6.1 MTB Step 3 - Valvular Heart Disease (Murmurs) Flashcards
GENERAL INFORMATION
What does ALL Valvular Heart Disease present with as the Chief Complaint?
Shortness of Breath (SOB), worse with Exertion/Exercise.
GENERAL INFORMATION
What are (5) Disorders/Causes that will be in the patient’s History but, with the exception of one, are probably too nonspecific to give the diagnosis of VHD?
- Hypertension (HTN)
- Myocardial Infarction (MI)
- Ischemia
- Increasing Age
- Rheumatic Fever - unlike the other conditions, this diagnosis with make the co-diagnosis of VHD clear
GENERAL INFORMATION
Young patients with Valvular Heart Disease will have one of which (4) Types?
-
Mitral Valve Prolapse (MVP)
- Young female, general population.
- Palpitations, Atypical Chest Pain not with exertion.
-
Hypertrophic Obstructive Cardiomyopathy (HOCM)
- Health young athlete.
-
Mitral Stenosis
- Immigrant or Pregnant = think Rheumatic Heart Disease.
-
Bicuspid Aortic Valve
- Turner Syndrome, Coarctation of Aorta.
PHYSICAL FINDINGS
- ALL Valvular Heart Disease can be EXPECTED to have which (2) Findings on Physical Exam?
- What are (3) POSSIBLE Findings on Physical Exam in ALL Valvular Heart Disease?
EXPECTED Findings on PE:
- Murmurs
- Rales
POSSIBLE Findings on PE:
- Peripheral Edema
- Carotid Pulse findings
- Gallops
MURMURS
What are (4) Systolic Murmurs related to Valvular Heart Diseases?
- Mitral Regurgitation
- Aortic Stenosis
- Mitral Valve Prolapse (MVP)
- Hypertrophic Obstructive Cardiomyopathy (HOCM)
MURMURS
What are (2) Diastolic Murmurs related to Valvular Heart Diseases?
- Mitral Stenosis
- Aortic Regurgitation
MURMURS
All Right-sided Murmurs INCREASE in Intensity with what?
Inhalation
Both Stenosis and Regurgitation of Tricuspid valve
MURMURS
All Left-sided Murmurs INCREASE in Intensity with what?
Exhalation
Mitral and Aortic valve lesions
VALSALVA, STANDING, SQUATTING, LEG RAISE
Which (2) Maneuvers INCREASE Venous Return to the Heart?
- Squatting
- Leg Raise
VALSALVA, STANDING, SQUATTING, LEG RAISE
Which (2) Maneuvers DECREASE Venous Return to the Heart?
- Valsalva = increases intrathoracic pressure
- Standing
VALSALVA, STANDING, SQUATTING, LEG RAISE
Which Murmurs INCREASE in Intensity (get Louder) with Squatting and Leg Raise?
- Aortic Stenosis (AS)
- Aortic Regurgitation (AR)
- Mitral Stenosis (MS)
- Mitral Regurgitation (MR)
- All Right-sided lesions
VALSALVA, STANDING, SQUATTING, LEG RAISE
Which Murmurs DECREASE in Intensity (get Quieter) with Squatting and Leg Raise?
- Mitral Valve Prolapse (MVP)
- Hypertrophic Obstructive Cardiomyopathy (HOCM)
VALSALVA, STANDING, SQUATTING, LEG RAISE
Which Murmurs INCREASE in Intensity (get Louder) with Valsalva and Standing?
- Mitral Valve Prolapse (MVP)
- Hypertrophic Obstructive Cardiomyopathy (HOCM)
VALSALVA, STANDING, SQUATTING, LEG RAISE
Which Murmurs DECREASE in Intensity (get Quieter) with Valsalva and Standing?
- Aortic Stenosis (AS)
- Aortic Regurgitation (AR)
- Mitral Stenosis (MS)
- Mitral Regurgitation (MR)
- All Right-sided lesions
EFFECTS OF HANDGRIP AND AMYL NITRATE
- What is the Effect of Handgrip on Afterload?
- Which Murmurs INCREASE in Intensity with Handgrip?
- Increases Afterload by compressing the arteries of the arm by contracting the muscles of the arm.
- Aortic Regurgitation, & Mitral Regurgitation by pushing blood backward into the heart. VSD because more blood now goes from the LV into the RV.