Exam 4 Valvular Disease Flashcards
most common level of aortic stenosis
aortic valve - 75%, as opposed to sub or supravalvular
age 30 - 65 aortic valve concerns
congenitally bicuspid aortic valve becomes calcified/stenotic. congenital
Sx aortic stenosis
fatigue, exertional dyspnea
late Sx aortic stenosis
dyspnea, angina, syncope, heart failure
heart sound aortic stenosis
systolic ejection murmur, crescendo-decrescendo
physical exam sign aortic stenosis
thrill in suprasternal notch or 2nd right ICS
grade 1 murmur
barely audible
grade 2 murmur
quiet but clearly audible
grade 3 murmur
moderately loud
grade 4 murmur
loud, with thrill
grade 5 murmur
very loud, thrill, hear with steth partially off chest
grade 6 murmur
very loud, thrill, hear with steth completely off chest
lab finding aortic stenosis
left ventricular hypertrophy
porcelain aorta
calcium deposits on aorta, can be seen in CXR
Tx of symptomatic aortic stenosis
cardio referral, probably valve replacement
symptomatic aortic stenosis
angina, syncope, dyspnea/CHf
surface area a/w severe aortic stenosis
< 1.0 cm squared
hypertrophic cardiomyopathy cause
inherited 60%
hypertrophic cardiomyopathy murmur
same as aortic stenosis, louder when pt. stands, valsalva
Tx hyptertophic cardiomyopathy
calcium channel blockers, beta blocker
hypertrophic cardiomyopathy description
enlarged heart muscle without cause for secondary hypertrophy
aortic regurg description
blood leaks back through aortic valve during diastole
aortic regurg causes
aortic insufficiency
physical exam signs aortic insufficiency/regurg
low diastolic, widened pulse pressure
aortic insufficiency/regurg requiring surgical intervention
ejection fraction <55%, symptomatic, asymptomatic with LV dilation, end systol 55mm, end diastolic 70mm
acute causes of aortic regurg
aortic dissection, surgical, endocarditis
progression of chronic aortic regurg
LV overload, dilation, hypertrophy, CHF, then <2 year survival
acute ar progression
pulmonary edema, doesn’t compensate for overload
Tx aortic regurg
valve replacement
heart sound aortic regurg
austin flint murmur - low pitched diast murmur at apex
lab findings aortic regurg
left ventricular hypertrophy, sometimes CHF/pulmonary edema
Tx aortic regurg
ace inhibitors, vasodilators, valve replacement if symptomatic
mitral regurg definition
blood leaks from LV into LA
mitral valve structures involved in mitral regurg
leaflets, chordae tendineae, papullary muscles, annulus
causes of acute mitral regurg
papillary muscle necrosis, endocarditis
causes chronic mitral regurg
endocarditis, inherited, marfan’s, rheumatic, etc
barlow syndrome
cause of mitral regurg, valve degen, a/w grave’s disease, marfan’s muscular dystrophy
a fib with mitral regurg
develops due to left atrial enlargement resulting from compensation
Sx mitral regurg
gradual appearance, dyspnea, fatigue, arrhythmias
heart sound mitral regurg
high pitched pansystolic murmur at apex
physical exam late mitral regurg
JVD, hepatomegaly, edema
lab findings mitral regurg
atrial enlargement, ventricular hypertrophies, a. fib.
Tx mitral regurg
ace inhibitors, vasodilators, Na reduction, diuretics, digitalis, valve repair or replacement
mitral valve prolapse description
during systole ballooning of mitral leaflets into left atrium
Tx mitral proplapse
most require none, if palp or arrhythmia beta blockers, if a/w regurgitation, use mitral regurg Tx
mitral stenosis description
narrowing mitral valve, increases LA pressure
cause of mitral stenosis
rheumatic heart disease most common
Sx mitral stenosis
dyspnea, pulmonary edema, pulmonary HTN, then right heart failure, a-fib, emboli
heart sound mitral stenosis
S1 opening snap then mid diastolic rumbling murmur
lab findings mitral stenosis
gigantic LA, smaller LV, right vent hypertrophy, a-fib, kerley B lines,
Tx mitral stenosis
mild: diuretics, Na restriction, warfarin a-fib embolus prevention, valve surgery
endocarditis description
vegetative growths on valve 2nd to bacterial infx
class 1 endocarditis requiring surgery
heart failure, pulmonary HTN, resistant organisms, heart block
class 2 endocarditis requiring surgery
recurrent emboli or vegetation in spite of abx
tricuspid regurg cause
right valve dysfunction a/w endocarditis
Tx endocarditis
abx
