CVS Valvular Disease Flashcards
Aortic root dilation: Marfan syndrome, syphilis
Post-inflammatory: RHD, infective endocarditis
Structural: bicuspid aortic valve (age < 65), aortic dissection
AR
2 common presentation for AS
Congenital bicuspid aortic valve : Patient < 65 yo
Degenerative” or senile calcific aortic stenosis:
patients > 65 yo
Systolic & diastolic bruit when femoral artery is compressed
Duroziez’s sign
Hx:
Fatigue, exertional dyspnea, and orthopnea (severe stenosis)
Hemoptysis, hoarseness (Ortner’s syndrome)
Edema, ascites if with pulmonary HTN
Atrial fibrillation, systemic thromboembolism
Physical exam: Inspection: Malar flush Precordial bulge, diffuse pulsation Palpation: RV heave if with pulmonary HTN + palpable P2
Mitral Stenosis (MS)
LA enlarges progressively progressive exertional dyspnea and fatigue
RHD
MVP (myxomatous degeneration of MV leaflets and chordae)
Infective endocarditis
HTN
Ischemic heart disease
HOCM
CHRONIC MR
Visible pulsations of retinal arteries and pupils
Becker’s sign
deMusset’s sign
Head-bobbing synchronous with the heartbeat
increase in afterload Incomplete emptying of LA LV hypertrophy decrease CO RV strain Pulmonary congestion
AS
A 50-year-old female presents with a holosystolic murmur heard best over the apex, radiating to the axilla. She has no signs of pulmonary hypertension or edema. What best explains her lack of symptoms?
a) The right ventricle is compensating with decreased compliance
b) The left atrium is compensating with increased compliance
c) The aorta is compensating with increased compliance
d) There is only a ballooning of the valve which would not result in any hemodynamic changes in the heart
B
confirmatory of valvular disease
Transthoracic echocardiography (TTE)
Murmurs:
Decrescendo, diastolic holodiastolic
Loudest along Erb’s point when leaning forward, on full expiration
AR
Physical exam:
Inspection: Downward displacement of apical impulse
Palpation: Forceful, brisk PMI
Heart sounds:
Widely-split S2 (early closure of aortic valve)
S3 (indicates severity of regurgitation)
Holosystolic, blowing, high-pitched, loudest over apex, radiates to the L axilla (+ L infrascapular)
MR
abrupt ↑ in LA pressure pulmonary edema
Rupture of chordae tendinae or papillary muscle (MI)
Infective endocarditis
acute MR
Pulsatile nailbeds
Quincke’s pulse
Corrigan’s pulse
Waterhammer pulse in the carotid area
‘a’ wave of JVP
S4
pre-systolic accentuation of MS
These are lost in atrial fibrillation:
A 20-year-old female with a recent history of panic attacks presents with chest pain with no specific triggers. She has a family history of CAD in her grandfather. Physical examination reveals tachycardia and an apical mid-systolic click that is followed by a murmur. Which of the following maneuvers and effect are expected?
a) Passive leg raising will cause the murmur to disappear
b) Valsalva maneuver will cause the click to occur earlier
c) Passive leg raising will lengthen the murmur duration
d) Passive leg raising will cause the click to occur earlier
e) Valsalva maneuver will shorten the murmur duration
B
