Valvular HD Flashcards
What are some causes of a systolic murmur
Aortic stenosis, mitral regurgitation, pulmonary stenosis
What are some causes of a diastolic murmur
Aortic or pulmonary regurg. Or mitral stenosis
Who do we always Echo?
Symptomatic Valve Dx Diastolic murmur Late or holosystolic murmur Radiating murmur Click murmur Grade 3 or louder
Who do we not echo?
Grade 2 or lower
Mid systolic murmur less than grade 3
A murmur that is 4/6 late peaking systolic murmur that radiates to the carotid and a paradoxically split S2 is what type of murmur?
Aortic stenosis
With aortic stenosis what findings would you anticipate?
EKG- hypertrophy
CXR-cardiomegally
Systolic murmur
What are the treatments with aortic stenosis
Don’t want tachycardia
Be careful lowering BP
Exercise restrictions for moderate to severe
Severe- AVR mechanical or prosthetic
With mechanical and prosthetic valves. You must do what to prevent clots? How do you do this?
Anticoagulate all mechanical valves with Coumadin and ASA for INR goal of either 2-3 or 2.5-3.5 for severe high risk (AF/Left ventricle dysf.)
Prosthetic valves ASA daily 75-100mg
With risk factors INR 2-3
Cause of aortic stenosis
Congenital
Calcification
Rheumatic heart Dx
Causes of aortic regurgitation
Idiopathic aortic dilation Bicuspid valve Calcification Rheumatic heart disease Marfans Dissection of the aorta Endocarditis Systemic HTN
Aortic regurg causes what symptoms?
Pulmonary edema from backing up into the lungs
Cardiogenic shock
Diastolic murmur
Widened pulse pressure (30-50 normal)
Austin-Flint rumble
LVH- EKG
Lv dialation
If Aortic Regurgitation is caused by bicuspid aortic valves then what is a concern?
AAA
What is the treatment for a AAA?
Beta blockers until operate.
Once it grows more then 5cm or more than 0.5cm in one year
What is the plan for AR
TEE/ECHO EKG
Beta blocker
If trauma or aortic dissection then-
Surgical emergency
Nipride and Inotropic agents may be helpful
Mitral stenosis is caused by?
Rheumatic fever
Congenital
SLE
Calcification
What are symptoms of Mitral stenosis?
CHF Orthoptera AF Diastolic murmur Opening snap EKG Left atrial enlargement
What murmur causes a diastolic murmur, low pitch rumbling radiating to axilla
Mitral stenosis
What is the treatment for mitral stenosis?
No strenuous exercise Fluid and salt restrictions Treat AF No echo annually unless severe Watch for pulmonary HTN
If pulmonary HTN occurs with mitral stenosis what should the patient have done?
Per cutaneous mitral balloon valvuloplasty
If severe MVR
What causes mitral regurgitation?
Rheumatic fever CAD Dilated LV I.E. Mitral prolapse
What murmur causes a pansystolic murmur loudest at apex and radiating to axilla and an S3 sound?
Mitral regurg
What is the treatment for mitral regurgitation?
None for general A symptomatic treatment
No vasodilators
ACEI, Coreg, bivebtricular pacing of severe
If the patient has a new murmur and fever what should you check for?
Endocarditis
What puts someone at risk for I.E.?
Heart defect IVDU Valve Previous I.E. Poor dentition
What are Janes way lesions?
Non painful lesions in hands that I.E. Patients can get
What are Oslers nodules
Painful lesions on toes that IE can get
If a patient with I.E. Is being treated with ABX and isn’t getting better what do you anticipate?
Paravalvular abscess
What are some diagnostic tests you’ll want with I.E.?
Blood cultures
CBC
Sediment rate
Echo TEE
Who would you prescribe prophylactic ABX to?
Previous I.E. Patients
Prosthetic HV patients
CHD that is I repaired or repaired with residual effects and 6 months after repair
Cardiac transplant with valvulopathy
When do you cover selected patients with ABX?
Dental work or work on skin, respiratory and musculoskeletal
What do you prescribe for ABX prophylactic coverage?
Amoxicillin 2GM 1 hour prior
Clindamycin 600 1 hour before
