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Valvular Ds Flashcards

1
Q

S1 and S2 Heart Sounds

A

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”

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2
Q

S3 Heart sound

A

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*

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3
Q

S4 Heart Sound

A
  • Occurs after atrial contraction at the end of diastole before S1 (active ventricular filling)
  • Atrial blood striking ventricle
  • Is indicative of DIASTOLIC HF*
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4
Q

Diagnosis of Valvular Disease

What is the main modality to diagnose valvular disease?

A

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

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5
Q

What is the best modality to further assess severity mitral valve disease?

A

Transesophageal Echocardiogram *
-more invasive
-Distinguish between moderate and severe

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6
Q

Aortic Stenosis: definition and sx

A
  • 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”

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7
Q

What is the most common valvular disease in the united states?

A

Aortic Stenosis

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8
Q

Aortic Stenosis causes

A

Congenital Defects (bicuspid valve)
Rheumatic Heart Disease
Endocarditis: MC - S. aureus
Connective Tissue ds: marfans
Degenerative Disease
- commonly from senescence = weakening of valve

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9
Q

Aortic Stenosis signs

A

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

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10
Q

Upon auscultation for aortic stenosis you will hear? ***

A

2nd Right intercostal space:
- Harsh cresendo-decrescendo SYSTOLIC murmur (lub pshhhHHHHhhh dub)
- with radiation to the carotids
- decreased S2 sounds

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11
Q

Medical treatment for aortic stenosis? + caution

A

Heart Failure Treatment!!:
- duretics
- vasodilators (- ACEi)

caution with: Beta-Blockers
- pts are preload dependent to overcome stenosis
- BBs will decrease preload and afterload

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12
Q

surgical treatment for aortic stenosis and when is it indicated

A

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

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13
Q

mechanical valves

A

Mechanical:
- requires LIFELONG anticoagulation with coumadin/warfarin (INR: 2.5-3.5)**
- lasts longer = Better for <50 year olds

types:
- bileaflet
- ball cage valve

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14
Q

Bioprostethic valves

A
  • MC valve type!
  • TAVR is only bio-prostetic
  • good for pts with anticoagulation contraindication and infants

types:
- bovine = cow
- porcine = pig
- equine = horse
- TAVR!!!

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15
Q

Transcatheter Aortic Valve Replacement (TAVR)

A

Used for low to high risk pts

MC approach: Femoral*
- Apical
- Subclavian

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16
Q

Aortic Regurgitation definition + sx

A

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

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17
Q

Aortic Regurgitation Causes

A

Rheumatic Fever*
Endocarditis*
Bicuspid Aorta*
Connective tissue ds:
- Marfan’s Syndrome
- Ehlers Danlos Syndrome
Aortic Dissection/Dilation
HTN, MI

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18
Q

Aortic Regurgitation signs

A

*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

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19
Q

aortic regurgitation treatment

A

Heart Failure Management: for afterload reduction
-ACE inhibitor (Ramipril, Lisinopril)
-ARB (Valsartan, Losartan)

Surgical Management: Aortic Valve Replacement
- DEFINITIVE tx
- indicated for acutely symptomatic OR asymptomatic with LV decompensation

20
Q

mitral stenosis definition and causes

A

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

21
Q

mitral stenosis sx

A

Dyspnea*
Orthopnea
Cough
Palpitations
Angina
Dizziness
Hemoptysis

22
Q

mitral stenosis signs

A

Left + Right Sided HF!!
- Left sided HF starts first, which then leads to right sided HF
AFIB

Auscultation:
- Opening snap with low pitched DIASTOLIC murmur
- Best heard at APEX in left lateral decubitus position

Mitral STEVE -> snappy old guy at WARfarin (= Afib) + L and R hf in L lateral decubitus position

23
Q

mitral stenosis treatment

A

Medical management
-Heart failure management (ace/arb)
-Anticoagulation in patient with afib -> Require WARFARIN

Surgical management:
-For symptomatic patients with severe mitral stenosis with a valve area of 1.0cm^2 or less
-Surgical mitral valve replacement: no prior valvular procedure
-Transcatheter mitral valve replacement -> Approved for valve-in-valve procedures where new valve is superimposed over old

