Term
| Mitral stenosis is most often caused by recurrent attacks of: |
|
Definition
|
|
Term
| What happens to the left atrium in mitral valve stenosis, and why? |
|
Definition
| it becomes dilated & hypertrophied due to increased work in filling the ventricles in diastole |
|
|
Term
| Signs & Symptoms of mitral valve stenosis |
|
Definition
dyspnea
hemoptysis with rust-colored sputum
atrial fibrillation
pulmonary venous hypertension
dysphagia for solids
opening snap followed by early- to mid-diastolic rumble |
|
|
Term
| What abnormal heart sounds are associated with mitral stenosis? |
|
Definition
| opening snap followed by early- to mid-diastolic rumble |
|
|
Term
| Why would someone with mitral valve stenosis have dyspnea & hemoptysis with rust-colored sputum? |
|
Definition
mitral valve stenosis causes high pressure in left atrium, which causes high pressure in the pulmonary system
this leads to pulmonary capillary congestion & hemorrhage into the alveoli |
|
|
Term
| Why would someone with mitral stenosis get atrial fibrillation? |
|
Definition
| Backed-up pressure leads to left atrial dilation and hypertrophy. The enlarged atrium is at greater risk of electrical problems (ex., irritated heart cells can become new pacemakers), which can lead to atrial fibrillation. |
|
|
Term
| How can atrial fibrillation cause life-threatening problems? |
|
Definition
| static blood inside the atrium can become thrombi, which can leave the interior of the heart and form clots in the cardiac vessels, body, or brain |
|
|
Term
| What is the most common cause of mitral regurgitation? |
|
Definition
|
|
Term
| Functional mitral valve regurgitation |
|
Definition
Regurgitation in which the papillary muscles, chordae, and valve leaflets of the mitral valve are normal.
(Cause: Ischemia or dilation of left ventricle stretches out the Mitral Valve (MV) ring and prevents leaflets from completely meeting when closed)
2. Cause: Ischemia or dilation of left ventricle stretches out the Mitral Valve (MV) ring and prevents leaflets from completely meeting when closed) |
|
|
Term
| What causes functional mitral valve regurgitation? |
|
Definition
| Ischemia or dilation of left ventricle (as in left-sided heart failure or left ventricular infarction) stretches out the Mitral Valve (MV) ring and prevents leaflets from completely meeting when closed |
|
|
Term
| Causes of mitral valve regurgitation |
|
Definition
Mitral valve prolapse
Functional mitral valve regurgitation
Infective endocarditis
Rupture or dysfunction of the papillary muscle in acute MI
Acute rheumatic fever
Libman-Sacks endocarditis in systemic lupus erythematosus |
|
|
Term
| What happens to the left atrium in mitral regurgitation? |
|
Definition
| becomes dilated and hypertrophied |
|
|
Term
| Mitral valve regurgitation leads to _______ (left or right) heart failure. Why? |
|
Definition
left
iVolume overload in the left ventricle and left atrium leads to LHF |
|
|
Term
| Mitral valve regurgitation leads to _______ (left or right) heart failure. Why? |
|
Definition
right
the pressure backs up, through the atrium, through the pulmonary system (causing pulmonary hypertension), and causes increased workload for the right heart |
|
|
Term
| Clinical findings of mitral regurgitation. |
|
Definition
Dyspnea, inspiratory crackles, and cough from Left Heart Failure (LHF)
Pansystolic murmur; S3 and S4 heart sounds |
|
|
Term
| What abnormal sounds would you hear with mitral regurgitation? |
|
Definition
| Pansystolic murmur; S3 and S4 heart sounds |
|
|
Term
|
Definition
| carcinoid tumors in the heart |
|
|
Term
| Is pulmonary stenosis a common valvular disease? |
|
Definition
|
|
Term
| Acquired pulmonary stenosis is associated with __________ heart disease |
|
Definition
carcinoid
(that is carcinoid tumors in the heart) |
|
|
Term
| Clinical findings for pulmonary stenosis. |
|
Definition
Systolic ejection murmur
Right ventricular hypertrophy |
|
|
Term
| What abnormal heart sounds are heard with pulmonary stenosis? |
|
Definition
|
|
Term
|
Definition
| the right atrioventricular valve |
|
|
Term
|
Definition
| the left atrioventricular valve (aka the bicuspid valve) |
|
|
Term
| Most common cause of tricuspid stenosis. |
|
Definition
|
|
Term
| Causes of tricuspid stenosis |
|
Definition
iRheumatic fever
carcinoid syndrome
endocarditis
endomyocardial fibrosis
lupus erythematosus |
|
|
Term
| What effect does tricuspid stenosis have on the right atrium? |
|
Definition
|
|
Term
| How does rheumatic fever cause tricuspid stenosis? |
|
Definition
| the valve leaflets become thickened and sclerotic as the chordae tendineae become shortened. The restricted valve opening hampers blood flow into the right ventricle and, subsequently, to the pulmonary vasculature. |
|
|
Term
| What effect does tricuspid stenosis have on the liver? The lungs? The limbs? |
|
Definition
obstructed venous return to the right heart causes blood to back up in the hepatic vein, which causes the liver to enlarge
It causes decreased flow to the lungs.
