Valvular Disease Cases Flashcards
physical presentation aortic stenosis
sustained LV impulse, little LV displacement
Lulsus parvus et Tardus of carotid muscle
Absent A2 or paradoxical split A2
Mumur systolic dcrescendo at base or upper right sternum - radiates to carotids
aortic stenosis on CXR
small cardiac enlargement (LVH)
post stenotic delation of ascending aorta
calcification of valve
point of intervention for aortic stenosis
severe stenosis with symptoms
causes of aortic regurgitation
abnormal leaflets
dilation of aortic root (anyeurism, dissection, syphilis, annuloaortic ectasia)
acute aortic regurg results in
quick rise in diastolic pressure > backs up to left atrium and into pulmonary vasc > edema or pulmonary congestions
chronic aortic regurg results in
volumne overload and some pressure overload of LV
ventricle dilates over time with increased compliance
reudced pressure to LA and pulmonary vasc
aortic regurgitation clinical presentaion
dyspnea on exertion
fatigue
reduced exercise tol
chest pain
physcial signs aortic regurg
hyperdynamic pulses
widened pulse pressure (diastolic less than half systolic)
decrcendo diastolic murmur
austin flint mumur (diastolic rumble)
CXR aortic regurg
enlarge LV
(acute unlikely to show, more likely to show pulmonary vascular congestion)
treatment acute aortic regurgitation
immediate surgical replacement
chronic aortic regurg treatment
asymptomatic w/ normal LVEF - followup with echo, Ca channel blocker or ACE if hypertensive
asymptomatic w/ low LVEF - valve replacement
symptomatic w/ normal LVEF - valve replacement
Acute mitral regurgitation leads to
normal LA size and compliance
high LA pressure
high pulmonary venous pressure
pul edema+congestion
prominent V waves on Cath
Emergency
chronic mitral regurg leads to
increased LA size and compliance
normal LA and pulmonary venous pressure
lower forward Cardiac Output
LVH
posible systolic dysfunction
auscultation Mitral valve regurg
holosytolic murmur at apex of heart
treatment acute mitral regurg
stablize with diuertics and vasodilators
consider emergent surgery (eg, if via endocarditis)
treatment chronic mitral regurg
monitor asymptomatic
repair or valve replace
little can be done if LV dysfxn
blood supply to papilary muscles
posteriomedial - right coronary
anterolateral - dual supply
most common caue mitral stenosis
Rheumatic fever
clinical presentation mitral stenosis
dyspnea+ reduced exercise capacity
worsens with increased HR (pregnancy)
possible sings of right sided failure
possible hoarseness, hemoptysis
physical exam findings mitral stenosis
early - opening snap and murmur
late - opening snap and murmur, RV lift
treatment mitral stenosis
dieretics if vasc congestion
if Afib - Beta block and Ca block, also anticoag therapy
valve replacement if refractive or severe Pul HTN
