Valvular Heart Disease Flashcards
S1 Intensity increase in (2)
Early stages of rheumatic MS
Hyperkinetic States
S1 becomes SOFTER in (2)
Late stages of MS
Contractile Dysfunction
A2-P2 Interval unusually narrow
Pulmonary Hypertension
A2-P2 Interval widened
Severe MR
Fixed Splitting A2-P2 interval
ASD
Reverse or Paradoxical Splitting of A2-P2 interval
Severe AS, HOCM, MI
A2-P2 Interval INCREASES during
INSPIRATION
narrows with expiration
Opening Snap
Mitral Stenosis
Tumor plop
Atrial Myxoma
Pericardial Knock
Constrictive Pericarditis
Crescendo Mid-systolic Murmur
Aortic Stenosis
Holosystolic Murmur
Mitral/Tricuspid Regurgitation
Murmur of VSD
Holosystolic murmur at Left Lower Sternal Border (Tricuspid)
Murmur of ASD
Systolic Ejection Murmur at 2nd ICS Left of Sternum (Pulmonic)
All other murmurs diminishes with standing and valsalva maneuver except?
HOCM, MVP
All other murmurs are louder when squatting except?
HOCM, MVP
70/M with chest pain on exertion, SOB for 2 months. 1 episode of syncope. 3/6 midsystolic murmur at the 2nd ICS right sternal border. With weak and delayed pulse.
DIAGNOSIS?
Aortic Stenosis
Cardinal Symptoms of AS
SYNCOPE
ANGINA
DYSPNEA
Best initial test for AS/AR
Transthoracic Echocardiogram
Treatment of choice for AS
AV valve replacement surgery
3 Principal Causes of AS
1 Congenital Bicuspid Valve with superimposed calcification
2 Calcification of normal trileaflet valve
3 Rheumatic Disease
Term for murmur transmitted downward confusing AS with MR
Galliverdin Effect
Average rate of hemodynamic progression in AS
decrease in aortic valve area of 0.12cm2/yr
62/M with HTN complains of fatigue and SOB. With high pitched, blowing, diastolic murmur on the left sternal border and widened pulse pressure. With murmur heard on femoral artery. DIAGNOSIS?
Aortic Regurgitation
Murmur heard over femoral artery is known as
DUROZIEZ SIGN
Etiology AR
Primary Valve disease and/or aortic root disease
Rumbling sound heard in severe AR
Austin Flint murmur
Jarring of the entire body and bobbing motion of the head in AR
De Musset Sign
Bounding ans forceful pulse, rapidly increasing and subsequently collapsing in AR
Water-Hammer or Corrigan’s pulse
Capillary pulsation at the root of the nail
Quincke’s pulse
Booming “pistol shot” sound over femoral arteries
Traube sign
Management for Acute AR
Diuretics, Vasodilators
Surgery within 24hrs
NO TO X BETA BLOCKERS
Management for Chronic AR
ACEi or ARBs
Diuretics
DHP CCB/BB
Surgery
30/F with hx of rheumatic fever presents with dyspnea and palpitation. Opening Snap heard followed by low pitched, tumbling, diastolic murmur at apex. DIAGNOSIS?
MITRAL STENOSIS
Most common cause of MS
Rheumatic Fever
Earliest CXR finding in MS
straightening of the upper left border of the cardiac silhoutte
Treatment of choic for MS
Percutaneous Transmitral Commissurotomy
Hemodynamic hallmark of MS
Abnormally elevated AV pressure gradient on 2D Echo or hemodynamic studies
2D Echo showed symmetric fusion of commissures, resulting in DOMING of leaflets in diastole (Hockey Stick Sign)
DIAGNOSIS?
MS
Normal Mitral valvular area
4 - 6 cm2
Mitral Stenosis
Mild - >1.5cm
Moderate - 1-1.5cm
Severe - <1.5cm
MS management
Diuretics for pulmonary congestion
Slow down HR - BB, Digoxin, NDHP CCB
Warfarin if with AF
Percutaneous Mitral Balloon valvotomy (most effective tx)
Valve replacement surgery
Penicillin prophylaxis for Group A B-hemolytic strep (rheumatic fever)
