VALVULAR DISEASES (not finished) Flashcards
S1 heart sound
lub
- mitral and tricuspid valve closure at beginning of systole
S2 heart sound
dub
- aortic and pulmonary valve closure at the end of ventricular systole and beginning of diastole
S3 heart sound
and what can it indicate
occurs at beginning of diastole following S2
- lower in pitch
- normal/benign in youth
can indicate volume overload
S4 heart sound
and what does it indicate
occurs after atrial contraction at the end of diastole, BEFORE S1
- blood being forced into a STIFF ventricle
DX of valvular ds
- Transthoracic echo: measure valve areas and gradients (main choice)
- TEE: better to assess severity of mitral valve ds (mod v. severe)
- cardiac cath
Aortic stenosis- definition
narrowing of aortic valve opening increasing afterload, leading to LV failure
MC VALVULAR DS IN US
the pressure/backflow that the LV has to overcome has INCREASED due to stenosis
Aortic Stenosis- causes
- congenital defects- bicuspid aortic valve (only has 2 flaps instead of usual 3)
- rheumatic heart ds (attack own heart valves)
- endocarditis (mc bacterial)
- connective tissue ds
- degenerative ds
aortic stenosis- symptoms
**- Dyspnea
- CP (not getting as much blood into coronary arteries)
- Syncope **
- orthopnea
- PND (paroxysmal noctural dyspnea)
- fatigue, dizzy, pre syncope
aortic stenosis- signs and auscultation
- L sided HF (rales, dec breath sounds at bases, hypoxia)
Auscultation: HARSH crescendo-decrescendo systolic murmur (2nd intercostala space, radiation to carotids)
- soft S2 or loss of S2
- parvus et tardus–diminish carotid pulse
- precordial thrill
aortic stenosis- Tx
medication and surgical
medication: HF tx (diuretics, vasodilators), caution with BB (can overload LV)
surgery:
- aortic valve replacement: symptomatic pt w/valve area 1.0 cm2 or less
- open (SAVR) v. Transcatheter (TAVR)
- bioprosthetic v. mechanical (need anticoag, coumadin, INR 2.5-3.5)
valve types
bioprosthetic
- MC type
- bovine, porcine, equine
- TAVR is ONLY bio prosthetic
mechanical
- bileaflet, ball cage
- good for pt <50 yrs
- LIFE LONG ANTICOAG W/COUMADIN
what are bioprosthetic valves used?
what do mechanical valves always requrie?
bio—> TAVR (open heart surgery)
mechanical–> life long anticoag w/COUMADIN (INR 2.5-3.5)
TAVR approaches
for what kind of pts?
MC approach?
for low to high risk pts
- femoral is MC
- apical or subclavian options
Aortic regurgitation- definition
inadequate closure of aortic insufficiency
- unable to remain closed during diastole, result in backflow from aorta to LV
aortic regurg- causes
rheumatic fever, endocarditis, bicuspid aortic valve, marfans, SLE, ehlers-danlos, aortic dissection, HTN, syph, acute MI
aortic regurg- symptoms
- dyspnea, orthopnea
- PND
- palpitations, angina
- dizzy, syncope
aortic regurg- signs and auscultation
- L sided HF
Auscultation:
- diastolic decrescendo murmur (LLSB)
- murmur inc w hand gripping, sitting, leaning forward (inc vasc resistance–inc afterload)
- corrigans pulse (forceful/rapid then collapses)
- austin flint murmur (low pitch, rumbling heard at apex)–> severe AR
aortic regurg- tx
medication + surgical (symp v. asymp)
medication: HF management
- afterload reductive (ACEi and ARB)
surgical: aortic valve replacement
- for acute symptomatic AR
- asymp AR–> LV decompensation
ACEi–> ramipril, lisinopril
ARB–> valsartan, losartan
mitral stenosis- defintion
narrowing of mitral valve, affecting blood flow between L atrium and ventricle
- inc L atrial pressure and volume overload
mitral stenosis- causes
and MC?
