Valvular disease Flashcards
heart sounds: S1, S2, S3, S4
-S1: AV valves closure at the beginning of systole
-“lub”
-S2: semilunar valve closure at the end of ventricular systole and the beginning of diastole
-“dub”
-S3: Occurs at the beginning of diastole following the S2
-Lower in pitch
-Benign in youth
-New can indicate volume overload
-S4: Occurs after atrial contraction at the end of diastole before S1
-Blood being forced into a stiff ventricle
dx of valvular disease
-Transthoracic echocardiogram*: dx!
-Visualization of the valve measuring valve areas and gradients
-Main modality to diagnose valvular disease
-Transesophageal echocardiogram:
-Best modality to further assess severity mitral valve disease (endocarditis, severe path)
-Distinguish between moderate and severe
-Cardiac catheterization
-aortic valve
-make sure valve issue isnt from blood not getting to that wall
aortic stenosis
-Narrowing of the aortic valve opening increasing afterload
-Leads to LV failure
-LV hypertrophy
-finger over hose
-listen over right 2nd intercostal space
-Most common valvular disease in the US*
-Causes:
-Congenital defects- Bicuspid valve (only two flaps)
-Rheumatic heart disease
-Endocarditis- Most commonly bacterial
-Connective tissue disorder
-Degenerative disease
aortic stenosis signs and symptoms
Dyspnea*
Orthopnea
PND
Fatigue
Chest pain*
Dizziness
Pre-syncope
Syncope*
-Left sided heart failure:
-Rales
-Decreased breath sounds at bases
-Hypoxia
-Auscultation:
-Harsh cresendo-decrescendo systolic murmur**
-2nd Right intercostal space*
-Radiation to the carotids*
-lub pshhHHHHhhh dub
-Soft s2 or loss of s2
-Parvus et tardus: diminish carotid pulse
-Pericordial thrill- severe
aortic stenosis tx
-Medical therapy:
-HF tx: diuretics and vasodilators
-Caution with beta-blockers -> risk for overloaded LV as pts are preload dependent
-Surgical therapy:
-Aortic valve replacement -> For symptomatic pt with valve area that is 1.0 cm2 or less
-Open (SAVR) vs. Transcatheter (TAVR)*
-Bio-prosthetic vs. Mechanical:
-Mechanical valves require anticoagulation
-Coumadin only FDA approved anticoagulation
-INR 2.5-3.5
bio-prosthetic valves
-MC
-types:
-Bovine = cow
-Porcine = pigs
-Equine = horse
-TAVR is only bio-prosthetic valves
mechanical vales
-Types:
-Bileaflet,
-Ball cage valve
-Favored if patient is <50 years
-Requires life-long anticoagulation with Coumadin*
transcatheter aortic valve replacement (TAVR)
-Low to high-risk patients
-Approach
-Femoral: Most common
-Apical
-Subclavian
aortic regurgitation
-inadequate closure of the aortic leaflets leading to LV volume overload
-Also known as aortic insufficiency
-Inability to remain closed during diastole resulting in backward flow from aorta to the left ventricle
-Causes:
-Rheumatic fever
-Endocarditis
-Bicuspid aortic valve
-Marfan’s syndrome
-SLE
-Ehlers-Danlos Syndrome
-Aortic dissection or dilation
-Hypertension
-Syphilis
-Acute MI
aortic regurgitation symptoms and signs
-Dyspnea
-Orthopnea
-PND
-Palpitations
-Angina
-Dizziness
-Syncope
-Paroxysmal nocturnal dyspnea
-Left sided heart failure
-Auscultation:
-Diastolic decresendo murmur best heard at LLSB
-Murmur increases with hand gripping, sitting and leaning forward
-Corrigan’s pulse- Bounding pulse due to increased stroke volume
-Austin-flint murmur:
-low pitch rumbling murmur
-Heard at the apex- Severe AR
aortic regurgitation tx
-Medical management
-Heart failure management
-Afterload reduction
-ACE inhibitor (Ramipril, Lisinopril)
-ARB (Valsartan, Losartan)
-Surgical management
-Definitive treatment with aortic valve replacement
-For acute of symptomatic AR
-Asymptomatic AR with LV decompensation
mitral stenosis
-narrowing of the mitral valve affecting blood flow between the left atrium and ventricle
-Cause increase left atrial pressure and volume overload
-Most common cause is rheumatic heart disease*- streptococcal antigens lead to scaring & narrowing
-Causes:
-Infective endocarditis
-Congenital
-Systemic lupus
-Rheumatoid arthritis
-Amyloidosis
-Degenerative disease
-Left atrial myxoma
mitral stenosis signs and symptoms
-Dyspnea*
-Orthopnea
-Cough
-Palpitations
-Angina
-Dizziness
-Syncope
-Hemoptysis !!
-Left sided heart failure AND right sided heart failure
-Atrial fibrillation- warfarin
-Auscultation:
-Opening snap with low pitched DIASTOLIC murmur
-Best heard at apex in left lateral decubitus position
-lub dub pshhh
mitral stenosis: tx
-Medical management
-Heart failure management
-Anticoagulation in patient with atrial fibrillation -> Require warfarin
-Surgical management
-For symptomatic patients with severe mitral stenosis with a valve area of 1.0cm2 or less
-Surgical mitral valve replacement
-Transcatheter mitral valve replacement -> Approved for valve-in-valve procedures
acronym sounds
mr as- systolic
ms ar- diastolic
pulmonic stenosis
-narrowing of the pulmonic vale causing right ventricular obstruction
-decreased blood flow between right ventricle and pulmonary artery
-causes:
-almost always congenital
-tetraolgy (4) of fallot=cyanotic lesion
-1. overriding aorta
-2. ventricular septal defect
-3. right ventricular outflow obstruction
-4. right ventricular hypertrophy
-symptoms:
-fatigue
-dyspnea
-syncope
-chest pain
-signs:
-right sided HF
-auscultation:
-mid systolic murmur
-best heard at 2-3rd left intercostal space
-radiated to the left shoulder
-increases with inspiration
murmurs chart
murmurs sound chart
