CVS Medicine Pulse➡️murmur Flashcards
Components of mitral valve
5 components 2 leaflet ant and post 2 commissure 1 annulus Chordae tendinae 25 primary 2 papillary muscle
Important function of annulus in mitral valve
Provides anchor for leaflet
Annular contraction for leaflet approximation
K a co aptation zone
What happens when annular dilation occurs in mitral valve
Zone of co aptation not formed
Mitral regurgitation
Most common site of prolapse of mitral valve
Posterior leaflet
Attachment of primary secondary tertiary chordae to leaflet
Primary to tip
Secondary to body
Tertiary to base
What is the cause of seconds MR in inferior wall MI
Posteromedial papillary muscle has single blood supply from RCA which also supplies inferior wall
Causes of MS
Most common
Mc rheumatic Other Atrial myxoma left Infective endocarditis Congenital parachute mitral valve
Fish mouth appearance is seen in
It is due to
Seen in MS
due to valve thickening& calcification
chordae and commisure fusion and shortening
Mc site of thrombosis in MS
LA appendage
Classification criteria for severe MS
50/1
More than 50 mm Hg systolic pulmonary artery pressure
Less than 1 cm2 valve surface area
First symptom of MS
Dyspnea on exertion
HR increase, diastolic time increase, LA pressure increase, dyspnea
Why is there RV hypertrophy and pulmonary artery hypertension in MS
LV filling pressure not adequate
LA pressure increase to compensate
Increase pulmonary artery pressure
RVH and Pulmonary HTN
Complications of MS
Atrial fibrillation Recurrent bronchitis Hemoptysis Hoarsness of voice Cough
Ortner syndrome
LA enlargement leads to Left RLN compression causing hoarsness of voice
Mitral facies
In severe MS,
PINK PURPLISH FACE due to decreased cardiac output
Pulse
BP
JVP
In MS
Pulse normal except in atrial fib irregular
BP normal in severe MS narrow pulse pressure
JVP
a wave - pulmonary HTN
v wave Tricuspid regurgitation
Inspection and palpation finding of MS
Parasternal heave
Palpable P2 tapping apex
Heart sounds in MS
S1 loud
S3 loud P2
S3 and S4 not heard in MS
Added sounds - Opening snap
How to assess severity of MS
Duration of murmur
Shorter S2 -OS Interval
Characterstic murmur in MS
Low pitched rough rumbling
Mid diastolic murmur
Heard at apex no radiation
Best heard in expiration
Mitral valve replacement if if echo shows?
Transthoracic echo show
Calcification
Associated MR
Clot
Xray in MS
Enlarged LA
Double density sign due to overlapping of LA RA
Straightening of left heart border
Left main bronchus lifted up- splaying of carena
Graham steel murmur is seen in
MS rarely in pulmonary regurgitation
High pitched blowing
Diastolic decrescendo
Loud palpable P2
Organic MR is known as
Primary MR
Leaflet or chordae relates problem
Organic MR is known as
Primary MR
Leaflet or chordae relates problem
Secondary MR occurs due to
Chordae and leaflet are normal
Annular dilation mc occurs in heart failure
Causes of primary MR
Mitral valve prolapse
Rheumatic
SLE, RA
Pathophysiology of MR
LV to LA retrograde flow LA dilates to maintain pressure LV compliance increase - Extensive LV dilation LV filling pressure doesn't increase EDV increase SV increase
What is earliest symptom of MR
Palpitations
Severe MR leads to pulmonary HTN due to
Left atrial pressure increase due to decrease LV contractility leading to pulmonary artery hypertension
Pulse
Bp
JVP
IN SEVERE MR
Hypokinetic pulse
Narrow pulse pressure
a wave
Inspection finding of MR
Parasternal heave in severe MR
Heart sounds of MR
S1 soft
S2 normal (in severe MR - widening)
S3 heard in moderate to severe MR
Murmur of MR
It is best heard in
Pan systolic murmur
High pitched, soft blowing
Left lateral decubitus with diaphragm
What is the sign for bad prognosis in MR
Ejection fraction less than 60
LV end sys diameter more than 40 mm
Cause of MVP
From najeeb
Absolute indication for surgery in MVP
MVP WITH MR
Murmur in MVP
High pitched musical murmur
Systolic murmur crescendo decrescendo
Sound in asymptomatic MVP
Non ejection click
Cause of acute MR
Papillary muscle rupture( inferior wall MI)
Chordal rupture( inf endocarditis)
Trauma
Acute MR C/F
Acute pulmonary edema or
Cardiogenic shock
Murmur- short Early systolic decrescendo
Pericardial space contains?
50 ml serous fluid which is ultrafiltrate of plasma
Pulmonary vein is intra_____, It is not intra_____
It is intrathoracic, not intrapericardial
Pulmonary vein is intra_____, It is not intra_____
It is intrathoracic, not intrapericardial
What happens to CO during inspiration and expiration
Inspiration
VR increase, RV pressure increase septum bulge towards left side, LV volume decrease, CO decrease
Vice versa in expiration
C/F of acute Pericarditis
Sharp, stabbing, pleuritic chest pain
Relieved by sitting up and leaning forward
Pericardial rub present
Global ST elevation diffuse T wave inversion
Most common cause of acute pericarditis
Post viral
Other cause of acute pericarditis
Hiv tb coxsackie Post mi Uremia Hydralazine IgG4, SLE, Sjogrens
Dresslers syndrome is seen in
Late pericarditis -1wk to few months after MI
Autoimmune
Fever ,pleuritic pain+ polyserositis
RUB PRESENT
Treatment of acute pericarditis
Nsaids only
Ibuprofen
Indomethacin
Aspirin
Causes of chronic constrictive pericarditis
Tb mc
Repeat episode of acute pericarditis
What is CCP
Obliteration of pericardial cavity by formation of granulation tissue, which contracts to form scar that calcifies
Other name for chronic constrictive pericarditis
Thickened calcific inelastic pericardium
Why is kussmaul sign seen in chronic constrictive pericarditis
Due to fall in intrathoracic pressure on inspiration
Chamber pressure fails to fall due to constrictive pericarditis leading to decrease venous return thus,
Jvp doesn’t fall on inspiration
Septal bounce is seen in
It is due to
Exaggerated ventricular interdependence seen in 1/3rd pt
Causes septal bounce in CCP