MC CAUSE is RHEUMATIC HEART DS (rheum. fever–untreated strep)
- infective endocarditis
- congenital
- sys. lupus
- rheumatoid arthritis
- amyloidosis
- degenerative ds
- L atrial myxoma
what can strep antigens lead to ?
scarring and narrowing of mitral valve
mitral stenosis- symptoms
- dyspnea, orthopnea
- cough, CP
- palpitations, angina
- dizzy, syncope
- hemoptysis
mitral stenosis- signs and auscultation
- L sided HF AND R sided
- afib
auscultation: opening snap with LOW pitched diastolic murmur
- heard at apex in L lateral decubitis position
mitral stenosis- Tx
medication + surgical
medication:
- HF management
- anticoag pt w/afib (warfarin)
surgical:
- symp pts w/severe valve area of 1.0 cm2 or less—> surgical mitral valve replacement OR transcatheter replacement (valve in valve)
valve in valve (ViV)–> placing new valve inside old previously implanted valve w/out removing the old
mitral regurg- definition
inadequate closure of mitral leaflets causing retrograde flow from LV into LA
- causes L atrial dilation, INC pulm pressure
mitral regurg- causes
MC cause in US? in developing countries?
MC in US- mitral valve prolapse
MC in developing countries- rheumatic fever
- endocarditis
- papillary muscle dysfunc
- chordae tendinae rupture
- rheumatic fever
- marfans
- degenerative ds
mitral regurg- symptoms
MOST are ASYMP
- palpitations
- CP
- dyspnea
- dizzy, syncope, fatigue
mitral regurg- signs and auscultation
- L sided HF
auscultation: blowing holosystolic murmur
- best heard at apex
- radiation to AXILLA
mitral regurg- Tx
medication + surgical
medication: HF management
- afterload reduction w ACE/ARBs
surgical:
- mitral valve replacement v. repair
- transcatheter mitral clip for HIGH RISK PTS
what is preferred- mitral valve replacement or repair? what are the benefits?
mitral REPAIR
- preserved LV function
- lower risk of endocarditis
- less thrombotic events
mitral valve prolapse- definition
misplacement of mitral leaflets into L atrium
MC Cause of mitral regurg in US
mitral valve prolapse- causes
- degeneration mitral valve
- marfans, ehlers danlos
- rheumatic fever
- papillary muscle rupture
mitral valve prolapse- symptoms
MOST ARE ASMYP
- PALPITATIONS
- CP
- dyspnea
- dizzy, syncope, fatigue
Mitral valve prolapse- signs and auscultation
- L sided HF
auscultation: - midsystolic ejection click
- best heard at APEX
tricuspid stenosis- definition
narrowing of tricuspid valve, causing volume overload of R atrium
CAN lead to R SIDED HF
Tricuspid stenosis- causes
- infective endocarditis
- rheumatic fever
- carcinoid syndrome
- radiation therapy
congenital: ebstein anomaly
tricuspid stenosis- symptoms
fatigue, abdominal distension, palpitations
tricuspid stenosis- signs and auscultation
- R sided HF
auscultation: mid diastolic murur at LLSB
- INC with INspiration
tricuspid regurg- definition
inadequate closure of tricuspid leaflets causing backflow of blood into R atrium during SYSTOLE
tricuspid regurg- causes
- pulm HTN
- COPD
- rheumatic fever
- endocarditis
- iv drug users
- PE
- congenital
- PPM/ICD wires
tricuspid regurg- signs and symptoms
symptoms:
- fatigue, weakness, SOB, palpitations
signs:
R sided HF
tricuspid regurg- auscultation and TX
auscultation: holosystolic murmur at LLSB
- inc w inspiration
- RADIATE TO XIPHOID
tx: diuretic therapy
pulmonic stenosis- definition
narrowing of pulmonic valve causing R ventricular obstruction
- dec blood flow between R ventricle and Pulm artery
pulmonic stenosis- causes
almost always CONGENITAL
- tetrology of fallot=cyanotic lesion
- overriding aorta
- ventricular septal defect
- R ventricular outflow obstruction
- RVH
pulmonic stenosis- symptoms
fatigue, dyspnea, syncope, CP
pulmonic stenosis- signs
R sided HF
auscultation: mid systolic murmur
- heard at 2-3rd L intercostal space
- radiates to L SHOULDER
- INC with INspiration
pulm regurg- definition
inadequate closure of tricuspid leaflets causing backflow of blood into R ventricle
pulm regurg- causes
congenital, pulm HTN, endocarditis, rheumatic fever
pulm regurg- signs and symptoms
symptoms: asymp until R HF
signs: R sided HF
- graham steel murmur–> high pitched decrescendo EARLY diastolic murmur at LUSB
- inc w inspiration
dentla prop
