PMT, Johnston - Valvular Heart Disease Flashcards
What are the three most common VHD conditions found?
1) Degenerative - (progressive) senile calcification
2) Myxomatous degeneration - MVP
3) Congenital - bicuspid AV
Regurg v. stenosis
- Regurg - failure to close adequately (vol overload, dilation). AR, MR.
- Stenosis - failure to open fully. Impedes forward flow. AS MS.
RHD - cause and criteria
Group A strep
2 major criteria or 1 major/2minor - Jones Criteria
Jones Major criteria
Joint - migratory polyarthritis Carditis Nodules (subq) Erythemous Marginatum Syndham chorea (Minor: fever, arthralgia, CRP or sed rate, leukocytosis, prolonged PRi, elevated ASO)
MS - what is it?
Narrowing leading to pulm HTN and RVF
4th decade
DOE, cough, orthopnea, PND, pulm edema, hemoptysis, arterial emboli, Afib.
Ortner syndrome
MS Symptoms
What is Ortner syndrome?
As LA enlarges due to MS, compression of Left recurrent laryngeal nerve = HOARSENESS, indicative of MS.
See: Malar rash
Hear: increase S1, opening snap after S2. Rumbling, diastolic MURMUR, low pitch at apex - use bell.
MS PE
MS tx (esp if in afib)
Anticoagulation therapy if in afib!!
Balloon valvuloplasty MVReplacement
If a person has MS, why do they develop progressive symptoms, leading to RV-Failure?
pressure b/u in LA»_space; pulm edema»_space; r side involvement
MS looks like what on ECG? What other tests are indicative of MS?
afib
LAE - see straight left heart broder on chest xray
Indicative of MS due to RF
**Causes of Mitral Regurgitation (MR): Chronic and Acute
- Acute: rupture of chordal tendineae, rupture of papillary muscle, ischemic papillary muscle dysfunction, IE, valve perforation.
- Chronic: MVP (most common), Mitral Annular Calcification
Left straight heart border indicative what?
LAE (possibly due to MS)
MR s/s
Immediately apparent?
- Inc LA pressure abruptly.
- Pulmonary edema, LVF.
**ASYMPTOMATIC FOR YEARS»_space; fatigue, DOE. Then ACUTE onset of orthopnea, PND, RHF/LHF, volume overload.
MS v. MR murmur (murmur and s1)
- MS = DIASTOLIC rumbling murmur, low pitch at apex. Increased S1, opening snap after S2.
- MR = SYSTOLIC murmur at apex, radiating to left axilla (correlates with severity of disease). Decreased S1 w/ systolic click.
Tx of MR (3)
Vasodilator - afterload reduction
Decrease resistance to flow
ACEi - chronic MR
MVP - what sex predominant, what is it, what happens during it?
F>M 7:1
Associated with Marfans
Mitral leaflets prolapse into LA during systole to cause MR.
What are s/s of MVP?
Tx hyper-adrenergic state with what (i.e. if pt has MVP and thyroid disorder)?
- Asymptomatic to arrhythmias, chest pain, syncope
- Systolic murmur (may have systolic click)
- Tx with BB (for anxiety and palpitations)
Etiology of AS
Degenerative (calcific or senile)
Congenital bicuspid aortic valve
Rheumatic or post inflammatory scarring
AoV Area in normal aortic valve v. in AS
Normal is 4square cm.
Severe AS if AoV is less than 1square cm.
** exertional DYSPNEA, ANGINA, SYNCOPE, HF **
AS s/s
- Narrowed Pulse Pressure
- Delayed pulses - Parvis/Tardus
- Harsh systolic murmur, 2nd ICS RSB, radiates to supra sternal notch/carotids.
- Gallavardin phenomenon (murmur)
AS PE
Pulse pressure: AI v. AS
AI = wide pp AS = narrow pp
What is Gallavardin phenomenon and what is it associated with?
Associate with AS.
When the murmur radiates to the apex.
