Valvular Heart Disease Flashcards

1
Q

Leading cause of valvular heart disease in US adults

A

Mechanical degeneration. Until recently it was rheumatic fever

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2
Q

Aortic Stenosis

A

1) Etiology: Most often seen in elderly. Unicuspid and bicuspid aortic valves can lead to symptoms in childhood and adolescence
2) History: May be asymptomatic for years despite significant stenosis. Once symptomatic, usually progresses from angina to syncope to CHF to death within 5 years. Symptoms (also indications for valve replacements) are ACS (Angina, CHF, Syncope)
3) Exam/Dx: Pulsus parvus et tardus (weak, delayed carotid upstroke) and a single or paradoxically split S2 sound. Systolic murmur radiating to carotids. Dx with echo
4) Treatment: AVR

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3
Q

Aortic regurgitation

A

1) Etiology: Acute: Infective endocarditis, aortic dissection, chest trauma. Chronic: valve malformations, rheumatic fever, connective tissue disorders

2) History:
Acute: Rapid onset of pulmonary congestion, cardiogenic shock and severe dyspnea
Chronic: Slowly progressive onset of dyspnea on exertion, orthopnea and PND

3) Exam/Dx:
PE: Blowing diastolic murmur at the L sternal border, mid-diastolic rumble (Austin-Flint murmur), and mid-diastolic apical murmur. Widened pulse pressure causes de Musset’s sign (head bob with heartbeat), Corrigan’s sign (water hammer pulse) and Duroziez’s sign (femoral bruit)
Dx: Echo

4) Treatment: Vasodilator therapy (dihydro CCBs or ACEIs) for isolated aortic regurgitation until symptoms become severe enough to warrant valve replacement

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4
Q

Mitral valve stenosis

A

1) Etiology: Most common etiology is rheumatic fever
2) History: Symptoms range from dyspnea, orthopnea, and PND to infective endocarditis and arrhythmias

3) Exam/Dx:
PE: Opening snap and mid-diastolic murmur at the apex; pulmonary edema
Dx: Echo

4) Treatment:
Antiarrythmics (B blockers, digoxin) for symptomatic relief; mitral balloon valvotomy and valve replacement are effective for severe cases

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5
Q

Mitral valve regurgitation

A

1) Etiology: Primarily secondary to rheumatic fever or chordae tendinae rupture after MI. Infective endocarditis.
2) History: Patients present with dyspnea, orthopea, and fatigue

3) Exam/Dx:
PE: Holosystolic murmur radiating to the axilla
Dx: Echo will demonstrate regurgitant flow; angio can assess the severity of disease

4) Treatment: Antiarrthymics if needed (AF is common with LAE; nitrates and diuretics to reduce preload). Valve repair or replacement for severe cases

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