Cardio. Valves (08-12) (1) Flashcards
Bicuspid aortic valve. 2 reasons to develop?
sporadically or through autosomal dominant with incomplete penetrance pattern
Most common type of congenital heart disease in adults?
Bicuspid aortic valve
Bicuspid aortic valve. inheritance pattern?
autosomal dominant with incomplete penetrance pattern
Bicuspid aortic valve. presentation depends on what?
on patients age
Bicuspid aortic valve. pathophysiology in younger patients? 2
Valvular leaflet abnormalities or aortic root dilation
Bicuspid aortic valve. in youger, feature and auscultation
This results in isolated aortic regurgitation (this leads to early decrescendo diastolic murmur which begins immediately after A2 which is best heard with the diaphragm of the stethoscope along the left sternal border at the 3rd and 4th intercostal spaces while the patient is sitting up, leaning forward, and holding a breath in full expiration)
Bicuspid aortic valve. pathophysiology in older patients?
calcification of aortic valves due to excessive wear-and-tear
Bicuspid aortic valve. in elderly. feature as a result of pathophysiology?
This leads to aortic stenosis
Bicuspid aortic valve. complications?2
a. Dilation of aortic root or ascending aorta.
–> Leads to aortic aneurysm and dissection.
–> Causes sudden death.
CHRONIC aortic regurgitation.
etiologies? 3
Congenital bicuspid aortic valve
Postinflammatory (eg, rheumatic heart disease, endocarditis)
Aortic root dilation (eg, Marfan syndrome, syphilis)
CHRONIC aortic regurgitation. pathophysiology?
Backflow from aorta into LV –> incr. in what?
incr. LV end-diastolic volume
CHRONIC aortic regurgitation. pathophysiology?
LV initially compensates with eccentric hypertrophy –> incr. in what?
incr. SV&CO
CHRONIC aortic regurgitation. pathophysiology?
Eventual LV dysfunction –> decr in what?
Eventual LV dysfunction –> decr. SV & CO –> heart failure
CHRONIC aortic regurgitation.
what murmur?
Diastolic decrescendo murmur
CHRONIC aortic regurgitation. what pulse findings? 2
Widened pulse pressure (incr. SBP & decr. DBP) findings
Rapid rise-rapid fall (“water-hammer’’) pulsation
CHRONIC aortic regurgitation. what femoral/carotid pulse finding?
Abrupt carotid distension & collapse, “pistol-shot” femoral pulses
CHRONIC aortic regurgitation. murmur kreive?
S1 - S2 decrendo - S1
What pulsus in Ao regurgitation (vs Ao stenosis)?
Pulsus bisferiens
What pulsus in Ao stenosis (vs Ao regurgitation)?
pulsus parvus et tardus
pulsus parvus et tardus in what?
Ao stenosis
Pulsus bisferiens in what?
Ao regurgitation
Pulsus bisferiens. Biphasic pulse. why?
It refers to 2 systolic peaks of the aortic pulse from left ventricular ejection separated by midsystolic dip
Pulsus bisferiens. in what 3 pathologies?
a. Aortic regurgitation
b. Hypertrophic cardiomyopathy
c. Large PDA
Aortic stenosis. what size area?
<3 cm2
Aortic stenosis. what size when become symptomatic?
Aortic stenosis becomes symptomatic when valve area <1 cm2
Aortic stenosis. common cause?
Age-related sclerocalcific changes in the aortic valves
Aortic stenosis. symtoms?
Chest pain, Dyspnea, Dizziness, Syncope
Aortic stenosis. carotid pulse?
Delayed and diminished carotid pulse (pulsus parvus et tardus)
Aortic stenosis. murmurs? 3
- Single and soft S2
- Audible S4
- Crescendo-decrescendo systolic murmur in the 2nd right ICS with radiation to carotids
Aortic stenosis. when manifests LVH?
LVH (does not occur until valve area <1 cm2)
Aortic stenosis. what pulse pressure?
narrow
Aortic stenosis. where intense pulse?
Incr. intensity of apical impulse
Aortic stenosis. murmur name and in what phase?
Systolic murmur (crescendo-decrescendo)
Aortic stenosis. what murmur in mild-moderate stenosis?
