Valvular heart disease Flashcards
What are the most common causes for valvular heart disease
Mitral regurge
Aortic stenosis
What is the most common cause for valvular disease in developing countries
Rheumatic heart disease
Where are congenital murmurs typically found
Aortic or pulmonic valve
What are some acquired murmurs
rheumatic fever
syphillis
endocarditis
cardiomyopathy
aortic aneurysm
What are complications that occur with valvular diseases
heart failure
stroke
clots
arrhythmias
death
What is occurring in the valve when regurgitation is occurring
leaflets don’t close properly and the blood back flows
**Generally from prolapse
What is occurring in the valve with stenosis s
Leaflets become thick /stiff from calcium deposit and may even fuse together
What is valvular atresia
valve isn’t formed
-solid tissue prevents blood flow between chambers
When are right sided murmurs louder
During inspiration
**(Rinspiration)
When are left sided murmurs louder
expiration
What murmurs get louder when after load is increased
aortic regurge
mitral regurge
VSD
What murmurs get quieter when after load is decreased
HOCM
Mitral prolapse
aortic stenosis
Which murmurs get louder when preload is increased
aortic stenosis
mitral stenosis
What murmurs get quieter with increasing preload
HOCM
Mitral prolapse
Which murmurs get loud with decreasing preload
HOCM
Mitral prolapse
Which positions will accentuate mitral murmurs
Mitral stenosis
**Causes S3 & S4 to accentuate
What murmur will get louder when the patient is sitting up and leaning forward
aortic regurge
What are common presenting valvular disease symptoms
chest pain
abdominal swelling
SOB
dizziness
What is the most common type of heart murmur
Innocent murmur
What causes innocent murmurs
rapid ejection of blood across the valve (Common in hyperkinetic state)
What are examples of hyperkinetic states
pregnancy
fever
anemia
rapid growth
Which characteristics make a murmur pathologic
Diastolic murmur
Holo- or late systolic
continuous
Grade >3
which murmurs do you hear mid systolic
innocent / functional
aortic stenosis
HOCM
Which murmurs do you hear late systolic
Mitral prolapse
Which murmurs are holosystolic
MR
TR
VSD
What is one of the most common and most serious valve diseases
Aortic stenosis
What are some of the aortic stenosis symptoms
breathlessness
chest pain /pressure /tightness
fainting
palpitations
decline in activities / ADL
What type of murmur does aortic stenosis have
systolic
crescendo - decrescendo
narrow pulse pressure on BP
What is the treatment of aortic stenosis
valve replacement
When is treatment of aortic stenosis indicated
once symptoms begin OR when LV dysfunction occurs
What is aortic regurge
leakage of the aortic valve each time to LV relaxes
What causes aortic regurge
valvular calcifications
endocarditis
aorta-dilation
What is the most common cause of chronic aortic regurge in children
ventricular septal defect
When will you hear aortic regurge best
while patient is supine
What type of murmur is aortic regurge
diastolic
**decrescendo murmur
What is corrigans pulse
wide pulse pressure
When is corrigans pulse seen
severe aortic regurge
When do you hear an Austin-flint murmurs
severe aortic regurge
**Heard at the apex of the heart
What is occurring in mitral regurge
volume overload which causes LV remodeling
What are some mitral regurge symptoms
LE edema
SOB
**Especially on exertion when laying down
What type of murmur is mitral regurge
holosystolic
Where will a mitral regurge murmur radiate
axilla or left sternal border
What effects does mitral regurge have on the body
slow progressive symptoms of heart failure and, if afib develops - palpitations
What is the treatment for mitral regurge
symptomatic patients and patients meeting echo criteria get a valve replacement / repair
What are some causes of mitral regurge
endocarditis
MI
HOCM
trauma
age
What is the most common cause of isolated MR
Mitral prolapse
What is heard with mitral valve prolapse
mid to late sharp systolic click (S1 / S2 normal)
How is mitral prolapse treated
does not usually require treatment
**Beta blockers can help with sx
What patient populations experience mitral stenosis
age 15-40 in developing nations
How will mitral stenosis present
hemoptysis
LE edema
palpitations
chest discomfort
What is the pathophys of mitral stenosis
pressure build up in the LA and sent back to lungs = congestion and SOB
What generally causes mitral stenosis
rheumatic fever
annular calcification
What will mitral stenosis sound like
Loud S1 with snappy-hallmark
Where is mitral stenosis heard best
At the apex of lungs with patient in left lateral decub
When are prophylactic abx agains endocarditis indicated with mitral stenosis
patients who have had a valve replacement
When are symptoms first noticed with pulmonary stenosis
while exercising
What is the general cause of pulmonary stenosis
congenital heart defect
When is pulmonary stenosis usually diagnosed
childhood
What are the complications associated with pulmonary stenosis
RVH
Right HF
Arrhythmia
Increased risk of infective carditis
What is the treatment for pulmonary stenosis
valvuloplasty
what does pulmonary stenosis sound like
increased S2 splitting
crescendo-decrescendo systolic
What is the most common cause of pulmonary insufficiency
pulmonary hypertension or tetralogy of fallot
How will pulmonary insufficiency found
high pitched
early decrescendo murmur
ends before S1
How do you treat pulmonary insufficiency
directed at cause
-valve replacement is not usually needed
What is the cause of tricuspid stenosis
rheumatic fever
What else is seen when a patient has tricuspid stenosis
tricuspid regurge
mitral stenosis
How will a tricuspid stenosis sound
Mid-diastolic rumble with pre systolic accentuation
Why are liver enzymes elevated with tricuspid stenosis
passive hepatic congestion
What is the treatment for tricuspid stenosis
diuretics
aldosterone antagonists
What generally causes tricuspid insufficiency
secondary to leaflet tethering from annular dilation and/or papillary muscle displacement
What is the best imaging for evaluating RV size and function
cardiac MRI
What will tricuspid insufficiency sound like
holosystolic with patient sitting upright
What are the best initial treatments for valvular disease
no smoking
more active
healthy weight
balanced diet
less alcohol
manage stress
What medications are beneficial in valvular disease
diuretics
blood thinners
anti-arrhythmics
abx (chronic / prophylaxis)
