Valvular HD and Murmurs Flashcards
stenosis causes ___ by ____
causes hypertrophy and HF from pressure overload
regurg causes ___ by ____
causes dilation from volume overload
list the systolic murmurs
MR TR AS PS VSD ASD
list the diastolic murmurs
AR MS PR TS Atrial Myxoma
list the 6 grades of murmurs
- barely audible
- faint, soft
- louder, easily heard
- very loud w/ palpable thrill (vibration)
- heart w/ stethoscope barely touching chest w/ thrill
- can heart w/o stethoscope or can hear w/ stethoscope close to chest, palpable thrill
acute causes of mitral regurg
- ischemic papillary muscle dysfunction
- rupture chordal tendinae
- infective endocarditis
- volume overload
chronic causes mitral regurg
- MVP
- myxomatous degeneration
- mitral annular calcification
PE for mitral regurg
- systolic murmur
- blowing at apex
- radiates to left axilla
demographic for MVP
females > males 7:1
sx/PE for MVP
- range from asymptomatic to having CP
- SVT
- PVCs
- dyspnea
- systolic murmur at apex
- may have click/murmur increase w/ valsalva and standing
how does decreased ventricular volume and chamber size affect MVP murmur
increases it
sx of tricupsid regurg
asymptomatic
auscultation for tricuspid regurg
blowing systolic mumur at 4th ICS LSB, increases on inspiration (Carvallo sign)
when is tricuspid regurg significant
when associated w/:
- pulmonary HTN
- lung dz
- RV infarction
- inferior wall MI
- pacemaker
- infectious endocarditis
how does tricuspid regurg affect jugular venous pulse
makes prominent V wave
two etiologies of AS
- degenerative calcification
- bicuspid (genetic)
sx AS
- dyspnea
- angina
- syncope
PE for AS
- harsh systolic mumur, crescendo-decrescendo, 2nd ICS RSB
- radiates to sternal notch/carotids
- diminished S2
- Pulsus parvus et tardus (weak and slow pulse)
- narrow pulse pressure (140/100)
ECG for AS
LVH, strain pattern (down sloping of ST segment - T wave)
what genetic conditions is bicuspid aortic valve related to
marfans, turner’s
bicuspid aortic valve sounds to auscultation
systolic murmur/click at LSB or apex
describe murmur of PS
crescendo-decrescendo at 2-3 ICS LSB, radiate to left shoulder and clavicle
what congenital defects are associated with tetrology of fallot
- PS
- VSD
- RVH
- overriding aorta
auscultatory findings of VSD
holosystolic mumur at lower LSB w/ thrill
auscultatory findings of ASD
systolic mumur upper LSB w/ fixed splitting of S2
etiology of MS
- rheumatic heart dz group A strep
- congenital
- mitral annular calcification
MS leads to ____
- pulm HTN
- RV failure
- left atrial enlargement
- a fib
sx MS
- dyspnea
- orthopnea
- palpitations
- hoarseness (compression of recurrent laryngeal n.)
PE for MS
diastolic murmur, low pitch, rumbling at apex
- increased S1 and S2 followed by opening snap
ECG for MS
- LAE if in sinus
- a fib
- RV hypertrophy
- right axis deviation if associated with pulm HTN
etiology TS
- rhematic dz**
- associated with mitral stenosis
- more common in females
auscultatory findings for TS
diastolic murmur LSB increases on inspiration (Carvallo sign)
effect of TS on jugular venous pulse
prominent A wave
ECG for TS
right atrial enlargement
acute causes AR
- infective endocarditis
- aortic dissection
- chest trauma
chronic causes AR
- calcific degeneration
- bicuspid aortic valve
- dilated aortic root
- rheumatic
AR causes ___ from ____
causes LVH and LHF from volume overload
sx of AR
acute: pulmonary edema from infectious endocarditis
chronic: dyspnea, orthopnea, angina
ausculatory findings AR
diastolic decrescendo murmur 3rd ICS LSB, soft S2
PE findings AR
- wide pulse pressure (130/50)
- DeMusset sign (head bob***)
- Quincke’s sign (capillary nail pulsations)
- Traube sign (pistol shot sounds over femoral a.)
- Duroziez’s sign (diastolic murmur over femoral a. w/ compressed w/ bell)
ausculatory findings PR
diastolic decrescendo murmur 2nd ICS LSB
PR is associated with ___
pulm HTN and increased S2
