Valvular Disease Flashcards
2nd right intercostal space
Aortic area
2nd left intercostal space
Pulmonic Area
Lower left sternal border at 4th intercostal space
Tricuspid area
Midclavicular line at 5th intercostal space
Mitral area (Apex)
What are dyspnea, easy fatigability, palpitation, and left sided heart failure symptoms of?
Mitral regurgitation
What’s the most common cause of mitral regurgitation?
MVP
Other causes: MI, infectious endocarditis, trauma that ruptures the papillary muscle, chordae tendinae rupture, valve leaflet rupture
What happens in chronic mitral regurgitation?
Left atria and left ventricle dilate and hypertrophy, diastolic filling of LV increases
EDV will be more than in a normal person
What happens in acute mitral regurgitation?
Left atrial pressure increases from increased volume, leads to increased pulmonary pressure and edema
Where would you listen to a mitral regurgitation? What would you expect to hear?
Apex of the heart
Holosystolic murmur that may radiate to the axilla; may hear a S3 (rapid ventricular villing)
How would you treat mitral regurg with development of a.fib?
anticoagulation
How would you treat mitral regurg with development of heart failure?
Diuretics (lasiks) and beta blockers
What’s the most common valvular heart disease coming in hot at 2% of the population?
Mitral Valve Prolapse
Young woman with palpitations or chest pain
Young athlete with syncope during practice
Elderly male with syncope
Common presentation of mitral valve prolapse
Mid to late systolic Click followed by late systolic murmur
Mitral Valve Prolapse
Only murmur that decreases with increased volume
Mitral Valve Prolapse
Ways to increase cardiac volume
Passive leg raise
Squatting
Inhalation
Ways to decrease cardiac volume
Valsalva maneuver (strain)
Sudden Standing
Exhalation
Treatment for symptomatic MVP
Beta blockers
Anti-platelet therapy for those with a hx of emboli
Outflow obstruction between left atria and left ventricle
Mitral Stenosis
What causes mitral stenosis?
Rheumatic Heart Disease (scarlet fever related to strep)
Dyspnea, hemoptysis, palpitations, and fatigue are symptoms of what?
Mitral stenosis
In mitral stenosis, what happens to cardiac output?
Eventually drops because there’s less blood going into the ventricle to be pumped out
Opening snap of mitral valve diastole
Mitral stenosis
How do you treat mitral stenosis?
Control rate with beta blocker or CCB
Smoldering lesion that usually doesn’t present until 6th-8th decade
Aortic Stenosis
Dyspnea, exertional syncope, pulmonary congestion, and fatigue are symptoms of what?
Aortic stenosis
What will a murmur in aortic stenosis sound like?
Paradoxically Split
Listen at right second intercostal space
Treatment for aortic stenosis
Avoid strenuous activity, diuretics for pulmonary congestion, surgical valve replacement
Dyspnea, pulmonary congestion, and chest pain are symptoms of what?
Aortic regurgitation
Fatigue and systemic vascular congestion are associated with what?
Tricuspid stenosis
What most commonly causes tricuspid stenosis?
Rheumatic heart disease
Can also be from infective endocarditis from IV drug abuse
What valve will you hear at the lower left sternal border?
Tricuspid valve
What antibiotics are usually given prophylactically?
Amoxicillin
Cephalexin or Clindamycin if ther’s a penicillin allergy
