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Cardiovascular > Heart Sounds and Valve Diseases > Flashcards

Heart Sounds and Valve Diseases Flashcards

1
Q

S1

A

closure of atrioventricular (mitral and tricuspid) vlaves

separation of sounds increases w/ RBBB

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2
Q

S2

A

closure of semilunar (aortic and pulmonic) valves

Aortic occurs before Pulmonic and interval elongates w/ inspiration

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3
Q

What makes heart sounds louder?

A

Stenosis: resistant valves require higher pressure to slam them shut
Tachycardia: shorter filling/ejection phases gives valves less time to retract toward closed position before pressure forces them shut

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4
Q

When dampens heart sounds?

A

Regurgitation dampens sounds

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5
Q

Systole occurs between…..

A

S1 and S2 sounds

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6
Q

Clicks, Opening Sounds occur with…..

A

Stenotic valves, prolapsed valves

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7
Q

S3 heart sound

A

Passive filling sound as high pressure atrial blood crashes into ventricle as soon as AV valve opens

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8
Q

S4 heart sound

A

Active sound as blood crashes against stiff (hypertrophic, reduced compliance) ventricles after atrial contraction

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9
Q

What processes cause murmurs?

A

Turbulent flow from stenotic or regurgitant valves

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10
Q

Shape and cause of Systolic Ejection Murmurs

A

Diamond shape, caused by stenosis of high pressure semilunar valves

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11
Q

Shape and cause of Pansystolic Murmurs

A

constant murmur through systole, caused by AV valve regurgitation

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12
Q

Shape and cause of early diastolic murmurs

A

Decrescendo immediately after S2, caused by regurgitation over high pressure semilunar valves

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13
Q

Shape and cause of late diastolic murmurs

A

Decrescendo mid-systole, caused by stenosis of AV valve, have opening click

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14
Q

Describe waves of jugular venous pressure diagram

A

A wave: atrial contraction forcing venous blood backward
C wave: small pressure created when tricuspid valve closes
V wave: pressure created as atrium fills, relieved w/ tricuspid opening

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15
Q

Causes of prominent A waves, V waves, and Y descents

A

A wave: right ventricle hypertrophy causes atrial blood to crash on stiff wall
V wave: tricuspid regurgitation provides addition volume to atrium, increasing pressure
Y descent: pericardial constriction

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16
Q

Causes of Mitral Valve Stenosis (5)

A

Mostly rheumatic heart disease

Also calcification, obstructing tumor/clot, congenital structure problem, or bad prosthetic valve

17
Q

Pathology of Mitral Stenosis

A

Increased LA pressure causes pulmonary HTN and LA dilation
Pulmonary HTN leads to right heart failure
LA dilation promotes atrial fibrillation, reduces CO

18
Q

Physical Exam findings in Mitral Stenosis

A

Symptoms: dyspnea, hemoptysis

Loud S1 sound; late diastolic murmur with opening sound

19
Q

Mitral Stenosis EKG findings

A

Initially LA enlargement

Later RVH and A-fib

20
Q

Treatment of Mitral Stenosis

A

Diuretics for congestion
Rate control blood to improve LV filling
Anti-coagulation for A-fib
Surgical replacement

21
Q

Causes of Mitral Regurgitation

A

Primary: valve defect from prolapse, endocarditis,
Funcitonal: LVH pulls valve apart

22
Q

Mitral Regurgitation Pathology

A

Increased LA pressure and volume creates reduced cardiac output (some of SV is retrograde)
Chronically causes LA dilation, reduced CO and A-fib

23
Q

Mitral Regurgitation Exam

A

Low CO symptoms (syncope, dyspnea, etc.)

Apical holosystolic murmur

24
Q

Mitral Regurgitation Treatment

A

Surgery

In functional, treat LHF (diuretics)

25
Q

Mitral Prolapse

A

Congenital, mild regurgitation, systolic rumble murmur w/ opening click

26
Q

Aortic Stenosis Causes

A 
Bicuspid valve (1-2% of population) promotes stenosis
Calcification, Rheumatic
27
Q

Aortic Stenosis Pathology

A

Reduced SV increases LV pressure, leads to LVH, low CO

Much higher systolic pressure gradient narrows pulse pressure

28
Q

Aortic Stenosis Exam

A

Symptoms: syncope, light headed, dyspnea, angina
PE: diamond systolic murmur radiating to carotids, S4, Parvus Tardus
EKG: LVH

29
Q

Aortic Stenosis Treatment

A

Valve replacement

Treat underlying LHF symptoms as necessary

30
Q

Aortic Regurgitation Causes

A

Calcific, Rheumatic, and aortic dilation

31
Q

Aortic Regurgitation Pathology

A

Increased LV volume increases SV which increases LV pressure. High pressure causes LVH and pulmonary symptoms.
Wide pulse pressure, angina

32
Q

Aortic Regurgitation Exam

A

Dyspnea, fatigue, low exercise tolerance (Low CO)

Early diastolic decrescendo murmur

33
Q

Tricuspid Stenosis

A

Rare, from rheumatic fever

Late diastolic decrescendo w/ opening sound, Large A wave in JVP

34
Q

Tricuspid Regurgitation

A

Functional caused by RVH, Primary from carcinoid
Holosystolic mumur that increases w/ inspiration
Large V wave in JVP

35
Q

Pulmonic Stenosis

A

Congenital or carcinoid causes

Diamond systolic mumur w/ opening sound

36
Q

Pulmonic Regurgitation

A

From pulmonary dilation 2’ to pulmonary HTN

Early diastolic decrescendo murmur

Cardiovascular (8 decks)

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