It causes peripheral edema. |
|
|
Term
| What abnormal heart sound does tricuspid stenosis cause? |
|
Definition
| Mid diastolic murmur caused by the blood flow through the stenotic valve (heard over the left sternal border) |
|
|
Term
| Most common cause of tricuspid regurgitation in adults. |
|
Definition
| functional tricuspid regurgitation |
|
|
Term
| Functional triscuspid valve regurgitation |
|
Definition
tricuspid valve regurgitation in which nothing is wrong with the valve itself
(Cause: Ischemia or dilation of right ventricle (as in right-sided heart failure, pulmonary hypertension, dilated cardiomyopathy, or right ventricular infarction) stretches out the Tricuspid Valve (TV) ring and prevents leaflets from completely meeting when closed) |
|
|
Term
| What causes tricuspid valve regurgitation? |
|
Definition
| Ischemia or dilation of right ventricle (as in right-sided heart failure, pulmonary hypertension, dilated cardiomyopathy, or right ventricular infarction) stretches out the Tricuspid Valve (TV) ring and prevents leaflets from completely meeting when closed |
|
|
Term
| Causes of tricuspid regurgitation |
|
Definition
Functional tricuspid valve (TV) regurgitation (stretching of the TV ring)
Congenital cardiac abnormalities
Infective endocarditis in intravenous drug abuse
Carcinoid heart disease |
|
|
Term
| Most common cause of tricuspid regurgitation in YOUNG adults? |
|
Definition
| Congenital cardiac abnormalities |
|
|
Term
| Tricuspid regurgitation is sometimes caused by infective endocarditis, most often in people who: |
|
Definition
|
|
Term
| Tricuspid regurgitation leads to _______ heart failure. |
|
Definition
|
|
Term
| Clinical findings in right tricuspid regurgitation |
|
Definition
pulsating liver
Giant c-v wave jugular venous pulse (in severe tricuspid regurgitation)
Pansystolic murmur; S3 and S4 heart sounds |
|
|
Term
|
Definition
| An abnormally prominent pulsation of the jugular vein in tricuspid valve insufficiency |
|
|
Term
| What happens to the liver in tricuspid regurgitation & why? |
|
Definition
It pulsates
blood regurgitates into the venous system with systole |
|
|
Term
| What abnormal heart sounds are heard with tricuspid regurgitation? |
|
Definition
Pansystolic murmur; S3 and S4 heart sounds
(S3-a low-pitched sound |
|
|
Term
|
Definition
a galloping sound shortly after S2; lower in pitch than S1 or S2
i. Sounds, to me, less like a separate sound, and more like S2 has got a little vibrato and some extra base |
|
|
Term
| What sound is S1 and what causes it? |
|
Definition
"lub"
caused by reverberation of blood when flow is suddenly cut off by closure of the atrioventricular valves, i.e. tricuspid and mitral (bicuspid), at the beginning of systole |
|
|
Term
| What sound is S2 and what causes it? |
|
Definition
"dub"
caused by the sudden block of reversing blood flow due to closure of the semilunar valves ( aortic valve and pulmonary valve) beginning of ventricular diastole. |
|
|
Term
| Name the 2 semilunar valves |
|
Definition
| aortic valve and pulmonary valve |
|
|
Term
|
Definition
Caused by oscillation of blood back and forth between the walls of an ventricle as blood rushes in from the the atria, or tensing of chordate tendinae during rapid filling and expansion of the ventricle
Indicates a larger than normal volume of blood filling the ventricle
Benign in youth, athletes, and pregnant women
Later in life, may indicate congestive heart failure |
|
|
Term
|
Definition
| Benign in youth, athletes, and pregnant women |
|
|
Term
| Best position for hearing left-sided S3 |
|
Definition
| at the apex of the heart (5th left intercostals space at the midclavicular line), particularly when patient is in left lateral position |
|
|
Term
| Where is the apex of the heart best heard? |
|
Definition
| 5th left intercostals space at the midclavicular line |
|
|
Term
|
Definition
| a galloping sound heard shortly before S1 (presystolic/atrial gallop) |
|
|
Term
|
Definition