Mitral STEVE -> snappy old guy at WARfarin + L and R hf

24
Q

Mitral Regurgitation
Definition + causes

A

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

25
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"
26
mitral regurgitation sx
-Dyspnea -Orthopnea -PND -Angina -Dizziness -Syncope -Palpitations
27
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"
28
Mitral valve prolapse definition and causes
Definition: - Misplacement of mitral leaflets into left atrium -MC cause of mitral regurgitation in US! Causes: -Degeneration of mitral valve -Marfans syndrome, Ehlers-Danlos syndrome -Rheumatic fever -Papillary muscle rupture - can be idiopathic in young ppl with no complications
29
mitral valve prolapse symptoms
Most = ASYMPTOMATIC until progression to mitral valve regurgitation -Palpitations * -Chest pain -Dyspnea -Dizziness -Syncope -Fatigue
30
mitral valve prolapse signs
Left sided HF with significant mitral regurgitation Auscultation: -Mid-systolic ejection click -Best heard at the APEX
31
Tricuspid Stenosis Definition + causes
Definition: - Narrowing of the tricuspid valve = volume overload of right atrium = RIGHT sided HF Causes: - Infective endocarditis: bacterial infection of the valve - Rheumatic fever - Carcinoid syndrome: can cause inflammation - Radiation therapy - Congenital
32
Symptoms + signs of Tricuspid Stenosis
Symptoms: - Fatigue - Abdominal distention - Palpitations Signs: - RIGHT sided HF* - Mid-DIASTOLIC murmur @ LLSB - Murmur increases with INSPIRATION -> higher thoracic gradient —- Diastolic: -Mitral/tricuspid stenosis -aortic/pulmonary regurgitation Tricuspid = 3 (middle is 2) MID diastolic + increase with inspiration "TRI to INSPIRE"
33
Tricuspid Regurgitation Definition + causes
Definition: Inadequate closure of the tricuspid leaflets = Back flow of blood into right atrium during systole Causes: -pulmonary HTN -COPD -rheumatic fever -endocarditis -IV drug use!!!*- staph -PE -congential -PPM/ICD wires "TRI to REGulate the PRICE + manage HF" - PPM/ICD wires -Rheumatic fever - IV drug use: staph - congenital - Endocarditis
34
Tricuspid Regurgitation sx and signs
Sx: -fatigue -weakness -SOB -palpitations Signs: -RIGHT sided HF Auscultations: -HOLOSYSTOLIC murmur at left lower sternal border -increases with inspiration -radiates to the xiphoid
35
Tricuspid Regurgitation tx
Right sided heart failure management: Diuretics! "TRI to REGulate the PRICE + manage HF"
36
Murmur summary: location and auscultation
37
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
38
tetraolgy of fallot
Overriding aorta - aorta is positioned over VSD: connected to R AND L ventricles -> receives mixed blood and sends it to body -> CYANOTIC Ventricular septal defect RV outflow obstruction: - pulmonary stenosis RV hypertrophy
39
pulmonic stenosis sx + signs
Symptoms: -fatigue -dyspnea -syncope -chest pain signs: -right sided HF Auscultation: -mid SYSTOLIC murmur -best heard at 2-3rd left intercostal space -radiated to the left shoulder -increases with inspiration
40
Pulmonary Regurgitation Definition + causes
Definition: - Inadequate closure of pulmonary valve = Back flow of blood into right ventricle during diastole Causes: - Congenital * - Pulm HTN * - Endocarditis (less common) - Rheumatic Fever (less common)
41
Pulmonary Regurgitation sx + signs
Symptoms: -Usually ASYMPTOMATIC until right sided HF Signs: -Right sided HF Ausculation: Graham-Steel murmur: - high pitched decrescendo early diastolic murmur at left upper sternal border -Murmur increases with inspiration
42
septal defects: atrial septal defect (ASD)
-Failed closure between the right and left atrium -Most commonly asymptomatic until adulthood - higher risk of stroke -Auscultation: systolic ejection murmur at 2nd L intercostal space*
43
septal defect: ventricular septal defect (VSD)
-Failed closure between the right and left ventricle -Auscultation: systolic murmur at LLSB* -Symptoms depend of size - cyanotic baby: VSD -Asymptomatic to failure to thrive
44
Dental Prophylaxis What patient population would need this?
Indications: *Hx of endocarditis *Prosthetic cardiac valve repair *Congenital heart disease -unrepaired cyanotic ds/repaired with residual defect - completely repaired congenital with prostetic material within 6 months - Pacemakers don’t need it unless its brand new - within 3 months these pts need: antibiotics 30-60 min prior to dental work - rich vascularization of the mouth that can easily spread pathogens to the heart - Prophylaxis against Endocarditis
45
septal defects: patent foramen ovale
-Failed closure of foramen ovale -Can be asymptomatic - hypercoagulo Embolic CVA known as paradoxical embolism - DVT can travel from RA to LA and cause CVA - clot travels from venous to atrial system
46
First line treatment for dental prophylaxis + allergies
First-line: Amoxicillin -2 grams 30-60 min prior to procedure PCN allergies: - Cephlaxin 2 grams - Clindamycin 600 mg - Azithromycin 500 mg
47
Reversal Agents

Cardiology (6 decks)

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