Learning issues unit 3 - Shandra

Tricuspid stenosis

A diastolic murmur - very rare! Accompanies mitral or aortic disease.

90% of the cases are rheumatic

Echo is diagnostic

What can cause incomplete emptying of ventricles

Aortic stenosis, DCM, HOCM, chronic HTN, cardiac temponade

Pulmonic stenosis

Asystolic murmur that can occur from congenital but also acquired like rheumatic heart disease (rare)

Usually asymptomatic, can have SOB from exertion and fatigue

Will hear splitting of S2 that I can radiate to back and a right ventricular heave

Atrial tachycardia

A form of SVT but uncommon - burst of regular tachycardia from atrial impulse generates outside Normal sinus node

Palpitations can have a sudden onset

Etiology of myocarditis

Inflammation of heart due to viral ( coxsackie, adenovirus, enterovious HIV) or parasitic infection ( chagas). Can be autoimmune, but rare

Diagnostics: EKG changes - st elevation. LABS: troponin elevation

Tx:If EF is reduced BB ACEI or statins

Endocarditis signs /symptoms

From Jane:

Fever, Roth spots, osler nodes, murmur, janeway lesions, anemia, nail bed hemorrhages, emboli

Endocarditis diagnostics and tx

Diagnostics: blood culture ( most common agent is S. Aureus), Oran echo to see vegetation

TX: Vancomycin and gentamicin

Echocaralogram

Sends high frequency sound waves into heart and echo back to form moving picture

Transthoracic is the MC to evaluate heart size, shape movement, and chambers

Why is S2 sounds heard more w/inspiration

Inspiration brings more blood return to RV so it ejects longer and the pulmonic valve then closes later than the aorta

Why are S3 and S4 heard?

S3- blood from LA collides W/ blood in overfilled ventricle: common in HF

S4-

When blood tries to enter a stiff LV: common in LVH or chronic HTN

What can an increased QRS complex indicate.

LVH, RVH, hypertrophic cardiomyopathy

How do you identify atrial enlargement from an EKG?

Look at the p-wave

Right atrial enlargement will have an overall tall p-wave

Left atrial enlargement Will a notched p-wave

Rheumatic heart disease effect on heart

• Causes inflammation of heart valves and myocardium. Myocardium can heal itself, but the valves remain damaged.

• B-Cells make antibodies against M proteins and Group A carbohydrates

• These antibodies cross react with the heart proteins that structurally look similar

When should a follow up occur for an MVP?

Echocardiogram should be done Q6 months if there is regurgitation

Asymptomatic non severe will have 1-2 year check up.

Sequellae of rheumatic heart disease if untreated

In 2-3 decades valvular stenosis or regard can occur. mitral valve is the most common.

Aschoff nodules - inflammatory lesions found on heart

Maccallum plaques - thickened, rough, wrinkled, subendocardial fibrosis

What can cause SVT ??

• AV nodal reentry tachy: reentry of AV node; pre-mature signal sent out quickly after AV node fires

• Functional tachy: increased sympathetic tone ↑ HR

• AV reciprocating tachy: additional accessory pathway that speeds up electrical activity

Evaluation of murmurs

Timing: S1 / S2

Duration:early, midsystolic, nolosystolic, crescendo, crescendo-decresendo

Grade: 1-6

Does the sound radiate?

Extra sounds, clicks, snaps _splitting

Movement changes: can it make the sound increase /decrease

TTE To visualize the valves

POTS

When BP / HR increase upon standing and subsides with sitting

More common in women; this is largely due to menstruation but also puberty, pregnancy, postpartum along with viral illnesses.

Pathophysiology: venous pooling, hypovolemia, ↑ sympathetic innervation

POTS tx

Water and salt to increase fluid volume ( one issue is hypovolemia)

Postural and psychophysiologic training

What is ASO titer looking at?

Streptomycin O, a toxin formed by group A streptococcus

ASO taters usually stay elevated for 6 months to a year

Why hold NSAIDs for rheumatic heart disease?

If the disease is from rheumatic heart dz, kidney function already bad

Can reduce renal blood flow causing more damage

Can ↑ BP