Produced when blood is forced into a stiff/hypertrophic ventricle
Usually a sign of a failing ventricle |
|
|
Term
| Best position for hearing S4 |
|
Definition
| Best heard at the cardiac apex with the patient in the left lateral position, holding his/her breath |
|
|
Term
| The cross-sectional area of the aorta is normally _________. Aortic stenosis begins when the cross-section is__________. Aortic stenosis is severe when the cross-section is ________ |
|
Definition
|
|
Term
| Most common cause of AV stenosis in patients > 60 years old? Most common cause in patients < 30 years old? |
|
Definition
Calcific AV stenosis of normal or bicuspid aortic valve
Congenital AV stenosis |
|
|
Term
| Causes of aortic stenosis. |
|
Definition
Calcific AV stenosis of normal or bicuspid aortic valve
Congenital AV stenosis
Age related sclerosis of the aortic valve
Chronic rheumatic fever |
|
|
Term
Explain the following mnemonic:
If a mousie hears the awful din
Of a screaming, hunting bird of prey
alpha abates the flow to gut & skin
beta boosts the flow to get away |
|
Definition
2 receptors receive sympathetic input to arterioles, changing bloodflow
When alpha1 adrenergic receptor is stimulated, it causes arterioles leading to gut & skin to constrict (LESS blood to gut & skin)
When beta2 adrenergic receptor is stimulated, it causes arterioles leading to skeletal muscle to relax (MORE blood to skeletal muscle) |
|
|
Term
| arteriovenous malformation (AVM) |
|
Definition
| an abnormal connection between artery & vein that by-passes the capillary system. It's most often congenital, can appear anywhere in the body, and is mostly asymptomatic (but can cause dramatic symptoms if it's somewhere important, like cerebral AVM) |
|
|
Term
| Where does an arteriovenous malformation cuase the most dramatic symptoms? |
|
Definition
|
|
Term
| How can an arteriovenous malformation cause heart failure? |
|
Definition
| they tend to bleed; the excess work of trying to keep up with the extra blood required by the AVM can lead to heart failure |
|
|
Term
| Von Hippel-Lindau disease |
|
Definition
a rare, genetic disorder in which hemangioblastomas (tumors in the CNS that are big balls of blood vessels) are found in the cerebellum, spinal cord, kidney and retina.
people with Von Hippel-Lindau disease are particularly likely to have arteriovenous malformations |
|
|
Term
| Where in the body do arteriovenous malformations cause the most dramatic symptoms? |
|
Definition
|
|
Term
| What is the most common clinical presentation of arteriovenous malformation |
|
Definition
| asymptomatic (only 12% are symptomatic) |
|
|
Term
| Why are arteriovenous malformations (AVM) likely to bleed? |
|
Definition
arteries are built for high pressure
veins are built for low pressure
normally, capillaries lower the pressure before the fluid gets into the vein, but that doesn't happen in AVM, and the vein is likely to break at the junction with the artery |
|
|
Term
| What sound does an arteriovenous malformation cause? |
|
Definition
| a bruit (rhythmic whooshing sound) |
|
|
Term
|
Definition
| a low-frequency whooshing sound heard over an area of turbulent flow (e.g., in an obstructed vessel or at an arteriovenous malformation) with each heartbeat |
|
|
Term
| How can an extensive arteriovenous malformation lead to heart failure? |
|
Definition
| This lack of sufficient capillaries means that less oxygen gets to the affected tissue (and less CO2 is taken away). This results in decreased oxygenated blood within capillaries, which may result in tissue hypoxia. This is counteracted by the heart working harder to increase blood flow to the fewer remaining capillaries or to maintain a certain perfusion of oxygenation within tissue. This extra work will over time results in heart failure |
|
|
Term
| Clinical presentation of arteriovenous malformation. |
|
Definition
Most asymptomatic; incidentally identified
Most general symptoms of a cerebral AVM include headache and epilepsy.
