Valvular Defects Flashcards
What size is the normal opening of the aortic valve? What size and pressure change indicates mild path? Severe path?
3-4 cm
1.5-3cm and <10 pressure change - mild
.8-1cm and 25-50 pressure change - severe
What type of aortic stenosis is associated with CAD? What is at a high level in the blood?
Tricuspid
High hsCRP
What are the three classic symptoms of aortic stenosis?
Angina
Syncope
HF - most common
When can the murmur be heard for aortic stenosis? What does it sound like? What delay elsewhere also occurs?
Systolic
Crescendo-Decrescendo - High-pitched/harsh
Delayed carotid pulse
What test is risky to do on a patient with symptomatic aortic stenosis?
Exercise test
What is standard treatment for aortic stenosis? What should be avoided?
Aortic valve replacement - transfemoral AVR
Avoid vasodilators
What diagnostic tool is best for aortic stenosis? What can be seen on ECG?
Echo - best
On ECG - LVH
What type of hypertrophy is caused by aortic stenosis?
Concentric hypertrophy
What type of hypertrophy is caused by aortic regurgitation? How do the parts of blood pressure change? Pulse pressure?
Eccentric hypertrophy
High systolic
Low diastolic
High PP
When can the murmur be heard for aortic regurgitation? What is a special murmur that can be heard? What causes it?
Early systolic
Austin Flint murmur - mitral valve diastolic rumble at apex due to aortic regurg hitting anterior open mitral leaflet
What high pulse sign is indicated by a sharp upstroke with a rapid decline in the carotid? For which valve defect?
Corrigan’s
Aortic Regurgitation
What is Durozeiz sign? For which valve defect?
Femoral systolic and diastolic bruits
Aortic Regurgitation
What high pulse sign is indicated by head bobbing? For which valve defect?
De Musset’s sign
Aortic Regurgiation
What is Quincke’s pulse? For what defect?
Systolic pulsing, diastolic blanch in capillary beds
Aortic Regurgitation
How is aortic regurgitation diagnosed? What is medical treatment? Surgical treatment?
Diagnosed - echo
Medical treatment - vasodialtors
Surgical - valve replacement before advanced symptoms
What is a common cause for mitral stenosis? Is it more common in men or women?
Rheumatic fever
Women
What are two clinical past findings that can indicate mitral stenosis?
Hemoptysis - blood in sputum due to bronchial rupture
Hoarseness (Ortner’s syndrome) - due to LA pressure on left recurrent laryngeal nerve
When can the murmur be heard for mitral stenosis? Which sound is louder than the other? What is a secondary sound that can be heard?
Diastolic - Low pitched
S1 louder than S2
2nd sound - pre-systolic - due to atrial contraction
What abnormalities can be seen on an EKG for mitral stenosis? What is used to diagnose? What is also often necessary?
A fib, LA abnormality, RVH
Echo
Cardiac cath
What two things are mainly used to treat mitral valve stenosis? A third? Surgical correction?
Anticoagulation and cardioversion Control A-fib with Class II or class IV Mechanical - balloon valvotomy, mitral commissurotomy, or valve replacement
What is the most common mitral regurgitation? Another cause? What type of hypertrophy does it cause?
Mitral valve prolapse - most common
Papillary muscle dysfunction
Eccentric hypertrophy
What are 3 pathophysiologies of mitral regurgitation? How are each treated?
Acute - low cardiac output, LV failure - vasodialators, intra-aortic balloon, surgery
Chronic compensated - asymptomatic, LA enlargement at low pressure - elective repair or replacement
Chronic symptomatic - Impaired LV contractility - surgical repair or replacement
When can the murmur be heard for mitral regurgitation? What can be heard in the middle? Which sound is decreased? When can RV lift be seen?
Apical, high pitched , Midsystolic click, late systolic murmur
S1 decreased
RV lift, increased P2 if pulmonary hypertension
What is the most common cause of Tricuspid regurgitation? What also can cause it? How can it be tested for
Left heart problems Carcinoid syndrome ( seritonin from liver tumor degenerated tricuspid valve) Serotonin metabolite 5-hydroxyindoleacetic acid
What visually can be seen in a patient with tricuspid regurgitation?
Large V-wave
When is the murmur heard for tricuspid regurgitation?
Holosystolic
How is tricuspid regurgitation treated?
Diuretics, treat cause, rarely surgical
What correlates to a murmur early diastolic decreschendo at the left sternal edge?
Pulmonary regurgitation
