Clinical Cardiology Flashcards
What kind of murmurs can you hear in the aortic area of auscultation?
Ejection type murmurs:
- Aortic stenosis
- Flow murmur
What kind of murmur can be heard in the pulmonic area of auscultation?
Ejection-type murmur
- Pulmonic stenosis
- Flow murmur
What kind of murmur can be heard in the left sternal border area of auscultation?
Early diastolic murmur
- Aortic regurgitation
- Pulmonic regurgitation
What kind of murmur can be heard in the mitral area of auscultation?
Pansystolic murmur
- Mitral regurgitation
Mid-to-late diastolic murmur
- Mitral stenosis
What kind of murmur can be heard in the tricuspid area of auscultation?
Pansystolic murmur
- Tricuspid regurgitation
- VEntricular septal defect
Mid-to-late diastolic murmur
- Tricuspid stenosis
- Atrial septal defect
What are the only low-pitch sounds that we can hear with the bell of our stethoscope ?
S3 and S4
Heard at the left side apex
What murmurs/sounds increase with inspiration?
- Tricuspid regurgitation
- Pulmonic regurgitation
- S2 differentiates into P2 and A2
What are the possible underlying pathologes associated with a systolic ejection sound?
- Aortic stenosis
- Pulmonic stenosis
What are the possible underlying pathologes associated with a pansystolic sound?
- Mitral regurgitation
- Tricuspid regurgitation
What are the possible underlying pathologes associated with a late systolic sound?
Mitral valve prolapse
What are the possible underlying pathologes associated with a early diasystolic sound?
- Aortic regurgitation
- Pulmonic regurgitation
What are the possible underlying pathologes associated with a mid-to-late diasystolic sound?
Mitral stenosis
What is the etiology of aortic stenosis?
- Degenerative calcification
- Bicuspid aortic valve
- Rheumatic aortic valve disease
What are the consequences of aortic stenosis ?
- LV undergoes concentric hypertrophy to compensate (stiffening)
- Increased afterload
- An unchanged end-diastolic volume
- An increased end-systolic volume
- A decreased stroke volume
What is the clinical presentation of aortis stenosis?
- S4 present, absent/reduced S2
- Ejection type murmur (crescendo-decrescendo between S1 and S2)
- The carotid pulse is going to feel late and week
- Symptoms: angina (5 years to live), syncope (3 years to live), heart failure (2 years to live)
What is the etiology of mitral stenosis?
- Congenital MS
- Mitral annulus calcification
- Infective endocarditis
- Rheumatic heart disease
What are the consequences of mitral stenosis?
- Pulmonary hypertension
- Left atrial enlargement (may result in atrial fibrillation, stroke)
What are the clinical manifestations of mitral stenosis ?
- Early: dyspnea on exertion, fever
- Later: dyspnea at rest, orthopnea, paroxysmal nocturnal dyspnea
- Latest: signs of right hear failure
- If asymptomatic (“ 80% 10 years survival), symptomatic (50-60% 10 years survival) and if pulmonary hypertension (3 years survival)
What can you find at physical examination of a patient with mitral stenosis?
- Loud S1 with disease progression (mitral valve snaps with LV pressure in systole)
- Reduced S1 later with disease progression
- Opening snap (OS) after S2 because the opening comes earlier thus at higher pressure
- Decrescendo diastolic rumble with pre-systolic accentuation (mid-to-late)
- LA enlargement, RV hypertrophy if PH present
- Thickened MV
How do you treat an aortic or mitral stenosis?
- Surgical valve replacement
- Transcatheter balloon to open it
- Reduce H20 and Na+ intake, slow HR and anticoagulant if atrial fibrillation
Explain the 2 types of right-sided stenosis
Trisuspid
- Rare
- Most common etiology is rheumatic
- Exam similar to MS (OS and diastolic murmur)
- Distended neck veins with large a-wave
- Treated with balloon dilatation or surgical correction
Pulmonary
- Rare
- Congenital
- Crescendo-decrescendo murmur, possible ejection click
- Treatable by balloon valvuloplasty
What are the advantages and disadvantages of mechanical valves ?
Advantages
- Durable
Disadvantages
- Thrombogenic
- High risk endocarditis
What are the advantages and disadvantages of bioprostethic valves ?
Advantages
- Less thrombogenis risk
Disadvantages
- High risk endocarditis
- Less durable
What is the etiology of aortic regurgitation?
- Abnormality of aortic valve
- Dilatation of aortic root
What are the consequences of aortic regurgitation?
- Enlarged ventricular silhouette
- Rounded isovolumetric relaxation
- Rounded end-diastolic filing
- Rounded isovolumetric contraction
- Increased diastolic LV volume
What are the Symptoms and clinical manifestation of aortic regurgitation?
- Dyspnea
- Wide pulse pressure, bounding pulse
- Low diastolic pressure: angina
- Leaky valve: blowing decrescendo diastolic murmur at left sternal border, possible Aunstin-Flint
- Signs: Bisferiens pulse (double pulse) Corrignan pulse (water hammer), hill sign (popliteal), Quincke sign (lit or nail bed)
What is the treatment of aortic regurgitation?
- Surgery if symptomatic
- 4 years if angina and 2 years with heart failure
What is the etiology of mitral regurgitation?
- Mitral annulus
- Leaflets
- Chordae tendineae
- Papullary muscles
- Left ventricle (secondary)
What are the consequences of mitral regurgitation?
- Acute: sudden damage (papillary muscle or chordae tendineae ruptured)
- Chronic: myxomatous degeneration, rheumatic deformity, congenital valve defect, mitral annular calcification
- Secondary: rupture by outside cause (ex: LV enlargement)
What is the pathophysiology of mitral regurgitation?
LA goes up, less blood pumped, rounded isovolumetric contraction, and relaxation, decreased end-systolic volume, increased diastolic LV volume and LV stroke volume increases to compensate.
Contributing factors: mitral orifice, pressure gradient LV to LA, systemic vascular resistance, LA compliance, duration of regurgitation and regurgitant fraction (volume of MR/SV)
What are the symptomes and clinical manifestations of mitral regurgitation?
- Acute: pulmonary edema and related symptoms
- Chronic: fatigue, weakness, dyspnea, potential right heart failure
- Holosystolic murmur, classically radiated to axilla, possible presence of S3
- LA enlargement, pulmonary edema
What is the treatment of mitral regurgitation?
- Acute MR need surgical emergency internveiton (20-25% 30 day mortality)
- Chronic MR: related to cause (repair preferred over replacement)
What is mitral prolapse?
“Parachuting”
Etiology: Inherited
Symptoms and clinical manifestations:
- Mid-systolic click and mid-to-late-systolic murmur (less loud when squatting)
- Large LV volume
- Dx confirmed by echo
What are the 2 right-sided valve regurgitation?
- Tricuspid: very common, typically functional and cause by something else, prominent V-wave, pulsatile liver, LLSB systolic murmur, treatment includes treating underlying condition, diuresis and sometimes surgical
- Pulmonary regurgitation: typically cause by pulmonary hypertension, high piteched decrescendo murmur and left sternal border