Other more specific symptoms depend on location
Symptoms can include:
Movement or coordination disorders; vertigo (dizziness); speech difficulties (dysarthria); communication disorders (alogia); Abnormal sensations (numbness, tingling, or pain); Cognitive dysfunctions (confusion, dementia or hallucinations).
Can be fatal if bleeding occurs in the CNS
Can lead to heart failure if AVM is extensive for a period of time. |
|
|
Term
| What would you see on an arteriogram with contrast of a person with an arteriovenous malformation? |
|
Definition
| a direct connection between artery and vein |
|
|
Term
| Macroscopic morphology of arteriovenous malformation. |
|
Definition
| a direct connection between artery and vein |
|
|
Term
| Microscopic histology of arteriovenous malformation. |
|
Definition
|
|
Term
| How is an arteriovenous malformation diagnosed? |
|
Definition
by arteriograms or imaging modalities with contrast
(most are incidentally discovered, but in some cases the arteriogram may be called for because the AVM is causing symptoms) |
|
|
Term
| How do you treat an arteriovenous malformation? |
|
Definition
Treatment reserved for symptomatic AVMs or cerebral AVMs, which may involve surgery or radiation therapy (since radiation may shrink some of these AVMs).
Embolization (cutting off blood supply to AVM) by introducing material to AVM by a radiographically guided catheter (mostly smaller AVMs). |
|
|
Term
| When do you treat an arteriovenous malformation? |
|
Definition
| when it's symptomatic OR if it's cerebral |
|
|
Term
| What is a nidus of vessels? |
|
Definition
| a nest (tangled malformation) of blood vessels |
|
|
Term
|
Definition
| localized, blood-filled dilation (balloon-like bulge) >50% of normal arterial diameter of a blood vessel; caused by a weakening of the vessel wall. |
|
|
Term
| Do aneurysms occur more frequently in arteries or veins, and why? |
|
Definition
| arteries, because it's a higher pressure system |
|
|
Term
| Where do berry aneurysms occur? |
|
Definition
| at arterial branch points from the circle of Willis |
|
|
Term
| Most common site of aneurysms. |
|
Definition
| at arterial branch points from the circle of Willis (called berry aneurysms) |
|
|
Term
| Where do most (94%) of non-intracranial aneurysms arise? |
|
Definition
| from the abdominal aorta, below the renal arteries (infrarenal) |
|
|
Term
| Berry aneurysms are mostly caused by ______________________, while abdominal aorta aneurysms are mostly caused by ___________________ |
|
Definition
congenital weakness in the vessel wall
atherosclerosis |
|
|
Term
| Are berry aneurysms common in the U.S.? How likely are they to rupture? |
|
Definition
fairly common: 0.2-7.9% of the US population has them
not very likely (12/100k, or 1/8,333) |
|
|
Term
| Are abdominal aorta aneurysms common in the US? Is rupture likely? |
|
Definition
fairly common: 0.5-3.2%
not very (4.4/100k, or 1/25k) |
|
|
Term
| What gender and race is most likely to get abdominal aortic aneurysms? |
|
Definition
white males
(white males 3.5 X more common than African American males) |
|
|
Term
|
Definition
| An aneurysm that resembles a small sack protruding from the wall of the vessel. A berry aneurysm is typically saccular. |
|
|
Term
|
Definition
| A widening of the vessel shaped like a spindle. (as opposed to saccular, which is a sac-like outpouching extending from the vessel wall) |
|
|
Term
| What sign of abdominal aortic aneurysm might one discover on physical exam? |
|
Definition
| one can feel a pulsatile mass by palpation or compression of the abdomen wall. |
|
|
Term
| What is the prognosis of ruptured abdominal aortic aneurysm? |
|
Definition
| very poor; more often than not it is fatal |
|
|
Term
| Why do berry aneurysms occur at branch points? |
|
Definition
| bifurcation of vessels leads to a concentration of high pressure focally on vessel wall |
|
|
Term
| What congenital defect of vessel walls is more likely in people with berry aneurysms? |
|
Definition
| decreased arterial elastin |
|
|
Term
| What change in the blood vessel wall contributes to abdominal aortic aneurysm? |
|
Definition
| atherosclerosis leads to degradation of elastin and collagen in the aortic wall |
|
|
Term
| How could an unruptured aneurysm lead to tissue hypoxia? |
|
Definition
| staisis in the bulging section of an aortic aneurysm, could throw a clot |
|
|
Term
| clinical signs of unruptured berry anuerysm. |
|
Definition
Most commonly asymptomatic
Pulsatile headache |
|
|
Term
| Clinical presentation of unruptured abdominal aortic aneurysm. |
|
Definition
Most commonly asymptomatic
may be able to palpate a pulsatile abdominal mass |
|
|
Term
| Clinical presentation of ruptured berry aneurysm. |
|
Definition
| Present as a stroke and increased intracranial pressure. |
|
|
Term
| Clinical presentation of ruptured abdominal aortic aneurysm. |
|
Definition
| Dramatic drop in blood pressure (hypotension), shock, rapid heart rate, pale, and lightheadedness. |
|
|
Term
| How would a berry aneurysm appear radiographically? |
|
Definition
can pick up in head CT, MRI, and arteriograph (before or after rupture).
