chapter 11 - adult valvular heart disease Flashcards
describe the murmur grading scale
I (one) - softer than can be heard with a stethoscope
II - just loud enough to be heard when stethoscope is just placed on the chest.
III- louder than grade II
IV - very loud murmur
V - can be heard when the stethoscope is a few millimeters off the chest wall
IV- murmurs that can be heard with the naked ear
what is an organic systolic murmur and which grade of murmur is usually organic
it is indicative of disease. grade II systolic murmur can be either normal (innocent) or abnormal (organic). grade III systolic murmur is always organic
what is a thrill
palpable vibration that can accompany a murmur
In HCM, a short _______ can sometimes be heard that is ____ when the patient stands
short grade III systolic murmur, louder when standing
when should an UWer be concerned about a grade II murmur that the physician is not aware of or is not concerned (has not investigated)
when there is a family history of hypertrophic cardiomyopathy (HCM)
what condition can cause childhood murmur and usually requires aortic valve replacement by age 50
bicuspid aortic valve
what is the clinical clue (Symptom) to diagnosing a bicuspid aortic valve
systolic ejection click
do grade I or II diastolic murmurs indicate disease
yes, can indicate significant disease
where is a murmur of aortic stenosis usually heard
systolic- upper sternum radiating to carotid
where is a murmur of aortic regurgitation usually heard
diastolic - left sternal edge, high pitch, decrescendo
where is the murmur of mitral stenosis usually heard
diastolic - rumbling, apex, with opening snap
where is the murmur of mitral regurgitation usually heard
systolic- blowing, apex, radiating to axilla
where is the murmur of VSD usually heard
systolic - 3rd and 4th intercostal space next to sternum
where is the murmur of MVP usually heard
late systolic - click, apex, not left sternal border
what are the characteristics of innocent/normal murmurs
left sternal edge location, grade I or II (III in children only), loudest supine but reduced or absent sitting, systolic/short/mid-systolic, may increase the same as organic murmurs, no abnormal heart sounds or clicks, nil TTE
is an EKG any help in deciding whether a murmur is normal or not
no
when is TEE preferred over TTE
when patient has barrel chest, extreme obesity, emphysema, intra cardiac factors, or aortic root disease - TEE would provide better visualization
what is a normal LVEF
55-65%
how much does the EF increase with exercise
usually 5%
what is mild, moderate, severe LV impairment (percentages)
mild 45-55%.
moderate 35-34%.
severe <35%.
if the echo report indicates mild regurg in all 3 valves, the valves are likely _______
normal
aortic sclerosis is associated with an increased risk of _______
CAD and stroke
50% of individuals with aortic sclerosis have ________
bicuspid aortic valve
what are the most common causes of valvular aortic stenosis
- congenital abnormal valve, either bicuspid or unicuspid, with calcification. 2. normal tri-leaflet (tricuspid) valve with degenerative changes, eventual calcification, and fibrosis. 3. rheumatic valve disease
symptoms of aortic stenosis can include: (4)
dyspnea, decreased exercise tolerance, syncope/dizziness, angina
what re 5 unfavorable features with aortic stenosis
presence of symptoms (angina, syncope), elev BP, abnml heart rhythm (e.g. afib, LBBB), very low fitness level and arrhythmias on exercise EKG, echo showingLV wall >16mm or EF <50% or mitral disease
what are 2 main general causes of aortic regurgitation
aortic valve leaflet (cusp) disease and deformityy of the aortic root and aorta
what re the most common specific causes of aortic regurg
congenital bicuspid valve, bacterial endocarditis, aortic root dilatation, marfan, ehlers-danlos.
what are other causes of aortic regurg
other congenital heart diseases (AV prolapse with VSD), RF, ankylosing spondylitis, RA, SLE, diet pill disease
what are poss symptoms of aortic regurg
fatigue, dyspnea, angina, palps
what is mitral stenosis
obstruction of blood flow from the left atrium to the LV caused by narrowing of the MV and creating a pressure gradient across the valve in diastole
what are causes of mitral stenosis
rheumatic fever, infective myocarditis, severe mitral annular calcification. rare: left atrial myxoma, congenital stenosis, carcinoid syndrome, SLE, RA, end-myocardial fibrosis
what are symptoms of mitral stenosis
dyspnea, decreased exercise tolerance, palms, cough, chest pain. also can occur: Afib, stroke, pulmonary edema, pulmonary hemorrhage
what is mitral regurg
blood flow from the LV to lt atrium during systole
what are causes of MR
abnormalities of mitral valve apparatus, MVP, myxomatous degeneration, rheumatic heart disease infective endocarditis, mitral annual calc, ruptured chord, degeneration with age, congenital cleft valve, other cardiac dsieases, Marfan, Ehlers-danlos
what are symptoms of MR
dyspnea, fatigue, decreased exercise tolerance, palms, blowing, high0putched holosytolic murmur best heard at apex
what are favorable features of MVP
female, apical click no murmur, degree of prolapse on echo <2.5, valve thickening <4, valve regurgitation 2+ or less, no change in 5 yrs of f/u, normal body build and habitus
what are unfavorable features of MVP (likely progression within next 5-10 yrs)
mitral regurgitation on echo grade II-III, major degree of prolapse and myxomatous change, valve thickening, progression on echos and clinical findings, enlarging LV and LAE, any symptoms, afib, progression of murmur to pansystolic, flail leaflet on echo
is MVP an important cause of cardiac morbidity and nortality
yes
what is the average age for mitral surgery for prolapse/myxomatous degeneration
57 years
one of the 2 most important measure of severity of aortic stenosis is the:
- grade of the murmur
- degree of sclerosis
- hypertrophy of the LV
- gradient across the valve
- gradient across the valve
what are the 2 most important measures on echo to evaluate severest of aortic stenosis
LV-aortic gradient and valve area
causes of death after heart valve surgery include which of the following
A. blood clots on the valve
B. ventricular arrhythmais
C. brain embolism
A B and C are correct
common causes of aortic stenosis include all of the following EXCEPT:
- congenital abnormalities
- aortic root dilatation
- valvular calcification
- rheumatic valve disease
- aortic root dilatation
what is TAVR
transcatheter aortic valve replacement
name 2 conditions TAVR can’t be used for
bicuspid or non calcified valve
Can nitrates be used to treat heart valve disease
Yes
Recent trends in the treatment of valve disease include all of the following except: A. Nitrates B. Beta blockers C. Anticardiolipin antibodies D. Calcium channel blockers
C anticardiolipin antibodies
