Valvular disorders P1 AND P2 trigger Flashcards
Presents medium pitched, harsh quality with thrill
aortic stenosis
2 ICS w radiation to carotids
aortic stenosis
midsystolic
aortic stenosis or MVP
CXR with dilated ascending aorta, enlarged cardiac sihouette
CXR for aortic stenosis
also see:
Calcified aortic valve
can be treated with statins
aortic stenosis
can be caused by aortic dissection and marfans
aortic regurgitation
widened pulse pressure on PE
aortic regurgitation
austin flint murmur
aortic regurgitation
S3 OR S4 gallop
aortic regurgitation
S4 gallop
Aortic stenosis
OR
aortic regurg
laterally displaces apical impulse
aortic stenosis
low pitched, diastolic murmur, heard at apex
This describes the austin flint murmur
but could also describe mitral stenosis!
Holo diastolic murmur
aortic regurgitation
or
SEVERE pulmonic regurgitation
high pitched and blowing murmur
aortic regurgitation
or
pulmonic regurgitation
what are the AVR surgery indications in aortic valve regurg
BEFORE THESE HAPPEN:
LV dilation >5cm
EF <50%
treat with BB
aortic regurgitation
in patients who are poor candidates for open heart surgery or are of intermediate risk, what treatment would be used for aortic stenosis
TAVR
when would you use ARBS instead of BB in an aortic regurg patients
in patients with marfans syndrome
can be caused by infective endocarditis, root dissection, and acute dysfunction of prosthetic valve
acute aortic regurgitation
can also be caused by traumatic rupture of aortic leaflets
heard best with patient sitting and leaning forward
aortic regurgitation and stenosis
results in hemodynamic instability, pulmonary congestion, and pulmonary edema.
acute aortic regurgitiation
low pitched, early diastolic murmur with rapid pulse
suggestive of cardiogenic shock!
symtpoms also include:
pale, cool extremities
weak, rapid pulse
when is a stat echo used
acute aortic regurgitataion
CXR showing cardiomegaly with LV prominence
acute and normal aortic regurgitation
could treat with hydralazine and furosemide if BP is stable. may need inotropic agents or vasopressors
acute aortic regurgitation (treat with vasodilator and diuretics if stable BP)
what is affected by marfans disease
the aortic root, therefore causing aortic regurg
MC demographic is women
tricuspid stenosis
LA enlargement
Mitral stenosis (initial hemodynamic change, may result in pulm congestion)
leads to right sided HF due to increased in pulmonary vascular resistance
mitral stenosis
typically develope symptoms of this disease in 4th-5th decade of life
Mitral stenosis (20-40 years following illness)
fatigue, exertional dyspnea, orthopnea
mitral stenosis
afib, hemoptysis, blood tinged sputum
mitral stenosis
may also see:
peripheral embolism
pulmonary edema
hoarsness as result of left recurrent laryngeal nerve compression
patient presenting with hoarsness and pulmonary edema
mitral stenosis
hoarsness d/t left recurrent laryngeal nerve compression
also presents with
afib
hemoptysis
blood tinged sputum
low-pitched, rumbling, diastolic murmur best heard at apex
mitral stenosis
best heard in LLD
mitral stenosis
S1 loud early on and opening snap heard following S2
mitral stenosis
EKG shows LA abnormality and RV hypertrophy pattern. also shows afib
Mitral stenosis
“hockey stick” of anterior MV leaflet
echo result for mitral sttenosis
what cannot be done in degenerative AS due to a high restenosis rate
balloon valvuloplasty
soft high pitched diastolic rumble. hear better on inspiration
tricuspid stenosiswh
what murmurs have an “opnening snap?”
mitral and tricuspid stenosis!
these murmurs are so similar except mitral is LOW picthed and tricuspid is HIGH pitched. also tricuspid is heard better on inspiration
WHY IS tricuspid stenosis increased during inspiration and mitral is not?
(i didnt get this and now i do)
increased venous return in inspiration!!!
tricuspid recieves venous blood from body, mitral just recieves from lungs.
EKG shows right atrial enlargement
tricuspid stenosis
treated with loops (torsemide or bumetanide) with addisiton of aldosterone antagonist if needed
Tricuspid stenosis!
loops for HF
aldosterone antagonist for liver congestion/ascities
palpable systolic liver pulsation
tricuspid regurgitation and stenosis
accentuated by leg raising and inspiration
tricuspid regurgitation
high pitche and pansystolic best heard at left sternal border
tricuspid regurgitation
EKG showing afib. cardiac cath showing elevated RA pressure
Triscuspid regurgitation
this murmur is typically a result of congenital defects such as noonan syndrome or trisomy 13
pulmonic stenosis
rare to be caused by anything else
progressive fatigure and dyspnea on exertion in adolesents or young adults is suggestive of what problem
pulmonic stenosis
what problem causes neonates to present at birth with cyanosis
pulmonic stenosis
presents with ejection murmur that increases during inspiration
pulmonic stenosis
RBBB seen on EKG
pulmonic regurgitation
caused by pulm HTN
pulmonic regurgitation
when do you do surgery in pulmonic regurgitation
very rarley, only if there is intractable RV failure
which valve replacement option is associated with LOWER risk of thromboembolic events?
tisssue!!! = less clot probability = plavix
mechanical = more clot probablility = warfarin!!!
EKG with LA abnormality, LVH pattern with possible afib
mitral regurgitation
treat with ACEI or hydralazine. also diuretics
mitral regurgitation
afterload reduction is ACEI or hydralazine
diuretics is for pulm congestion/edema
disease of aortic leaflets, aortic root or both
aortic regurgitation causes
leads to LVH and diastolic dysfunction
aortic stenosis
when are inotropic agents and vasopressors used
acute aortic regurgitation
which causes pulm edema and HTN and therefore leads to R sided HF
mitral stenosis
who is NOT a candidate for balloon valvuloplasty in MS
- patients with calcified leaflets and chords
- LA thrombus
caused by posterior wall MI
MV prolapse
LV dilation
mitral regurgitation
in a male patient >40 or a menopausal patient w R sided HF
what is used to assess mitral regurgitaition
cirinary angiography
