Notes in 01.A Valvular Heart Disease

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Status	Last Update	Fields
Published	06/26/2023	93fd2c87d0ee437198a92cd7eb17293a-oa-1
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Published	06/26/2023	Severity of Murmur (rarely / often)  {{c1::rarely}} correlates with the severety of valve lesion. Stenosis in the {{c1::av valves}} produces…
Published	06/26/2023	Murmurs: A murmur is caused by {{c1::Turbulent blood flow in the heart}}{{c1::Pathologic murmu}}r occurs when blood flows through a valve wh…
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Published	06/26/2023	Physiologic Maneuvers:Increased Venous returns:{{c2::Supine}} position{{c2::Squatting}}Leg {{c2::elevation}}Increases all murmurs except for {{c1::hyp…
Published	06/26/2023	{{c1::Aortic Stenosis}}:Most common valve lesionMost cases caused by degeneration of {{c1::normal aortic valves}}Causes aside from aging:{{c2::Rheumat…
Published	06/26/2023	Aortic Stenosis:Known risk fx- {{c1::HTN, DM, HLD, Smoking}}Rheumatic Valve disease: progressive {{c1::fibrosis}} occurs with {{c1::fusion of the valv…
Published	06/26/2023	Aortic Stenosis:There is a long period of time where patients with mild to moderate stenosis are asxOnce the degree of stenosis becomes severe, progno…
Published	06/26/2023	Aortic Stenosis:Sx include Progressive {{c1::Dyspnea}} on exertion, angina, dizziness, syncope, presyncopeOther non specific Sx may be due to AS as we…
Published	06/26/2023	Aortic Stenosis: MurmurClassically described as a {{c1::systolic Crescendo - decrescendo}} murmur heard best at the {{c2::right sternal borde}}r …
Published	06/26/2023	Aortic Stenosis: {{c1::Tee}} indicated in pts with S/Sx of AS or a bicuspid aortic valve for accurate dx of the cause of AS, hemodynamic severity…
Published	06/26/2023	Aortic Stenosis: Therapy:No medical therapy is helpful{{c1::AVR}} is recommended for pts with severe AS, or moderate to severe AS with EF <{{c1::50…
Published	06/26/2023	Aortic {{c1::Regurgitation}}:Less common than aortic stenosisCauses: {{c2::Dilation}} of the aortic root{{c2::marfans}}A{{c2::ortic valve di…
Published	06/26/2023	Aortic Regurg: Chronic:In Chronic Regurgitation, the increase backflow into the {{c1::LV}} causes increased {{c1::LV EDV}}, Eventual {{c1::LV dilation…
Published	06/26/2023	Aortic Regurgitation: In acute aortic regurgiation - the LV has not yet allowed to {{c1::remodel to accomodate}} the increase in {{c1::LV end dia…
Published	06/26/2023	Aortic Regurg PE:Murmur is {{c1::diastolic}}, {{c2::high pitched}} "blowing" murmur at the {{c2::left sternal}} boderPts often present widened pu…
Published	06/26/2023	Eponymous PE findings with aortic Regurgitation:{{c1::Corrigan's pulse}}- Rapid rise and fall of carotid pulse{{c1::Traube's}} sign- pistol shot sound…
Published	06/26/2023	Aortic Regurgitation: Other testing:CXR may be normal, though evidence suggestive of a cause may be present such as {{c1::widened mediastinum}} i…
Published	06/26/2023	Aortic Regurg: AAC/AHA staging:Stage A- {{c1::at  risk}}Stage b- progressieStage c- Asx {{c1::severe}}Stage d- Sx {{c1::severe}}
Published	06/26/2023	Aortic Regurg tx:Acute aortic regurg is a surgical emergency, and if this is expected, {{c1::STAT TTE}} is indiacted. In chronic: {{c1::aortic va…
Published	06/26/2023	Mitral Stenosis:Uncommon2/3 patients are {{c1::female}}Higher prevalence in {{c2::developing nations}}Onset usually occurs in the {{c1::third / f…
Published	06/26/2023	Mitral Stenosis: Progressive Degrees of stenosis, pts experiencing worsening {{c1::dyspnea, PND, Orthopnea}} x3Chronically elevated left atrial p…
Published	06/26/2023	Mitral Stenosis PE: Loud {{c1::S1}}- forceful closure of {{c3::mitral valve}}An {{c1::opening snap}} after S2 as the valve is forced open by…
