Valve disease Flashcards
Causes:
- Rheumatic heart dz
- LV dilation
- Coronary heart disease, damaging papillary muscle
- Mitral valve prolapse
- Infective endocarditis
Mitral regurgitation
In mitral regurg, the blood flows from where to where?
Backwards from the LV to the LA
LV volume increases progressively as severity of _____ _____ increases.
Mitral regurg
LV function- well preserved initially; often deteriorates in later stages as does cardiac output (CO). LV compensates for volume overload via the Starling mechanism.
Mitral regurg
Often asymptomatic for years
Fatigue, DOE, orthopnea- symptoms of left sided heart failure (detailed discussion later in CV system).
Mitral regurg
Murmur over second right intercostal space
Mid systolic
Medium pitch; harsh
Aortic stenosis
Carotid pulses are thready in aortic….
Stenosis
Bounding pulses with widened pulse pressures are found in..
Aortic regurg (insufficiency)
Murmur heard 2-4th LICS
*systolic and diastolic decrescendo
High pitch, blowing
Aortic regurgitation
Murmur at apex
Diastolic
Low pitch
Mitral stenosis
Murmur at apex
Systolic
Medium to high pitch, blowing
Mitral regurg
____ murmurs are intensified when pt sits up and leans forward
Aortic
____ murmurs are intensified when pt lays on left side (decubitus position)
Mitral
Mid to late systolic click
High pitched late systolic murmur heard best at apex
*improves with squatting (heard louder when standing)
Mitral valve prolapse
Right sided murmurs heard best with..
Inspiration
Right ventricular outflow obstruction of blood
*almost always congenital…a dz of the young
Pulmonic stenosis
Harsh mid systolic ejection cresc-decrescendo murmur (maximal at LUSB) radiates to neck
- *increases w inspiration
- signs of right sided HF
- systolic ejection click
Pulmonic stenosis
Most commonly caused by pulmonary hypertension
Retrograde of blood flow from pulmonary after into right ventricle..R sided volume overload
Pulmonic stenosis
Graham Steell Murmur: brief, decrescendo early diastolic murmur at LUSB (2nd LICS) with full inspiration
Pulmonic regurg
Blood backs up into R atria…R atrial enlargement leading to R sided failure
*mid diastolic rumble at L lower sternal border
Tricuspid stenosis
Blood flows from LV into LA *sx of L sided HF *systolic murmur (usually holosystolic) **if severe enough, can have S3 gallop HIGH PITCHED AND BLOWING*
Mitral regurg
Females more common
Age 15-30
Arrhythmias common (PACs, PVCs, PSVT, etc)
*myxomatous degeneration of MV leaflet tissue
Mitral valve prolapse
Valve leaflets thicken and calcify
*mostly caused by rheumatic fever
Mitral stenosis
L atrial pressure rises in order to propel blood across the stenotic valve
*pulmonary congestion can develop
Mitral stenosis
DOE, orthopnea
PACs, A fib**, A flutter
Opening “snap” of MV-apex heard after S2
Diastolic rumble after
Mitral stenosis
“lub dub snap”
Percutaneous balloon valvuloplasty should be the first step in treating..
Mitral stenosis!!
“wear and tear”
thickening/calcification without fusing
*seen commonly in aging
Aortic stenosis
What happens to L ventricular pressure in aortic stenosis?
Increases!!
but the aortic pressure will be normal, so there will be a large gradient across the aortic valve
Obstruction to LV outflow
Systolic gradient between LV and aorta
*cardiac output normal at rest but does not adequately rise w activity
Aortic stenosis
Exertional dyspnea, Angina, Syncope
- S4 common
- Crescendo-decrescendo in mid to late systole
- harsh, low pitched
- best heard at base, radiates to carotids
Aortic stenosis
Ace inhibitors and ARBs may decrease mortality in which valvular dz
Aortic stenosis
can replace valve if severe enough
is Transcatheter Aortic Valve Implantation is a good technique?
No…lots of complications
Basically a last ditch effort
75% male Rheumatic heart dz Infective endocarditis on previously deformed valve Aortic root dz and dilation Bicuspid aortic valve
Aortic regurg
Increase LVEDV (Preload) LV dilates to allow increased SV
*over time, LV function gradually declines and EF deteriorates
Aortic regurg
Arterial pulse: rapid rising “water hammer pulse” and collapsing pulse
Aortic regurg
“Quinke’s pulse”: alternate flushing and palling of the skin at nail root
- Pistol shot sound over femoral artery in systole
- Arterial pulse pressure widened
Aortic regurg
Apex displaced laterally/inferiorly
- diastolic thrill may be present along LSB
- S3 common: high pitched, blowing diastolic decrescendo murmur (LSB)
BEST HEARD W DIAPHRAGM W PATIENT SITTING UPRIGHT/LEANING FORWARD
Aortic regurg
Tx like CHF..AFTERLOAD REDUCTION WITH VASODILATORS
Aortic regurg
can also replace valve
