Left Valves and MVP Flashcards
This murmur results from dilation of the aortic root and sometimes the ascending aorta as well
aortic insufficiency
What is the most common cause of AI?
congenital–bicuspid valve
Where can you hear AI? When can you hear it? What does it sound like?
LLSB, early diastole, blowing
What is a common and unique symptoms of AI? What is this caused by?
“pounding’ heart beat/palpitations. Caused by hyperdynamic pulse that occurs with large stroke volume and rapid runoff. (Basically the LV pumps out a lot of blood creating a big systolic pressure, and then a lot of it rushes back into the LV and does not participate with diastolic pressure)
What is another murmur that occurs in diastole? It is low pitched and heard at the apex. We were told to “just be aware”
Austin Flint
Are there any additional heart sounds that can be heard in AI?
S3, occasionally
What’s the difference b/t chronic and acute AI?
Chronic AI gives heart time to adapt and compensate by dilating or with hypertrophy. Acute AI give heart no time to adapt and LV will be overwhelmed with blood supply. Back up will cause flash pulm edema.
How do you treat AI?
mild–vasodilators (ACEI and CCB) to reduce afterload
severe–valve replacement
This murmur is typically acquired. Symptoms often don’t develop for years, but once they present patients have a rapid decline in mortality. Symptoms most often include angina, syncope, and CHF
Aortic Stenosis
Does AS occur in systole or diastole?
systole
What does AS sound like?
systolic crescendo-decrescendo
Are there extra heart sounds in AS?
S4, occasionally
What are the important causes of AS?
Acquired: calcification or rheumatic dz
Congenital: bicuspid valve
What are the 3 key symptoms/complications of AS?
angina, syncope, CHF
During your physical exam of a patient with suspected AS, what else might you classically notice?
pulsus parvus et tardus–weak and late carotid pulse
This diastolic murmur is most commonly caused by rheumatic disease, and is therefore very rare in the western world. It is characterized by an opening snap, diastolic “rumbling” murmur, and can be heard best at the apex.
Mitral stenosis
What symptoms are commonly a/w MS?
insidious onset, dyspnea, and AFIB
Why would you suspect afib in MS?
back up of blood into the LA may cause dilation of the LA…dilation/stretch will irritate those myocytes and trigger afib
What is your treatment for MS?
Valvuloplasty (temporary) replace valve! (can manage symptoms with diuretics. Maintain good rhythm and HR)
What is the most common cause of mitral regurgitation?
MVP
How can you diagnose MVP?
echo! is the only way to see prolapse
What demographic of patients most commonly has MVP?
women
What symptoms will you expect in MVP patients? What has this historically been a problem?
CP, palpitations, dizziness, anxiety–problematic b/c this is often mistaken for panic attack.
What does MVP sound like on PE?
midsystolic click (will eventually develop systolic murmur with development of MR)
How do you treat MVP?
usually don’t, symptomatic patients can be given BB. Consider valve replacement only with progressing MR
This is a blowing holosystolic murmur that radiates to the axilla. It can be heard at the LLSB and apex.
Mitral regurgitation
What causes MR? (chronically)
#1) MVP-most common 2) rheumatic dz also causes
How do MR patients typically present?
Usually have a prolonged asymptomatic period, but develop AFIB (dilation LA) and CHF (and CHF symptoms). Usually also have MVP symptoms as well.
What is something special you might notice on PE for an MR patient?
Laterally placed PMI
What might cause an acute mitral regurge?
ischemia, rupture of chordae tendinae
Why would ischemia cause an acute MR?
the posteriomedial papillary muscle only has a single blood supply (posterior descending artery)
How would you manage acute MR?
SURGERY, ASAP (stabilize until sx with Na Nitroprusside, Inotropes, or balloon)
How would you manage chronic MR?
reduce afterload (ACEI), decrease preload (diuretics) and valve replacement
When would you do a valve replacement for MR?
for symptomatic patients, or asymptomatic patients who’s EF <55%
What murmur radiates to the carotid?
Aortic stenosis
What murmur radiates to the axilla or back?
mitral regurge
what murmur has a loud S1 and has an opening snap and is heard at the apex?
MS
what murmur is blowing holosystolic and is heard best at apex or LLSB
MR
What murmur is blowing early diastolic and heard at the LLSB (sometimes S3)
AI
What murmur is a/w a water hammer pulse?
AI
What murmur is heard at the RUSB during systole with an S4 heart sound?J
AS