29. Mitral and Tricuspid Valve Disease Flashcards
Describe a pulmonic regurgitation murmur.
an early S2 murmur that decrescendos, heard along the upper left sternal border
How is mitral stenosis treated?
- beta blockers to slow HR 2. diuretics for CHF 3. anticoagulants if A-fib 4. valve replacement 5. percutaneous balloon
How do you treat mitral valve regurg?
- diuretics for CHF 2. ACE inhibitors or ARBs for afterload reduction 3. mitral valve repair or replacement surgery
What sound does mitral valve prolapse cause?
a nonejection click that is mid- to late-systolic and then a murmur of regurgitation
What are the diastolic murmurs?
- aortic regurgitation 2.
When is S3 abnormal? What does it indicate?
in older people; heart disease, like CHF
What are the s/s of mitral regurg?
CHF, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, edema
Where is an aortic regurgitation murmur heard?
along the L sternal border
Describe an aortic regurgitation murmur.
an early diastolic S2 murmur that decrescendos, heard along the L sternal border
How are S3 and S4 heard best?
at the apex in the L lateral decubitus position
What is a diastolic rumble?
a low freq decrescendo murmur due to turbulent flow across the stenotic mitral valve during diastole
What is aortic regurgitation?
blood comes backwards thru the aortic valve to the LV
What is S4?
a pressure overload condition heard due to atrial contraction into concentric hypertrophy of the ventricle; always pathological
What is the most common cause of mitral stenosis?
Rheumatic HD
How is tricuspid stenosis treated?
- diuretics 2. surgery
What is tricuspid stenosis?
a rare hardening of the tricuspid valve, usually from Rheumatic heart disease
____% of mitral stenosis cases are rheumatic.
80
When do symptoms of valve dysfunction post-Rheumatic fever present?
10-30 years later
What are the echo findings of mitral stenosis?
- LA enlargement 2. restricted opening of MV during diastole 3. thickened MV leaflets
What is mitral valve prolapse?
valve flaps pushed the wrong direction until they’re caught by the chordae tendinae
______ leads to chronic rheumatic heart disease.
Inflammation of the vascular endocardium
What is JVD with visable systolic V wave, hepatomegaly, and a holosystolic murmur along the sternal border that increases intensity with inspiration indicative of?***
tricuspid regurg
______ leads to increased pressure w/I the LA, pulmonary vasculature, and R heart.
Mitral valve stenosis
How does tricuspid stenosis sound?
an opening snap followed by a mid-diastolic rumble
What causes the loud S1 in mitral stenosis?
forceful closing of the mitral valve
How is the severity of mitral stenosis determined?
use echo to measure or visualize
Mitral valve stenosis leads to ______.
increased pressure w/I the LA, pulmonary vasculature, and R heart.
What causes an opening snap?
stiff mitral valve flaps shooting open during rapid filling phase
What part of the mitral valve is abnormal to cause MV regurg?
any part (annulus, leaflets, chordae, pap muscles)
What are the buzzwords for tricuspid regurg?
JVD with visable systolic V wave, hepatomegaly, holosystolic murmur along the sternal border that increases intensity with inspiration
Elevated RA pressure leads to _____.
increased venous pressure
Where would a tricuspid stenosis murmur be heard?
near the sternum and it would intensify with inspiration
What is mitral stenosis?
stiffening of the mitral valve that doesn’t allow blood through well
When would you treat mitral valve stenosis?
- when the pt is symptomatic 2. if the pt has pulm HTN 3. if the pt has A-fib
What can cause tricuspid regurg?
- a congenital structure abnormality 2. endocarditis 3. heart disease 4. Rheumatic fever 5. radiation 6. drugs
What does a midsystolic click followed by a late systolic murmur indicate?
mitral valve prolapse
What is acute rheumatic fever?
an inflammatory condition involving the heart, skin, and/or CT 2a to a group A strep infection
What can damage the mitral valve and therefore cause MV regurg?
- myxomatous degeneration 2. ischemic heart disease 3. endocarditis 4. Rheumatic heart disease 5. LV enlargement (stretches out MV)
How does a mitral stenosis murmur sound?
a diastolic murmur starting right after at S2 with an opening snap and then decrescendo with a pre-systolic accentuation
When is S3 normal?
in young people
The ____ valve opens in diastole, allowing blood to flow from the LA to the LV.
mitral
What are the EKG findings of mitral stenosis?
- LA enlargement 2. RVH if pulm HTN has developed 3. possible A-fib
- LA enlargement 2. RVH if pulm HTN has developed 3. possible A-fib
EKG findings of mitral stenosis
What is tricuspid regurg?
tricuspid valve doesn’t close completely during systole, allowing blood to flow backwards into the RA
What is a loud S1 with an opening snap and a diastolic rumble indicative of?***
mitral stenosis
- LA enlargement 2. restricted opening of MV during diastole 3. thickened MV leaflets
echo findings for mitral stenosis
When is the opening snap heard?
after S2
Name 6 s/s of mitral stenosis.
- dyspnea 2. hemoptysis 3. pulmonary HTN 4. R sided heart failure 5. A-fib 6. thromboembolism
How is a mitral stenosis murmur described?
an opening snap followed by a mid-diastolic rumble
Name the 4 parts of the mitral valve.
- Annulus 2. Leaflets 3. Chordae 4. Papillary muscles
What is S3?
a volume overload condition heard in early diastole during the rapid filling phase caused by tensing of chordae tendinae; can be normal in young people
What is another name for S3?
a ventricular gallop
What is another name for S4?
an atrial gallop
Describe the murmur in mitral valve prolapse.
a mid-systolic click with a late-systolic murmur (btw S1 and S2)
How is tricuspid regurg treated?
- treat the underlying cause, if possible 2. diuretics 3. tricuspid repair/replacement surgery
What does a holosystoic murmur at the apex with radiation to the axilla indicate?
mitral valve regurg
The mitral valve opens in _____, allowing blood to flow from the LA to the LV.
diastole
What causes the opening snap in mitral stenosis?
opening of the stenotic mitral leaflets
What is mitral regurg?
inadequate mitral valve closure, so blood is allowed to flow backward from the LV to the LA
Inflammation of the vascular endocardium leads to _____.
chronic rheumatic heart disease
