Patho: Valvular Diseases
Terms
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- When it comes to valvular disorders, what 2 valves are the most common? If the valve has a rheumatic or calcificative etiology in origin what are the most likely valve effected?
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Mitral and aortic
Rheumatic: mitral
Calcification: aortic - Which valvular disorder results in a loud S1 and a sound opening snap?
- Mitral stenosis.
- In mitral stenosis, what is the treatment of choice and what type of therapy do we need to to consider due to preponderance to atrial fib?
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Treatment of choice: valve replacement. Need to consider anticoagulant therapy due to atrial fib and tendency for clot to form.
Other treatments include commissurotomy or balloon mitral replacement. - What is the #1 etiology of mitral stenosis?
- Rheumatic fever.
- What is the classic mitral regurg murmur sound like?
- Holosystolic mumur that radiates into left axilla from lateral decubitus position. There also is a prominent S3.
- In nondental prophylaxis for a valvular disorder, what should be the treatment of choice?- or if allergic...
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Amp/gent; if allergic vanco
In dental proceding-
If NO allergy:
Amox: Adults 2 g, children 50 mg/kg orally one hour before procedure
If Allergic to PCN go: Clindamycin, Cephalexin or Cefadroxil, or AZ or Clarithromycin. - What is the 3 over 6 crescendo/decrescendo murmur that radiates up into patient's neck? What are the sympotms patients experience?
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Mitral stenosis
Symptoms: angina, syncope, dysnea (classic triad) along with faint pulses and fatigue, pulmonary congestion. - What is the etiology for aortic stenosis if the patient is "younger"- "older"?
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Younger- rheumatic fever
Older- calcification of valve - What is the only treatment option for aortic stenosis once the patient becomes symptomatic?
- Surgery
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If, when recording a patient's bp there is a dramatic difference between the diastolic and systolic pressure, what valvular disorder are you suspecting?
What is another name for this condition AND another major symptom? -
Aortic regurg./Austin-Flint murmur
Bounding pulse-"waterhammer" - A patient is seeing you for palpatations. When taking that history, might about that it might tip you off to a possible diagnosis being aortic regurg?
- A long history of palpations that the patient has just tolerated over the years.
- Which type of valvular replacement has an anticoagulant as a part of the therapy-mechanical or bioprosthetic? Which of the two valvular replacements is typically tried first?
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Mechanical generally needs anticoagulant therapy.
Bioprosthetic is typically tried first. - Which of the two valvular replacements, mechanical or bioprosthetic, has a high failure rate BUT a lower complication rate?
- Biosprosthetic= higher failure rate BUT lower complication rate. FYI: Tried first and does not typically take anticoagulants.