Heart Valve Problems Flashcards
What is at “thrill” when describing a murmur?
-if you were to put your hand where your hearing the murmur you would feel fluid moving under your hand
When grading a murmur(s) 1 through 6 where do you feel a thrill?
-you feel a thrill in the 4-6 murmurs
What is the pnuemonic for aortic stenosis ?
ASH
angina, syncope, heart failure
What makes up the S1 heart sound?
-the closing of the mitral and tricuspid valves, M1 and T1
What makes up the S2 heart sound?
-the closing of the aortic and pulmonic valves, A2 and P2
How do you get an S3 heart sound?
-the splashing of blood into the ventricle in CHF
What is the S4 heart sound?
-the sound of a stiff ventricle, in diastolic CHF or ischemia
When will you hear a rub when auscultating the heart?
-pericarditis, (so pericardial friction rub)
What is a Gallup?
- S1 and S2 plus an S3–think systolic CHF
- S1 and Sw plus an S4–think diastolic CHF or ischemia
You hear a fixed splitting of S2 in the pulmonic listening area, and you palpate a left peristernal lift. What’s the Dx?
-ASD
A chest x-ray shows increased pulmonary arteries and increased pulmonary vascularity. You note a fixed splitting of S2 and a peristernal lift. What is the Dx?
-ASD
What is coarctation of the aorta?
-narrowing of the aorta, usually distal to the subclavian artery
Boy presents with calf cramping with exercise. He has higher BP in arms than legs and a brachial femoral pulse lag. What is the Dx? How do you follow and counsel parents on sibilings?
- coarctation of the aorta
- He needs to be followed and so do siblings because he is going to get hypertrophic cardiomyopathy, so will siblings.
Kid has calf cramping and 3 sign/ rib notching on x-ray. What’s he got?
-coarctation of the aorta
Lower BP in legs and rib notching on CXR.
-coarctation of the aorta
Continuous machinery murmur. Baby has failure to thrive. (Adult is asymptomatic). Dx and Tx?
Dx is patent ductus arteriosis
Tx for baby is indomethacin
Pansystolic/Holosystolic murmer mid sternal border.
VSD
Most common heart defect
VSD
This shunting starts left to right but then ends right to left. What is significant when it becomes right to left?
VSD
-surgery is not longer possible when it ends in right to left (Eisenmenger syndrome)
kid with TET spells, (squatting child)
Tetralogy of fallot (squats and it goes away)
kid has RVH, VSD, PS and overriding aorta
Tetralogy of fallot
Which kids should you be suspicious of tetralogy of fallot?
- Down’s Syndrome
- Di George Syndrome
- congenital rubella
What kids get transposition of the great vessels?
mom is diabetic
Cor Pulmonale from congenital heart defects, left to right shunting then right to left shunting?
-Eisenmenger syndrome, to late to do surgery when the shunt gets to right to left.
Patient presents with (ASH) chest pain (angina), syncope with effort, and heart failure. PE shows narrow pulse pressure, apical lift, S4 gallop, and slow carotid upstroke w/murmur. What’s he got?
-Aortic Stenosis
How do you treat aortic stenosis?
- valve replacement
- Nitro and ACEI may cause severe hypotension, as they already have low pulse pressure
In a young patient with ASH, angina, syncope, and heart failure (S4 heart sound), what is his problem?
-bicuspid aortic valve
Austin Flint murmur
low pitched rumbling murmur heard best the cardiac apex
heard in Aortic Regurgitation
Patient presents with fatigue and dyspnea, palpitations, and chest pain (angina). On exam he has a low pitched rumbling murmur heard at the cardiac apex.
-Aortic Regurgitation
What happens to the Aortic valve such that one gets aortic regurgitation?
- Leaflet degeneration: 1, rheumatic fever, 2 endocarditis, 3, connective tissue disorders
- Aortic Root enlargement: 1, HTN, Marfan’s, Syphilis,
What is the Tx for Aortic Regurgitation?
-ACEI, Bblocker, loop diuretic
Patient comes in with PHD, palpitations (a-fib), heart failure (CHF), and dyspnea with exertion. Auscultation shows opening snap and low pitched diastolic rumble at the apex.
-Mitral Stenosis
What is the treatment for mitral stenosis?
-medical, slow down the heart to allow for better filing—give them a beta blocker or a calcium channel blocker
Holosystolic murmur radiating to the axillae
-Mitral Regurgitaion
Tx for Mitral Regurgitation
-Medical, Bblocker, loop diuretic, ACEI
Young woman with sharp stabbing pain and palpitations presents. She is noted to have a mid systolic click and and late apical systolic murmur? what is her murmur?
- Mitral Valve Prolapse
- Tx with reassurance and maybe a Blocker
young adult (> 50) or old person comes in with ASH, (angina, syncope, heart failure). They have a narrow pulse pressure, apical lift, S4, and a slow carotid upstroke. What valve disorder do they have?
Aortic stenosis
if this is a real young person think HOCM (hypertrophic cardiomyopathy
A young person with aortic stenosis think of what problem?
-bicuspid aortic valve
Gallivardin’s phenonemon
Aortic stenosis, musical murmur, low rumble that radiates to the carotids
Austin Flint muruer
Aortic regurgitation
person has fatigue and dyspnea and Austin Flint murmur, whats the Dx?
-Aortic regurgitation
murmur following opening snap, and is decrescendo, low pitched diastolic rumble best heard at the apex. Patient has palpitations, HF, and dyspnea with exertion.
-Mitral stenosis
What are the symptoms of mitral stenosis?
(PHD), palpitations (a-fib), heart failure, dyspnea with exertion.
What is the treatment for mitral stenosis?
-Bblocker or calcium channel blocker to slow the heart in order to allow for better heart refill, longer diastole.
Halosystolic murmer, high pitched, best heard at the apex with the diaphragm in the left lateral decubitus position, radiates to the axilla.
-Mitral regurgitation
What are the symptoms of mitral regurgitation?
-same as for mitral stenosis, PHD, palpitations, heart failure, dyspnea with exertion
What is the tx for mitral regurgitation?
surgery
if they refuse surgery, tx with Bblocker, loop diuretic, ACEI, (so tx like heart failure)
Young lady with sharp jabbing chest pain, palpitations but no EKG changes or arrhythmia, and short of breath (dyspnea). Heart exam includes mid-systolic click and late apical systolic murmur. What is the Dx?
-Mitral valve prolapse
Mid diastolic murmur best heard over the left sternal border with rumbling. Patient has JVD, so it looks like right heart failure. Has a hx of rheumatic fever.
tricuspid stenosis
What is the tx for tricuspid stenosis?
surgery
Patient has a pansystolic murmur with Carvallo sign, best heard on left sternal border. Patient has used fen-Phen (dexfenfluramine) or is an IV drug user or has pulmonary hypertension.
-tricuspid regurgitation
Patient has pulmonary hypertension now comes in with complaints of dyspnea with exertion. She has a Gramsteel murmur. What is the Dx?
-Pulmonary regurgitation
high pitched diastolic decrescendo murmur, left upper mid sternal area, patient has pulmonary hypertension.
Gramsteel murmur
kid with Noonan syndrome has SOB anda crescendo decrescendo murmur left upper sternal border that increases with inspiration and radiated diffusely.
Pulmonary stenosis
middle aged guy with carcinoid syndrome has SOB and a crescendo decrescendo murmur left upper sternal border that increases with inspiration and radiates diffusely.
Pulmonary stenois
What do you do for continued tx for a person with a mechanical valve.
- warfarin therapy, INR 2.5-3.5
- you should hear a click on auscultation if not there is a problem
