4th Year Valvular Heart Disease Flashcards
grading of murmurs?
1-6
grade 1 murmur
slightest possible murmur, frequently overlooked
grade 2 murmur
slight murmur
should not be missed
grade 3 murmur
moderate murmur
no palpable thrill
grade 4 murmur
loud murmur with palpable thrill
grade 5 murmur
very loud murmur with easily palpable thrill
grade 6 murmur
extremely loud murmur, can be heard with the stethoscope not even on the chest wall
presentation of aortic stenosis
low volume pulse
forceful displaced apex
ejection systolic murmur radiating to carotids (crescendo decrescendo), slow rising pulse
classic triad in aortic stenosis?
angina
syncope
heart failure
murmur in aortic stenosis
ejection systolic murmur radiating to the carotids (crescendo decrescendo)
what is aortic sclerosis
senile degeneration of the valve
management of aortic stenosis
diuretics
nitrates
beta blockers
replacement
features of aortic regurgitation
collasping pulse
wide pulse pressure
early diastolic murmur left sternal edge
what signs are associated with aortic regurgitation?
Corrigan’s sign (carotid pulsation)
Qunicke’s sign (capillary pulsations in nailbed)
Traube’s sign (pistol shots over femoral arteries)
de Musset’s sign (head nodding in time with pulse)
management of aortic regurgitation
symptoms (nifedipine/ACEI) and surgery
murmur in aortic regurgitation
early diastolic murmur left sternal edge
features of mitral stenosis
AF malar flush tapping undisplaced apex beat mid-diastolic murmur localised to apex heard best on left
murmur in mitral stenosis
mid-diastolic rumbling localised to apex (heard best when patient on their left side)
JVP waves in mitral stenosis
prominent a waves and raised JVP
management of mitral stenosis
mitral valvotomy or replacement
features of mitral regurgitation
pansystolic murmur radiating to axilla jerky pulse displaced apex 3rd heart sound pulmonary oedema
murmur in mitral regurgitation
pansystolic murmur radiating to the axilla
murmur in tricuspid regurgitation
pansystolic murmur at lower sternal edge in inspiration
presentation of tricuspid regurgitaiton
venous congestion
reduced CO
murmur
increased JVP with prominent v waves
murmur in tricuspid stenosis
diastolic murmur at left sternal edge in inspiration
murmur in pulmonary regurgitation
pulmonary hypertension with decrescendo murmur in early diastole at left sternal edge
what is pulmonary stenosis associated with?
carcinoid syndrome
features of pulmonary stenosis
a wave 4th heart sound left parasternal heave thrill ejection systolic murmur in LUSE
management of pulmonary stenosis
balloon valvuloplasty
grades of severity of pulmonary stenosis
MILD= <50mmHg MODERATE= 50-80mmHg SEVERE= >80mmHg
what causes mitral valve prolapse?
myxomatous degeneration
what is mitral valve prolapse associated with?
females
rheumatic heart disease
IHD
presentation of mitral valve prolapse
mid-late systolic click
high pitched late-systolic murmur
management of mitral valve prolapse
symptoms
repair or replace
risks MR and IE
