Valvular Ds Flashcards
S1 and S2 Heart Sounds
S1:
- Mitral & Tricuspid Valve closure at the beginning of systole
- Represents systolic “LUB”
S2:
- Aortic & Pulmonary Valve closure at the beginning of diastole/end of systole
- Represents diastolic “DUB”
S3 Heart sound
S3:
- Occurs at beginning of diastole following S2
- Ventricular Filling/Distension
Features of S3:
- Lower in pitch
- Benign in youth*
- If new sound = volume overload
Is indicative of SYSTOLIC HF*
S4 Heart Sound
- Occurs after atrial contraction at the end of diastole before S1 (active ventricular filling)
- Atrial blood striking ventricle
- Is indicative of DIASTOLIC HF*
Diagnosis of Valvular Disease
What is the main modality to diagnose valvular disease?
Transthoracic echocardiogram
- start with this first
-Visualization of the valve measuring valve areas and gradients
Other options:
- Transesophageal echocardiogram (TEE): BEST FOR MITRAL VALVE ds
- cardiac catheterization: surgical intervention
What is the best modality to further assess severity mitral valve disease?
Transesophageal Echocardiogram *
-more invasive
-Distinguish between moderate and severe
Aortic Stenosis: definition and sx
- Definition: Narrowing of aortic valve opening = ↑ AFTERLOAD = ↑
Resistance to blood flow = LV Failure - MC valvular disease!!!
sx:
- Dyspnea!
- Chest Pain!
- Syncope !
- Orthopnea
“Narrowing of the aortic valve opening increasing afterload, leads to LV failure”
What is the most common valvular disease in the united states?
Aortic Stenosis
Aortic Stenosis causes
Congenital Defects (bicuspid valve)
Rheumatic Heart Disease
Endocarditis: MC - S. aureus
Connective Tissue ds: marfans
Degenerative Disease
- commonly from senescence = weakening of valve
Aortic Stenosis signs
LEFT Sided Heart Failure!!!*
- Rales
- Decreased breath sounds at bases
- Hypoxia
On Auscultation:
1) Harsh Crescendo-Decrescendo systolic murmur **
- systolic murmur: lub pshhhHHHHhhh dub
- right 2nd intercostal space that radiates to carotids *
2) Decreased S2 sound
Diminished Carotid Pulse: Pulsus Parvus Et Tardus (Weak & Late pulse)
Pericordial thrill
Upon auscultation for aortic stenosis you will hear? ***
2nd Right intercostal space:
- Harsh cresendo-decrescendo SYSTOLIC murmur (lub pshhhHHHHhhh dub)
- with radiation to the carotids
- decreased S2 sounds
Medical treatment for aortic stenosis? + caution
Heart Failure Treatment!!:
- duretics
- vasodilators (- ACEi)
caution with: Beta-Blockers
- pts are preload dependent to overcome stenosis
- BBs will decrease preload and afterload
surgical treatment for aortic stenosis and when is it indicated
Aortic Valve Replacement!!!
Indication:
- Symptomatic pt with valve area less than 1.0 cm^2
Types of valves:
- Open vs Transcatheter (TAVR)
- Bioprosthetic vs Mechanical
mechanical valves
Mechanical:
- requires LIFELONG anticoagulation with coumadin/warfarin (INR: 2.5-3.5)**
- lasts longer = Better for <50 year olds
types:
- bileaflet
- ball cage valve
Bioprostethic valves
- MC valve type!
- TAVR is only bio-prostetic
- good for pts with anticoagulation contraindication and infants
types:
- bovine = cow
- porcine = pig
- equine = horse
- TAVR!!!
Transcatheter Aortic Valve Replacement (TAVR)
Used for low to high risk pts
MC approach: Femoral*
- Apical
- Subclavian
Aortic Regurgitation definition + sx
Definition: Inadequate closure of the aortic leaflets during DIASTOLE
- backward blood flow into LV
- causes LV VOLUME OVERLOAD
sx:
*Dyspnea
*Orthopnea
*PND
*Palpitations
*Angina
*Dizziness
*Syncope
*Paroxysmal nocturnal dyspnea
Aortic Regurgitation Causes
Rheumatic Fever*
Endocarditis*
Bicuspid Aorta*
Connective tissue ds:
- Marfan’s Syndrome
- Ehlers Danlos Syndrome
Aortic Dissection/Dilation
HTN, MI
Aortic Regurgitation signs
*Left sided HF!!!
*Corrigan’s pulse:
- bounding pulse from increased stroke volume
*Austin-flint murmur:
- Low pitch rumbling murmur heard at apex
Auscultation***:
- DIASTOLIC Decrescendo murmur best heard at LLSB
- Murmur INCREASES with hand gripping, sitting, leaning forward (increases when theres greater blood flow back to heart)
———
A REGULAR named Austin flint and corrigan = increases the amount you shake hands, sitting and leaning forward for convo
mitral stenosis definition and causes
Definition:
-Narrowing of mitral valve = ↓ blood flow from LA to LV
-causes: ↑ LA pressure & volume overload
Causes:
- rheumatic heart disease* (MC): streptococcal antigens lead to scaring & narrowing
-Infective endocarditis
-Congenital
-Systemic lupus
-Rheumatoid arthritis
-Amyloidosis
-Degenerative disease
-Left atrial myxoma
“STEVE Loves his CRADLER”
-Congenital
-Rheumatic HD* : MC = strep
-Amyloidosis
-Degenerative ds
-Lupus
-Endocardits
-Rheumatoid arthritis
- L atrial Myxoma
mitral stenosis sx
Dyspnea*
Orthopnea
Cough
Palpitations
Angina
Dizziness
Hemoptysis
Mitral Regurgitation
Definition + causes
Definition:
- Inadequate closure of mitral valve leaflets = backward flow of blood into left atrium
- Causes: left atrial dilation and increase pulmonary pressure
Causes:
- Mitral Valve Prolapse:* MC in US
- Rheumatic fever* MC developing countries
- Endocarditis
- Papillary muscle dysfunction
- Marfan’s syndrome
“Mitral Regurgitation: MR PEM Radiates
Mitral Regurgitation Signs, What do you hear on auscultation?
Left sided HF
Auscultation:
*Blowing HOLOSYSTOLIC murmur
*Best heard at the apex with radiation to the axilla
“holosystolic = pan-systolic that occurs throughout the entire systole, indicating abnormal blood flow”
Treatment for Mitral Regurgitation
Medical: HF management
- Afterload reduction: ACE/ARBs
Surgery: replacement vs. mitral valve REPAIR
-Mitral valve REPAIR preferred over replacement*
-Benefits of repair:
-Preserved LV function
-lower risk of endocarditis
-Less thrombotic events
Transcatheter Mitral Clip:
- High risk patient
- not surgical candidates
- “ -its a bandaid fix , makes it less severe, makes less symptoms”
Murmur summary: location and auscultation
pulmonic stenosis def + causes
Definition:
-narrowing of the pulmonic vale causing right ventricular obstruction
-decreased blood flow between right ventricle and pulmonary artery
Causes: almost always CONGENITAL
-tetraolgy of fallot = combination of heart defects which is a CYANOTIC lesion
-1. overriding aorta
-2. ventricular septal defect
-3. RV outflow obstruction: pulmonary stemosis or small pulmonary valve
-4. RV hypertrophy
Reversal Agents
