Cardiac Valve Dysfunction Flashcards
What are the different types of murmurs
- Crescendo decrescendo mumur, increaseing intensity which then decreases
- Pan or Holo murmur, constant intensity
- Decrescendo murmur, decreasing intensity
- Decrescendo crescendo murmur
What kind of valve defect is this and how does the intensity of the murmur compare over time
This is aortic stenosis since the maximum pressure in the aorta is less than the maximum systolic pressure of the left ventricle (and also becuase the valve opnes late).
This will be a crescendo decrescendo murmur as initially when the valve is opening up there is less blood flow across it and this blood flow increases, hence causing the sound of the murmur to increase and then it decreases as the blood flow decreases.
He said the mumur will depend on the pressure changes
What happens to the blood pressure in aortic valve stenosis and how can you listen to aortic valve stenosis on a stethoscope
Systolic pressure is reduced, diastolic pressure is increased and hence the pulse pressure will be reduced.
There is paradoxical splitting of the S2 during expiration which can be heard using a steth
How do you see aortic stenosis on EKG
Left axis deviation since there will be left ventricle hypertrophy to generate a high pressure.
Also the P zero curve will shift upwards since the EDV increases
Also there might be atrial hypertrophy since the left ventricle compliance decreases
Aortic valve insufficiency murmur
The aortic valve leaflets fail to close in this FYI
This murmur is heard the loudest when there is most flow of blood into the left ventricle which is during the beginning of diastole or when the valve just about closes. As the blood fills up left ventricle the mumur gets fainter and hence it is a decrescendo murmur which is heard on S2
How does pulse pressure changes with aortic insufficiency
The diastolic pressure is below normal whereas the systolic pressure is normal which causes the pulse pressure to be huge
Rate of runoff is increased (abnormal route is abnormal), SV also increases so the pulse pressure is increased
How does this look like on the graph
Preload is increased
How does the blood distribution differ in aortic valve regurgitation and what changes take place to the left ventricle
The amount of blood delivered to the organs, the effective stroke volume decreases.
Also the ventricle will be stretching more so it can lead to left ventricle hypertrophy which can cause atrial hypertrophy and lead to pulmonary edema
Mitral valve insufficiency murmur
Pan systolic murmur, the backflow of blood from the leaky mitral valve will cause a constant murmur.
Also the pressure increases in the left atrium and this can cause atrial hypertrophy
Mitral valve stenosis murmur
IMPORTANT: this is a diastolic murmur. It is important to know why - the blood flows through this valve in diastole when the ventricle is filling. It initially flows the most and then the flow decreases.
So this murmur is diastolic decrescendo crescendo murmur!, there is a crescendo at the end since the blood will flow again when the atria is contracting
Note that in the graph the first thing he labelled was that there is a pressure difference between the left atrium and the left ventricle, usually at that point in time they have the same pressure
How does the EKG look like for this
I is net negative, aVF is positive so there is right axis deviation indicating right ventricle hypertrophy
What is the most common symptoms of mitral valve stenosis
Pulmonary edema since the atrial pressure is high throughout the entire cardiac cycle when it is pushing blood into the left ventricle
Can there be left ventricular hypertrophy in mitral valve stenosis
Never, left ventricles doesnt get filled sufficiently
Mnemonics
