6: Vulvular heart disease Flashcards
S1
Mitral and Tricuspid
Left side of the valves are more susceptible to disease
due to higher pressure
S2
Aortic and Pulmonary
S2 Splitting-
Physiological- during inspiration
Fixed- ASD or VSD (Higher: ASD, Lower: VSD)
Wide split- Pulmonary HTN, Right branch block
Reverse- Aortic stenosis, Systemic HTN
S3
Turbulence
S4
Blood hitting non-compliant ventricle wall
Aortic stenosis- info
Systolic murmur
Causes
1: congenital (Unicuspid/Bicuspid valve) (3-4th)
2: Rheumatic fever (valves fuse together) (4-5th)
3: calcification (7-8th decade)
Concentric hypertrophy on LV-> LV failure
Aortic stenosis- sx
1: angina (1: increased demand, decreased supply to coronary arteries. 2: Mechanical compression of coronary arteries by hypertrophied LV. 3: Calcium embolus. 4: Pre-existing coronary artery disease)
2: syncope at exertion (since CO cannot go up to meet the demand of exertion)
3: Dyspnea (Left heart failure)
AS- exams
Apical impulse- shifted, and strong*
Weak delayed peripheral pulse* (Pulsus parvus tardus)
Soft single S2-> paradoxical split (reverse)
S4
AS- murmur
L: Left 2nd ICS I: 1--6 P: medium pitch Q: Harsh R: radiate to neck S: crescendo- decrescendo T: btw S1- S2 There is ejection click (calcification) [right before the murmur] Murmur louder on expiration (Exception: hypertrophic cardiomyopathy, Mitral collapses) (Squating increase blood on both sides, Valsalva decrease blood on both sides)
AS- severity
1: Pressure gradient across valve >70
2: Orifice <0.8cm2
3: paradoxical split
4: the murmur moves late/ closer to the S2
AS- complication
Left heart failure (CHF)
V-fib
AS- dx
Eco-cardiogram (exam of choice)
EKG (show LV hypertrophy; left axis deviation [V5, V6: Tall R. V1, V2: Deep S. the SUM of tall R and deep S should be more than 35 boxes])*
AS- tx
Valvular replacement (best results out of all 4 valve disease) Balloon aortic valvuloplasty Ross's operation (give pulmonary valve to aorta and give prostatic to pulmonary since pts own valve lasts longer)
Mitral stenosis- info
Diastolic murmur
Pressure buildup in left atrium-> hypertrophy of LA
Pulmonary HTN-> hemoptysis*
RVF* (whereas AS leads to LVF)
MS- causes
Rheumatic fever- MCC* Congenital SLE Calcification Rheumatic arthritis
MS- sx
L atrium hypertrophy compress local structures-> Ortner’s syndrome (hoarseness of voice)*
Dysphasia
A-fib-> mural thrombus-> cerebral embolus*
sx of RVF (JVD, Liver cirrhosis, hemoptysis)
Central cyanosis
S1- delayed and loud*
Palpitations- A-fib
MS- murmur
L: 5th ICS mid clavicular I: 1-6 P: low pitch Q: Rumble R: no radiation S: decrescendo T: diastolic
PSA; Pre-systolic accentuation (atrial contraction)
MS- severity
Smaller the gap btw S2 and murmur, more severe it is.
Orifice: <1cm: severe
MS- Right heart regurge**
1: Tricuspid regurge (louder in inspiration): Corvello’s sign
2: pulmonary valve regurge (blowing decrescendo murmur): Graham Steel sign
MS- exam
EKG-
- A-fib
- Bi-fib p wave (delay of LA p wave on LEAD II. on LEAD V1: RA is positive and LA is negative peaks on p wave)
MS- tx
Correction is better than replacement on surgery-> thus repair the existing M valve first*
MR- cause
any of 5 things can be damaged Annulus Leaflet Chorda tendenie Papillary muscle Myocardium
MVP- cause
Myxomatous degeneration; type 3 collagen degenerates-> posterior leaflet is more affected (posterior valve is supplied by single artery; R coronary)
MR- heart sound
S3
S1- gets barried in murmur (No lov for MR)
Wide split of S2
MR- murmur
L: Mitral area I: 1-6 P: high pitch Q: blowing R: axilla S: platau T: systolic
MVP- murmur
1- multiple click
similar to AS murmur
Crescendo-Decrescendo
Gets louder on valsalva, quieter on squating (to Ddx with AS)
MR- exam
Eco-cardiogram
MR- tx
symptomatic
Mvalve repair
Aortic regurgitation- info
Eccentric hypertrophy by volume overload (much more than MR)
Extreme shift of apical impulse
Pulmonary HTN
AR- sx
Pulse pressure: wide
Systole is very high, Diastole is very low
1: Corrigan pulse: strong pulse that rapidly collapses like water hammer
2: de Musset sign: each heart beat, pts head bob
3: Quinckie’s sign: Capillary pulsations when light is transmitted through the pts fingertip
4: Traube sign: pistol shot on femoral artery with stetho
AR- cause
Takayasu
Syphyllus
Ankylosing spondilitis
AR- murmur
L I: 1-6 P: high pitch Q: blowing or musical R: no S: decrescendo T: diastolic
Austin Flint murmur: the regurg blood hits anterior leaflet of Mitral valves
Hand-grip exercise**
1: increase systemic resistance
2: increased left ventricular filling
Murmurs
AR: louder
AS: quieter
MR/ MS: louder
MVP/hypertrophic cardiomyopathy: quieter
Mitral regurgitation- info
During systolie, blood regurge back into LA
1: Acute; Pressure build up in LA-> RVF (IE, RF, MI)
2: Chronic; blood all comes back into LV (S3)-> volume overload-> eccentric hypertrophy of LV (Myxomatous degeneration-> mitral valve prolapse, Calcification, RF)