141 Valvular Heart Disease

Question 1

Mitral stenosis

Answer 1

Etiology: Rheumatic (some congetial)

**Bicuspid**

Pathophysiologic mechanisms:

• Pulmonary venous congestion
• Pulmonary arterial hypertension
• Right ventricular dysfunction
• Systemic venous congestion
• • Low cardiac output
• • Atrial fibrillation–> systemic embolization
  
  • This population at increased risk of embolization because of turbulent blood flow

Physical findings:

• Normal to decreased LV impulse
• Increased RV impulse
• Loud S1
• Opening snap
• Diastolic rumble with presystolic
• accentuation
• Signs of pulmonary hypertension

Tx:

• Balloon to open/crack the mitral vaulve

Question 2

Extra Heart Sounds

Answer 2

Question 3

Mitral Stenosis Heart Sounds

Answer 3

low pitched, best heard with patient lying on left side

opening snap occurs earlier and closer to second heart sound as the murmur gets worse

Question 4

Aortic Stenosis