Early-peaking systolic murmur suggests mild to moderate aortic stenosis;
Aortic stenosis.what murmur in severe stenosis?
Late-peaking systolic murmur suggests severe aortic stenosis.
Aortic stenosis. diagnostic method?
cardioecho
Aortic stenosis. differential? 1
Hypertrophic cardiomyopathy: No radiation to carotids, murmur heard best at left lower sternal border.
what is second most common type of aortic stenosis?
SUPRAVALVULAR AORTIC STENOSIS
SUPRAVALVULAR AORTIC STENOSIS. definition?
It usually refers to congenital left ventricular outflow tract obstruction due to discrete or diffuse narrowing of the ascending aorta
SUPRAVALVULAR AORTIC STENOSIS. what murmur and where?
Midsystolic murmur best heard at 1st right intercostal space
SUPRAVALVULAR AORTIC STENOSIS. what pulse changes? Blood pressure?
Unequal carotid pulses
Differential blood pressure in the upper extremities
SUPRAVALVULAR AORTIC STENOSIS. what one more feature palpated?
Palpable thrill in the suprasternal notch
SUPRAVALVULAR AORTIC STENOSIS. complications?
a. Left ventricular hypertrophy (high-voltage QRS complexes, lateral ST segment depression, lateral T wave inversion)
b. Coronary artery stenosis
Pulmonic valve stenosis. etiology? 2
Congenital (usually isolated defect)
Rarely acquired (eg. carcinoid)
Pulmonic valve stenosis. clinical presentation. severe?
Right-sided HF in childhood
Pulmonic valve stenosis. clinical presentation. mild-moderate?
symptoms (eg dyspnea) in early adulthood
Pulmonic valve stenosis. murmur? 2
Crescendo-decrescendo murmur (incr. on inspiration)
Systolic ejection click and widened split of S2
Pulmonic valve stenosis. diagnosis?
cardioecho
Pulmonic valve stenosis. treatment 2
Percutaneous balloon valvulotomy (preffered) * balloon just dilates
Surgical repair in some cases
Pulmonic valve stenosis. ejection click. where heard and when?
high-pitched sound after S1 best heard during expiration
Pulmonic valve stenosis. where best heard murmur and when?
Crescendo-decrescendo systolic murmur best heard over the left 2nd ICS. It increases with inspiration (due to increased preload)
Pulmonic valve stenosis. widened split. when best heard?
Widened splitting (which is further increased during inspiration)
MITRAL STENOSIS. clinical features - on respiratory
Dyspnea, orthopnea, PND (parox. nocturnal dyspnea), hemoptysis
MITRAL STENOSIS. thromboembolic feature?
Afib, systemic thromboembolism
MITRAL STENOSIS. voice symptoms?
Voice hoarseness from recurrent laryngeal nerve compression due to LAE (Ortner syndrome)
MITRAL STENOSIS. what is Ortner syndrome?
Voice hoarseness from recurrent laryngeal nerve compression due to LAE (Ortner syndrome)
MITRAL STENOSIS. clinical feature - face?
Mitral facies (pinkish-purple patches on cheeks)
MITRAL STENOSIS. S1 and S2?
Loud S1, loud P2 if pulmonary hypertension
MITRAL STENOSIS. what specific murmur?
Opening snap (high-frequency early diastolic sound)
MITRAL STENOSIS. what rumble, where heard?
Mid-diastolic rumble (best heard at cardiac apex
MITRAL STENOSIS. diagnostics? 3
xray, TTE, ECG
MITRAL STENOSIS. whats on xray? 4
Pulmonary blood flow redistribution to upper lobes,
dilated pulmonary vessels,
LAE,
flattened left heart border
MITRAL STENOSIS. whats on ecg?
,,P mitrale” (broad and notched P waves), atrial tachyarrhythmias, RVH (tall R waves in V1 and V2)
MITRAL STENOSIS. whats on TTE?
MV thickening/calcification/ decr. mobility, coexisting MR
MITRAL STENOSIS. complications?
Afib.
MITRAL STENOSIS. murmur schema?
S1-S2 short break OS decreascendo -> crescendo - S1