Published	06/26/2023	Mitral Stenosis Tx:Medical therapy not helpful in slowing disease progressionIn the 2014, the recommended first line tx for severe (stage D) patients …
Published	06/26/2023	{{c1::Mitral Regur}}g: Second most common valvular lesion, behind aortic stenosisOften identifiable on {{c1::TEE color dopler }}
Published	06/26/2023	Mitral Regurgitation: Classification / causes:Primary- Something is wrong with the vavle or valve apparatus itself{{c1::Mitral valve prolapse}}- from …
Published	06/26/2023	Mitral regurg:{{c1::Mitral valve prolapse}} deserves special mention as it is a common cause of mitral regurgitation - and it is easily testable!Leafl…
Published	06/26/2023	Mitral Regurg: On exam:the classic finding is a {{c2::midsystolic click f}}ollowed by a {{c1::late systolic murmur}} heard at the apexHaving the …
Published	06/26/2023	Mitral Regurgitation:In chronic MR- Persistent backflow into the {{c1::left atrium}} causes {{c1::left atrial dilation,}} subseqient {{c1::LV dilation…
Published	06/26/2023	Mitral Regurgitation:In acute mitral Regurgitation- most commonly mitral valve {{c1::endocarditiis}} or {{c1::ischemic}} mitral regurg- the left atriu…
Published	06/26/2023	Mitral Regurgitation: PEMurmur is described as {{c1::high}} pitch, {{c1::holosystolic}} murmur best heard at the {{c2::cardiac apex}} with r…
Published	06/26/2023	Mitral RegurgLike acute aortic regurg, acite mitral regurgitation is a {{c3::surgical emergency}}As a temporizing measure- {{c2::arterial vasodilator}…
Published	06/26/2023	Mitral Regurg: Tx:Standard medical therapy in pts with heart failurechronic- surgurey is recommended for stage D pts with EF < {{c1::30}}%, or stag…
Published	06/26/2023	Tricuspid StenosisMost common etiology is {{c1::rheumatic heart disease}}Other less common etiologies - {{c1::carcinoid }} syndrome, obdtructing …
Published	06/26/2023	Tricuspid Stenosis: Sx:Sx of {{c1::right heart disfunction}}, {{c1::Lower extremity edema, ascites, progressive SOB}}May present with {{c2::…
Published	06/26/2023	Tricuspid Stenosis:{{c1::Loop diuretics}} can be used to alleviate R sided volume overload{{c1::Tricuspid Valve surgery}} is recommeneded for:Patient …
Published	06/26/2023	Tricuspid Regurgitation:Trivial / mild degrees of TR are common findings on TTECauses can be divided into primary and secondaryPrimary:{{c1::Endocardi…
Published	06/26/2023	Tricuspid Regurgitation:Occurs in 1/20,000 infants{{c1::Apical displacement}} of the tricuspid valve leafletsCan present with {{c1::rhf}}, {{c1::cyano…
Published	06/26/2023	Tricuspid Regurgitation:Sx:Like tricuspid stenosis, pts can  present with sx of {{c2::right heart failure}}Signs:{{c1::S3}}Prominent {{c1::JVP}} …
Published	06/26/2023	Tricuspid Regurgitation:Stages A,B,C,D similar to previous - defined by specific {{c2::TTE criteria}}{{c1::diuretics}} can be used to allevieate r sid…
Published	06/26/2023	Pulmonic Stenosis:Essential a {{c1::congential Disease}}Associated with {{c1::right hear dysfunction}} and associated sxOn exam, pts have a {{c2::syst…
Published	06/26/2023	Pulmonic Regurgitation:Mild - modrerate degrees of pulmonic regurgitation are normal findings on {{c2::TTE}}Mostly congenital- may also be result&nbsp…
Published	06/26/2023	Recommended Antibiotic Prophylaxis for dental procedures:Pts with prior episodes of {{c1::infective endocarditis}}{{c1::Prosthetic cardiac}} valvesUnr…
Published	06/26/2023	Rheumatic Fever Secondary Prophylaxis:
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Published	06/26/2023	Prosthetic Valves:Two types availible- {{c1::mechanical}} and {{c1::biprosthetic }}{{c2::Tissue Valves}} degenerate quicker, but do not require a…
Published	06/26/2023	Prosthetic Valves: Anticoagulation:Required for all patinets with {{c1::mechanical valves}}Mechanical Mitral valve- inr {{c2::2.5-3.5}}Mechanical…
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