murmurs Flashcards
mitral stenosis etiology
rhematic fever
immune mediated damage to mitral valve leading to fish mouth shaped orifice
mitral stenosis pressure
increased LA pressure (and size)
increased pulmonary venous pressure
leads to pulmonary congestion
mitral stenosis exacerbation
anything that increases flow across mitral valve: exercise, tachy
mitral stenosis long term (2)
pulomnary HTN (leading to RHF) A fib due to increase LA size and pressure
mitral stenosis symptoms
exertional dyspnea, orthopnea, PND
palpitations
hemoptysis
mitral stenosis murmur
low pitched DIASTOLIC rumble with S2 followed by opening snap
closer S2 and opening snap = worse
Loud S1
mitral stenosis tx
beta blocker: decrease HR and CO
diuretics for pulm congestion and edema
balloon valvuloplasty
aortic stenosis etiology
calcification of valve - early in abnl bicuspid, later for tricuspid
rheumatic fever
aortic stenosis remodeling
increased LV hypertrophy, causing obstruction to LV outflow
late: increaed LV, LA
aortic stenosis severe
CO decreases causing angina with exertion
LV dilation and dysfunction
pulls apart mitral valve annulua apart, causing MR
aortic stenosis symptoms
angina, syncope or HF
many are asymptomatic
aortic stenosis murmur
hard cresendo-decresendo SYSTOLIC murmur radiating to carotids
softer with valsalva - less flow across valve
second right intercostal space
soft S2
parvus et tardus: delayed carotid upstrokes (weak and slow rising carotid pulse)
precordial thrill
aortic stenosis tx
valve replacement is treatment of choice
aortic regurg etiology
inadequate closure of aortic valve causing regurg blood flow into LV
infective endocarditis, trauma, aortic dissection
bicuspid valve, marfan, ehlers-danlos, ankylosing spondylitis, SLE
syphilitic aortisis, osteogenica imperfecta
aortic regurg pressure
LV dilation and hypertrophy to maintain stroke volume and prevent diastolic pressure from increasing
Increased LV end diastolic volume and pressure, leading to pulmonary congestion
Causing increased LV and pulmonary pressures (late)
aortic regurg murmur
DIASTOLIC decresendo murmur
INCREASES with increased SVR, eg handgrip, causes backflow through incompetent valve
aortic regurg symptoms
dysnea on exertion, PND, orthopnea
palpitations, angina
cyanosis and shock in acute AR
widened pulse pressure (high SBP with low DBP)
water hammer pulse : rapidly increasing pulse that decreases in late systole
displaced PMI
handgrip effect, squatting
increases SVR
aortic regurg tx
afterload reduction (salt restriction, ACEi, arterial dilators), vasodilators, salt restriction Surgery is definative Acute AR: medical emergency, emergent replacement
mitral regurg etiology
acute: endocarditis (staph a), papillary muscle rupture, chordae tendineae rupture, inferior MI with papillary muscle displacement
chronic: MVP, rheumatic fever, marfan, cardiomyopathy
mitral regurg pressure - acute
increase in LA pressure with normal LA size and compliance causing back flow into pulomnary circ leading to acute pulm edema
increased LV end diastolic volume and filling pressure
decreased CO with hypotension and shock
mitral regurg pressure - chronic
gradual elevation of LA pressure in setting of dialted LA and LV with increased LA compliance
LV dysfunction
pulm htn from chronic backflow
mitral regurg murmur
HOLOSYSTOLIC at apex radiates to axilla
soft S1, wide S2, S3 gallop
mitral regurg tx
afterload reduction with vasodilators
valve replacement or repair before LV dilates too much
mitral regurg sympotoms
dysnea on exertion, PND
palpitations
pulm edema
Afib
tricuspid regurg etiology
usu RV dilation, due to LV failure, RV infarction, inferior wall MI, cor pulmonale, pulm HTN
endocarditis in IVDU
epstein anomoly - downward displacement of valve into RV
tricuspid regurg symtpoms
usu asymp, signs of RVF (ascities, hepatomegaly, edema, JVD), pulsitile liver
afib
tricuspid regurg mumur
Blowing holosystolic at LLSB
louder with inspiration, reduced with expiration or valsalva
valsalva effect, standing
reduces preload, reduces LV size
increases HOCM and MVP
decreases AS, pulmonic stenosis, and triC regurg
MVP etiology
myxomatous degeneration of valve leaflet or chordae tendineae
Marfan, osteogenesis imperfecta, Ehlers Danlos
most common cause of MR in developed countries
MVP symptoms
most asymp, palpitations and chest pain
rare TIA
MVP murmur
Mid-late SYSTOLIC murmur, with mid systolic click
increses with standing and valsalva because LV size is reduced allowing murmur and click to occur sooner
squatting decreases because LV size is increased
MVP tx
usu nothing, beta blockers for chest pain
HOCM murmur (intraventricular septal hypertrophy)
(cresendo-decresendo) SYSTOLIC ejection murmur without carotid radiation
louder with valsava - less blood to push wall apart
softer with handgrip, squating - more blood to push walls apart
VSD murmur
holosystolic with LATE diastolic rumble
can see LV overload, and pum htn from increased RV volumes
PDA murmur
communication iwth aorta and pulmonary artery
continuous machine like murmur
rubella
closure - indomethacin
patent - prostaglandin during transposition
ASD murmur
wide split S2 and soft mid systolic at LUSB
increased flow across pulmonary vasculature
coarctation of aorta
narrowing of constriction of aorta
HTN in UE, with hypotension in LE
midsystolic murmur heard in back
figure of 3
nitrates
vasodilate, decrease LV volume, wall stress
Tetralogy of fallot
Harsh Crescendo descendo systolic murmur at left upper eternal Border with single s2
