murmur Flashcards
symptoms of aortic stenosis
chest pain, SOB, syncope (esp on exercise)
what type of murmur is aortic stenosis
ejection systolic - radiates to carotids
what manouvre decreases aortic stenosis
valsava
features of severe aortic stenosis (5)
narrow pulse pressure // slow rising pulse // soft or absent S2 // S4 // thrill // LV hypertrophy
causes of aortic stenosis (5)
calcification // bicuspid aortic valve // williams syndrome // post-rhemuatic // HOCM
most common cause of aortic stenosis in 65+
calcification
most common cause of aortic stenosis in <65
bicuspid aortic valve
what is treatment for asymptomatic aortic stenosis
observe
what feature of asymptomatic aortic stenosis may warrent treatment
valvular gradient >40 mmHg + features of LV systolic dysfunction
mx for aortic stenosis
surgical valve replacement in fit patients // catheter in unwell // (balloon children)
most common murmur
aortic stenosis
RF mitral regurg
female, low BMI, age, renal dsyfunction, previous MI, previous mitral disease, collagen disorder
causes of mitral regurg (5)
following coronary artery disease or post MI // mitral valve prolapse // endocarditis // rheumatic fever // congenital
murmur of mitral regurg
panysystolic ‘blowing’ // loudest in apex // S1 quiet, S2 may split
ECG mitral regurg
broad p wave
imaging for mitral regurg
CXR: cardiomegaly // echo
medical mx mitral regurg (5)
nitrates // diuretics // positive inotropes // balloon pump // ACEi for HF
surgery for mitral regurg
1st = repaire // 2nd = artificial or pig
causes mitral stenosis
RHEUMATIC FEVER
symptoms mitral stenosis (5)
SOB // haemoptysis // malar flush (in cheeks) // Afib // weak pulse
murmur mitral stenosis
mid diastolic (expiration) // loud S1 (snap)
severe murmur MS
increased length // opening snap becomes closer to S2
imaging mitral stenosis
CXR = LA enlarged // echo
mx for mitral stenosis with AF
warfarin
mx asymptomatic mitral stenosis
monitor + echos
mx symptomatic mitral stenosis
surgery - balloon or replacement
what causes valve disease –> aortic regurg
rheumatic fever! // calcified / endocarditis // bicuspid valve // SLE or RA
what causes aortic root disease –> aortic regurg
marfans or EDS // bicuspid aortic valve // dissection // hypertension // syphilis
murmur aortic regurg
early diastolic
signs aortic regurg
wide pulse pressure // collapsing pulse // quinckes sign (nailbed pulse) // De Musset’s sign (head bobbing)
invx aortic regurg
echo
mx aortic regurg
(mx for HF) // surgery if severe
what causes tricuspid regurg
RV infarction // COPD // rheumatic heart // endocarditis (IVDU)
murmur tricuspid regurg
pansystolic // JVP // pulsatile hepatomegaly // left parasternal heave
what can cause mitral valve prolapse
congenital heart disease // cardiomyopathy // Turners, marfans, fragile X // polycystic kidneys // WPW
symptoms mitral valve prolapse
paliptations // mid systolic click (squatting) // late systolic click (standing)
biggest con of biological heart valve
degeneration
what medication given for biological heart valves
aspirin long term // no need for anticoag (maybe warfarin 3 months)
biggest con mechanical valve
thrombosis and life long coag
