#13 - Aortic stenosis, Aortic valve insufficiency/ Mitral Valve insufficiency (Brown) Flashcards
classic triad of symptoms for aortic valve stenosis
Exertional angina
exertional syncope
exertional dyspnea
NO FATIGUE
T/F At the time of presentation, patients with aortic valve stenosis can be monitored before intervening.
False. They deteriorate rapidly after presentation with symptoms, so you need to fix it with surgery ASAP.
Which valvulur disease would cause angina, dyspnea, and syncope with no fatigue?
aortic valve stenosis.
Case:
- low diastolic pressure
- wide pulse pressure
- long blowing murmur.
Diagnosis?
severe chronic mitral regurgitation / insufficiency
Case:
- long systolic murmur
- hyperkinetic apical impulse heard near left anterior axillary line
Diagnosis?
chronic mitral regurgitation
(aortic valve regurg has a hyperkinetic impulse, but the location isn’t changed - it would not be heard over the axillary line.
You see a patient. He has elevated JVP, which drops when he breathes in. What is the most likely diagnosis?
Pericardial effusion w/ tamponade
Case
- ascites
- leg edema
- increased JVP
- positive Kussmaul sign (JVP rises with inspiration)
Diagnosis?
Constrictive pericarditis.
Case.
- long systolic murmur
- normal diastolic pressure
- narrow pulse pressure
aortic stenosis
diastolic pressure stays normal, since filling isn’t affected.
Since the LV can’t push its fluid out normally (reduced either in volume or time), this will impact the systolic pressure, reducing the pulse pressure.
What kind of murmur is heard with aortic stenosis?
systolic murmur.
crescendo-decrescendo in nature
Physical exam findings for aortic stenosis.
- BP can be normal
- Pulse pressure often decreased (due to low systolic pressure.)
- weak carotid pulse with sustained upstroke (carotid massages your finger instead of tapping it) - due to increased time it takes to get fluid through the small hole.
- hyperkinetic apical thrust - enlarged and sustained but NOT displaced.
T/F - in aortic stenosis, the pressure gradient across the valve correlates with severity of symptoms.
True.
What happens to the Left ventricle in aortic stenosis?
It becomes hypertrophic but NOT dilated (since stenosis requires increased force but not increased storke volume. )
-it also becomes quite stiff
What labs do you do for aortic stenosis?
EKG,
CXR
Echocardiogram
What does EKG show with aortic stenosis?
LV hypertrophy.
CXR findings for aortic stenosis.
normal heart size.
- post-stenotic dilatation of the aorta may be seen.
- calcification of the aortic valve may be seen.
Echocardiogram findings for aortic stenosis.
- high pressure gradient across valve
- hypertrophy.