1. Two heart valves that cause trouble ARMS = Aortic Regurgitation or Mitral Stenosis
  2. Systolic Murmurs Mitral Regurg, Physiologic Murmur, Aortic Stenosis, MVP
    Mr., Peyton Manning, As, MVP
  3. Characterisitic of ACUTE mitral regurg Systolic murmur, usually occurs afer rupture of the chordae tendinaea, ruptrued papillary muscle after MI or secondary to bacterial endocarditis. S/S of failure APPEAR ABRUBTLY with deterioation
  4. Aortic Stenosis most common age 15-65, usually CONGENITAL, Rheumatic FEVER 2nd common cause, prolonged asymptomaticperiod (until 5th or 6th decade) than deterioration at onset of s/s
  5. most common cause of Aortic Stenosis in somebody younger than 65 CONGENITAL
  6. Aortic Valve listening area 2nd right interspace close to the sternum
  7. Aortic Stenosis Complications (ASC) angina (66%) syncope (usually exertional) CHF (dyspnea, usually rapid dodwnhill course at this point
  8. Aortic Stenosis heard loudest Upper sternal border R 2nd IC and carotids, apex, usually audible S4, narrow pulse pressure, CARDIOMEGALY OCCURS LATE, ekg usually normal
  9. Aortic Regurgitation etiology rheumatic heart disease, congenital deformity, aortic root abnormalities, syphillis
  10. Aortic Regurgitation course: prolonged asymptomatic perdiod even with exercise, then decreaased exercise tolerance (later stages), very late CHF
  11. S/S OF Aortic Regurg angina, CHF, dizziness, aware of heartbeat pounding , atypical chest pain (mechanical interaction b/w the heart and the chest wall)
  12. Aortic Regurgitation Physical exam very wide pulse pressure, arterial pulses are wide and quick, PMI displaced downward and left
  13. Define pulse pressure (and normal) Pulse pressure is the difference between the systolic and diastolic pressure readings, normal is 40 (120-80)
  14. Late findings of Aortic Regurgitation –VERY LARGE and dilated left ventricle with enlargement downward
    –ekg: left ventricular hypertrophy
  15. Etiology of mitral stenosis rheumatic heart disease
  16. S/S of Mitral Stenosis dyspnea (most common), A-fib, hemoptysis, right ventricular hypertrophy, LOUD S1, apical diastolicmurmur radiating toward the axilla, left atrium enlarged
  17. Mitral stenosis stage 1 asymptomatic (20 yrs), then gradual reduction in exercise tolerance
  18. Mitral Stenosis stage 2 onset of pulmonary congstion
  19. Mitral Stenosis stage 3 development of pulm HTN
  20. Mitral Stenosis stage 4 severe state of low cardiac output
  21. Mitral Stenosis average age of DEATH 48 years
  22. Mital stenosis listening point Mitral Area (Apical) 5th left interspace medial to the MCL
  23. Pulmonic Area 2nd left sternal border interspace.
  24. Tricuspid Area 5th left interspace close to the sternum.
  25. Those at risk for Mitral Valve Prolapse (MVP) common in women 14-30
  26. s/s of MVP asymptomatic, palpitations, PACs, PVCs w/evercise, PSVT, chest pain, dyspnea, dizziness, numbness
  27. MVP physical exam findings –first midsystolic click heard best at apex and LSB,
    –second (later), Late Systolic Click, heard better WITH STANDING, decreases with squatting.
  28. A patient with longstanding HTN has developed CHF, which class of HTN medication needs to be discontinued Calcium channal blockers (amlodipine)
  29. Most common manifestation of angioedema secondary to an ACE inhibitor use swollen face
  30. Side effect you might see with ACE or ARB HYPERkalemia
  31. Secondary benefit may see with HCTZ use? incresed serum calcium, helps osteoporosis
  32. What type of murumr is typical with a Physiologic murmur? Systolic
  33. A 50yr old man with HTN and DM has dyslipidemia. What is normally elevated on his lipid panal? triglycerides (normal <150) this can mean insulin resistance if see in conjuction with low HDL
  34. Most common s/e of 24yr Female dx with MVP experiences PACs
  35. A SYSTOLIC murmur best heart at the Apex is most likely. Mitral Regurgitation
  36. Symptomatic Aortic Regurgiation is heard best at Right sternal border, 2nd ICS, diastolic heart sounds loudes
  37. What would you expect to hear with Mitral Stenosis Diastolic sounds heard loudes at the apex
  38. a patient with poorly managed DM complains of lower leg pain when she walks. What is the most common DX and symptoms peripheral arterial disease with diminished haird growth on her legs



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