Appearance varies depending on the type, but BA usually saccular (looks like a blueberry or cranberry) |
|
|
Term
| macroscopic appearance of a berry aneurysm |
|
Definition
| Appearance varies depending on the type, but BA usually saccular (looks like a blueberry or cranberry); occurs at a branch point in the circle of Willis |
|
|
Term
| Microscopic appearance of a biopsy of a berry aneurysm |
|
Definition
| Decreased elastin; chronic inflammation with hemosiderin-laden phagocytes. |
|
|
Term
| How does an abdominal aortic aneurysm appear in radiology? |
|
Definition
Dilated aorta (usually below renal arteries)
can pick up in abdominal ultrasound, CT, MRI, and arteriograph (before or after rupture). |
|
|
Term
| Macroscopic appearance of an abdominal aortic aneurysm. |
|
Definition
| Dilated aorta (usually below renal arteries) |
|
|
Term
| Microscopic appearance of a biopsy of an abdominal aortic aneurysm. |
|
Definition
| Atherosclerotic changes; chronic inflammation and neovascularity of vessel wall. |
|
|
Term
| How is an unruptured berry aneurysm usually diagnosed? |
|
Definition
| usually detected on radiographic studies for headaches |
|
|
Term
| How is a ruptured berry aneurysm usually diagnosed? |
|
Definition
| Symptoms of subarachnoid hemorrhage, and imaging studies demonstrate subarachnoid bleeding. |
|
|
Term
| How is an unruptured abdominal aortic aneurysm usually diagnosed? |
|
Definition
| 38% detected by physical examination; 62% detected incidentally on radiologic studies obtained for other reasons. |
|
|
Term
| How is an ruptured abdominal aortic aneurysm usually diagnosed? |
|
Definition
| Symptoms of shock; Need imaging study to detect peritoneal blood collection. |
|
|
Term
| A person has an abdominal aortic aneurysm when the abdominal aortic diameter is >_______ |
|
Definition
|
|
Term
| If you've been monitoring an abdominal aortic aneurysm over time, what finding is suggestive of impending rupture? |
|
Definition
| increase in size on serial imaging > 10 mm/year |
|
|
Term
|
Definition
| a localized, irreversible arterial dilatation due to destruction of the vessel wall by infection. |
|
|
Term
| Where do mycotic aneurysms usually occur? |
|
Definition
thoracic or suprarenal aorta (that is, in the abdomen above the renal arteries)
mycotic aneurysm--a localized, irreversible arterial dilatation due to destruction of the vessel wall by infection. |
|
|
Term
| How do you treat an unruptured berry aneurysm? |
|
Definition
Surgery can be used to prevent rupture (ex., by placing a surgical clip at the base), but is associated with high operative morbidity and mortality rates (Intraoperative aneurysmal rupture has morbidity and mortality rate of 30-35%).
so don't treat unless it looks like rupture is imminent |
|
|
Term
| How do treat a ruptured berry aneurysm? |
|
Definition
| Mostly medical supportive care; maybe surgical to release increased intracranial pressure. |
|
|
Term
| How do you treat unruptured abdominal aortic aneurysm? |
|
Definition
Requires surgery to repair AAA (ex., replace the aneurysm with a graft of manmade material or by inserting a stent graft of metal-reinforced cloth that will cover all of the aneurysm and block it off from the pressure of the flowing blood, allowing the aneurysm to shrink back to normal size).
surgery carries significant risk of morbidity and mortality, so this is not done for small aneurysms that aren't increasing in size |
|
|
Term
| How do you treat a ruptured abdominal aortic aneurysm? |
|
Definition
stabilize with fluids and blood transfusions
emergency surgery to repair rupture |
|
|
