume]
|
|
congenital lesions associated with bicuspid aortic valve
|
coarctation of the aorta, interrupted aortic arch, Turner syndrome
|
|
treatment of MR
|
prompt cardiac surgery if acute; vasodilators, inotropes, IABP
|
|
leading cause of native valve, prosthetic valve, and cardiac device infections
|
staphylococcal infections (previously strep)
|
|
NOTE: Although TEE requires greater operator training and sedation of the patient, it should be regarded as an acceptable primary diagnostic test without previous transthoracic echocardiography in certain clinical situations:
|
intermediate or high pretest probability of endocarditis, particularly in patients with Staphylococcus aureus bacteremia; patients with prosthetic heart valves; evaluation for complications of endocarditis, such as intracardiac abscess, valve perforation, or fistula formation.
|
|
Indications for surgery in infective endocarditis include: (...if mass is causing problems)
|
(1) severe hemodynamic perturbation [severe left-sided valvular regurgitation or fistula formation and HF]; (2) persistent infection despite appropriate antibiotics (persistent bacteremia or intracardiac abscess, or involvement of prosthetic surface); (3) HR of recurrent embolic event [large vegetation]
|
|
anticoagulation after implantation of prosthetic valve
|
warfarin at least 3 months + asprin 75-100mg/d; after which biologic valves stop warfarin and continue aspirin and mechanical vales continue both (to INR of 2-3 for AVR and 2.5-3.5 for MVR)
|
|
used for bridging anticoagulation in patients who have HIT
|
bivalirudin
|
|
low risk for valve thrombosis, bridging?
|
stop coumadin 48-72 h and restart within 24 hours
|
|
indications for PFO closure in asymptomatic patients?
|
There is no indication for PFO closure in asymptomatic patients.
|
|
ASDs located in the middle portion of the atrial septum near the fossa ovalis membrane
|
ostium secundum
|
|
ASD located in the lowest portion of the atrial septum near the cardiac crux
|
ostium primum
|
|
ASD located near the superior vena cava
|
sinus venosus defects
|
|
a communication between the coronary sinus and the left atrium
|
coronary sinus defect or unroofed coronary sinus
|
|
genetic syndromes associated with ASD
|
Holt-Oram syndrome involves bilateral UE abnormalities and congenital heart defects, most commonly an ASD. Down syndrome associated with ostium primum or secundum ASDs or VSDs. Familial occurrence of ostium secundum ASD is recognized and linked to chromosome 5.
|
|
clinical findings in ASD (5)
|
JVD, parasternal impulse, systolic flow M2 at 2nd L ICS, fixed splitting of S2; diastolic flow rumble across TV in large shunts
|
|
diagnostic work-up for ASD
|
TTE for primum and secundum; TEE / CMR for sinus venosus and coronary sinus ASDs; EKG, CXR; exercise testing to document exercise limitation; diagnostic cath if with PAH to determine whether closure is indicated
|
|
main indications for ASD closure (2)
|
presence of symptoms and a Qp:Qs ratio greater than 1.5 to 2.0 to avoid long-term complications.
|
|
Four types of VSD
|
perimembranous VSD (>80%), subpulmonary VSD, muscular VSDs, inlet defects
|
|
murmur in VSD (small VSDs)
|
loud holosystolic m2, at L lower sternal border, obliterates S2, may be palpable
|
|
when is closure of VSD indicated
|
when there is a Qp:Qs ratio of 2.0 or greater and evidence of left ventricular volume overload or a history of endocarditis
|
|
NOTE: Large VSDs with reversal of the cardiac shunt (becoming a right-to-left shunt) and pulmonary arterial hypertension (Eisenmenger syndrome) should not be closed;
|
closure will result in clinical deterioration.
|