[3] Valvular Heart Disease in Adults Flashcards
Define: Stenosis
Narrowing of heart valve
Define: Regurgitation
Failure of heart valve to close
Normal MV Orifice
Significant Obstruction
N: 4-6cm^2
SO: <2cm^2
Smallest MV Orifice Compatible With Life
0.3cm^2
[Pathophysiology of MS]
Left Atrium and Pulmonary Artery Wedge Pressure
Increased
Prominent A waves and gradual Y descent
[Pathophysiology of MS]
Left Ventricular End Diastolic Pressure
Normal in MS
[Pathophysiology of MS]
Cardiac Output
May be normal but generally worsens progressively
[Symptoms and Complications]
Mitral Stenosis
- Exertional Dyspnea, Orthopnea, PND
- Acute Pulmonary Edema
- Atrial Arrythmias
4 Hemoptysis
[Physical Findings]
Inspection of Mitral Stenosis
- Malar flush with pinched and blue facies
- Prominent alpha waves in JVP in sinus rhythm
- Single c-v wave in AF
[Physical Findings]
Palpation of Mitral Stenosis
- Right ventricular tap with palpable S1
2. Diastolic Trill
[Physical Findings]
Auscultation of Mitral Stenosis
Describe:
S1
P2
Low-pitched, rumbling, diastolic murmur
Accentuated and Snapping S1
Accentuated P2 in pulmonary hypertension
Opening snap follows P2
[Laboratory Examination]
ECG of Mitral Stenosis
Left and Right Atrial Enlargement
Right Axis Deviation
Right Ventricular Enlargement
What is the most sensitive and specific non-invasive method for diagnosis of Mitral Stenosis?
Echocardiogram
Using cardiac catheterization should be applied in what age for Filipinos?
Males: > 55 yo
Females: > 60 yo
Mitral Regurgitation is commonly caused by?
Chronic RHD in 90% of Cases
Effect of MR on the LA and LV
Enlargement in both, the larger the LV gets, the worse the MR becomes
[Auscultation of Mitral Regurgitation]
Describe Murmur
Grade III/IV Holosystolic Murmur at Apex and Radiates to Axilla
[Auscultation of Mitral Regurgitation]
Describe S sounds
S1 Absent or Soft
S2 Widely Split
S3 Due to sudden tensing of papillary muscles
S4 Audible
What is the most sensitive and specific non-invasive method for diagnosis of Mitral Regurgitation?
Echocardiogram
Why do you give vasodilators to people with MR?
Lower the afterload
Define: Critical Aortic Stenosis
Peak systolic pressure gradient of 50mmHg
AV Area < 0.5 cm^2
[Aortic Stenosis]
CO at Rest
CO with Exercise
Normal
Subnormal Rise
Why do you not perform Percutaneous Balloon Aortic Valvuloplasty on the elderly?
Usually have calcifications and this might cause an embolism
Marfan’s Syndrome usually causes what valvular disease?
Aortic Regurgitation
[Auscultation of Aortic Regurgitation]
Describe Murmur
High-pitched, blowing, decrescendo diastolic murmur
How do you intensify Aortic Regurgitation murmurs? How does this happen?
Handgrip Maneuver
Increases the afterload, causing more regurgitation to occur
What would cause increase in the sound of a murmur in Tricuspid Stenosis?
Inspiration
Causes increased amounts of blood to flow into the heart, causing a larger sound
Do you replace the Tricuspid Valve?
No, because low blood flow would make it prone to infection and increased chances of thrombus infection
Why would Mitral Stenosis cause Hoarseness of Voice
Enlargement of LA can compress the Left Recurrent Laryngeal Nerve
Pulsus parvus et tardus is found in which Valvular Disease?
Aortic Stenosis
Bisferiens pulse is found in which Valvular Disease?
Aortic Stenosis
Murmur heard in Aortic Stenosis
Systolic Crescendo-Decrescendo Murmur
What is Demusset’s Sign
Jarring of entire body
Head bobbing with each systole
What is Corrigan’s Pulse
“Water Hammer Pulse”
Collapses as arterial pressure falls rapidly during late systole and diastole
What is Traube’s Sign
Pistol shot pulse heard over femoral artery
What is Quicke’s Pulse
Capillary pulsations when pressure is applied to the nail
What is Durozier’s Sign
To-and-fro murmur with femoral artery compression
Austin-Flint Murmurs are heard during which kind of Valvular Disease?
Mitral Regurgitation
Carvallo’s Sign is usually heard during what kind of Valvular Disease?
Tricuspid Regurgitation
What is Carvallo’s Sign?
Holosystolic murmurs intensified by inspiration
