Right Valves and Pulm HTN Flashcards
What is the most common murmur?
Left systolic murmur
How common are right heart murmurs compared to left heart murmurs?
10 x less common on the right
How common are diastolic murmurs compared to systolic murmurs?
Diastolic murmurs are 10 x less common
Respiration will change the sound of a murmur only on the _________ side of the heart
right
Deep inspiration increases or decreases the sound of a right sided murmur? Why?
Increases b/c inspiration increases venous return and preload to heart. More blood = more pressure = louder sound
I am a crescendo-decrescendo murmur heard during diastole. Most people have me to a slight degree, but I become a problem if you have pulmonary hypertension
Pulmonary regurgitation
I am a crescendo-decrescendo murmur heard on systole. As I get worse, my sound is louder and occurs later in the cardiac cycle. Each time I make noise you hear an ejection click.
Pulmonary stenosis
I am a holosystolic murmur that gets quieter as I become more severe. You can hear me loudest when a patient inspires.
Tricuspid regurgitation
I am a diastolic murmur that is very rare. I am caused by rheumatic heart disease or endocarditis. (Don’t use IV drugs, or you’ll get endocarditis.)
Tricuspid stenosis
On the right side, what murmurs can be heard in systole?
Pulmonary stenosis and Tricuspid regurge
On the right side, what murmurs can be heard in diastole?
Pulmonary regurge and tricuspid stenosis
what causes tricuspid regurge?
dilation of the RV second to left sided HF or pulm htn
How will you treat tricuspid regurge?
reduce afterload, treat underlying condition (LHF or pulm htn), consider valve replacement
How do you treat tricuspid stenosis?
FIX VALVE (balloon or valve replacement) Diuretics can provide some symptom relief until valve is fixed.
What is the most common cause of pulmonic stenosis?
congenital, bi-valve
In pulmonic stenosis, the blood in the RV cannot get out and into the lungs fast enough, how will you treat this?
Really can’t treat with meds, need balloon or valve replacement.
Pulmonic regurgitation second to pulm htn will cause ______________ which typically progresses into _______________.
RV hypertrophy progresses to systolic HF
How will you treat pulmonic regurge?
treat underlying condition (pulm htn) and consider valve replacement
When do you really want to look at making a diagnosis of pulmonary hypertension?
when you see right sided HF without left HF symptoms.
What are typical RHF symptoms?
JVD, ascites, peripheral edema, hepatomegaly
What are typical LHF symptoms?
dyspnea, orthopnea, cough, crackles
What pressures have to be present to make a dx of pulm htn?
pulmonary arterial pressure > 25mmHg
What happens to the heart when it has to pump against high pulmonary pressure?
increased afterload causes RVH which leads to RHF
What are the 5 classifications of pulm htn?
1) Pulmonary Arterial HTN
2) Pulmonary Venous HTN
3) Pulm htn of hypoxia or lung dz
4) Pulm htn of thrombosis
5) Miscellaneous
What might cause pulm artery htn?
HIV, sporadic onset, toxicity
What might cause pulm venous htn?
LEFT SIDED HD (this is most common, but we are looking for pulm htn in the absence of left sided symptom)
What might cause pulm htn of hypoxia or lung dz?
COPD* OSA* interstitial lung dz, altitude
What might cause pulm htn of thrombosis?
PE***
What are some miscellaneous causes of pulm htn?
sarcoidosis, anemia, histiocytosis
In the ABSENCE of left heart symptoms, and an increased RV pressure, what 3 things must you consider and rule out?
pulm htn due to COPD, OSA, PE (these are by far the most common)
How can you tell the difference b/w pulm arterial htn and pulm venous htn?
PAH will have mean arterial pressure >25mmHg, and a Pulm capillary WP < 15mmHg. (Meaning high pressure in pulm artery, but low pressure in LA) VS. PVH will have a high wedge pressure as well
Sternal heaves mean you have __________
RV hypertrophy
What can cause RVH?
pulm htn, tricuspid regurge, pulm stenosis, pulm regurge
So if you feel a sternal heave, you need to consider these diagnoses:
pulm htn, tricuspid regurge, pulm stenosis, pulm regurge
Systole begins with what heart sound?
S1
What are the key valves in S1, what are they doing?
Mitral and Tricuspid are closing (M1 and T1)
What heart sound ends systole?
S2
What are the key valves in S2 and what are they doing?
Aortic and Pulmonic are closing (A2 and P2)
