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1.Most common cause of valvular dz?
2. Valves most often effected?
- 1. Rheumatic fever - group A hemolytic streptococci.
- 2. Mitral 1st and Aortic 2nd.
When is 4th heart sound heard?
1. during atrial contraction
1. Aortic Stenosis cause what type of murmur?
2. What kind of overload does it cause?
3. What type of hypertrophy does it cause?
- 1. Systolic ejection murmur that may radiate into neck.
- 2. Pressure overload
- 3. concentric hypertrophy
1. Sarcomeres added in parallel = what kind of hypertrophy?
2. sarcomeres added in series =?
- 1. concentric
- 2. eccentric
1. Normal Aortic valve area?
2. Transvalvular pressure > than ____ is indicative of AS.
- 1.) 2.5-3.5 cm2.
- 2. >50 mmHg or Aortic area < 1cm2.
1. When is AR/AI heard?
2. where is the best place to hear, sound, timing?
3. which is worse short murmur or prolonged murmur?
4. what kind of overload is AR and what kind of hypertrophy?
5. What does it do to edocardium and subendocardial flow?
- 1. diastole
- 2. maximally heard over LV, High pitch Blowing/swish, diastole
- 3. short is worse
- 4. Volume overload causing eccentric hypertrophy
- 5. Decreases d/t increased LV pressure.
1. In summary, AS causes what to blood flow?
2. In summary, AR causes what to blood flow?
3. Net result for both?
- 1. Aortic ejection is empeded
- 2. Regurgitation back into LV during diastole
- 3. Decrease in stoke volume, thus Decrease CO.
1. MR sounds like? and at what part of the cardiac cycle?
2. Where can you best hear the murmur?
3. What arrhythmia can MR cause?
4. What kind of lesion is MR?
- 1. High pitched blowing during systole
- 2. LV apex
- 3. Atrial fib.
- 4. volume overload
1. MS - When is it best heard?
2. MS - what does it sound like?
3. What word is used to describe the cadence?
4. What affect does MS have on Pulm and hrt.
5. How does MS affect LV?
6. What kind of lesion?
- 1. last third of diastole
- 2. Thrill over apex
- 3. kentuky
- 4. increase LA pressure, Pulm edema, RV failure.
- 5. LV is normal with less effect on MAP and CO.
- 6. Pressure overload
1. Normal MV area? and when do symptoms occur?
1. 4-6 cm2 . < 50% reduction
1. What congenital lesions cause LEFT to right shunting?
2. What congenital lesions cause RIGHT to left?
- 1. ASD, VSD, and PDA
- 2. Tetralogy of Fallot
1. ASD - What is the cause?
2. T/F - 1/3 of the population do not have fibrotic closer but high LA pressure keeps FO closed.
3. What type of murmur heard and location?
4. Clinical Presentation?
- 1. d/t patent foramen ovale
- 2. T
- 3. Systolic murmur over Pulmonic valve area
- 4. ECG -rt axis deviation & RBBB, AF or SVT,
- CXR -> prominant Pulm arteries.
1. VSD - T/F most common congenital heart defect 25-35%.
2. What type of murmur?
3. If Pulm HTN developes?
4. ECG appearance if Pulm HTN present?
- 1. T
- 2. Holosystolic/loudest lft sternal boarder
- 3. May result is a switch to Rt to left d/t increase PVR over time.
- 4. Rt axis deviation d/t RA and RV enlargement.
1. PDA - Murmur
2. Heart remodel?
- 1. Machinery murmur that waxes and wanes. louder during systole
- 2. LV hypertrophy d/t to net decrease in CO. thus hrt pumps 2x as hard.
1. TOF is a Lft to right or a right to left shunt
2. TOF presentation
3. ECG Deviation
- 1. Rt to lft.
- 2. Arterial hypoxemia -> "blue baby"
- 3. Axis deviation with LV hypertrophy