valvular heart disease Flashcards
what is the most common cause of mitral stenosis
rheumatic heart disease. rarely congenital, post-radiation, calcification.
what is the consequence of mitral stenosis
impaired filling of the left ventricle, pulmonary congestion, increased left atrial pressure. reduced CO and secondary pulmonary vasoconstriction occurs. this causes right heart failure.
what are the clinical presentations in mitral stenosis
dyspnea, orthopnea, fatigue, wasting, hemoptysis due to rupture of pulmonary vessels, systemic embolism, hoarseness. right sided heart failure.
physical findings of mitral stenosis
Afib is common. decreased pulse pressure.
large left atria and right ventricle.
what is the murmur of mitral stenosis
Loud S1, opening snap following S2. diastolic rumble.
what is the treatment for mitral stenosis
balloon valvulotomy
mitral regurgitation is what
when blood back flows from the ventricle into the atria due to insufficiency. t
what is the most common cause of mitral regurg
ischemia. other causes of HTN, CHF, left ventricular hypertrophy, rheumatic fever.
what are the consequences of mitral regurgitation
more blood in the left atria and reduced CO. this causes volume overload and an increase in preload. the after load is reduced due to reduced cardiac output. this leads to increased left ventricular function and eventually failure. which ultimately leads to Right-failure.
what are the physical findings for mitral regurgitation
diminished but brisk carotid upstroke. distended neck veins.
large left ventricle and atria.
what is the murmur of mitral regurgitation
holosystolic apical murmur that radiates to the axilla and often accompanied by thrill. S3 with soft S1 and widely split S2.
what is mitral valve prolapse
when the leaflets of the mitral valve bulge in the left atria.
what are the causes of MVP
usually congenital. occurs in greater frequency with EDS, marfans, PCKD, and greater in women.
what are the symptoms of MVP
usually asymptomatic. can have lightheadedness, palpitations, syncope, and chest pain which is often due to arrhythmias.
what is the murmur for MVP
mid-to-late systolic click and a late systolic murmur at the cardiac apex.
what makes the murmur in MVP worse
valsalva or standing.
what makes MVP murmur better
squatting or leg raise.
what is aortic stenosis
calcification of the aortic valve and degeneration common in the elderly.
what are the causes of aortic stenosis
aging, rheumatic fever that affected the valve. (the mitral valve is almost invariably affected if the aortic is).
what is the consequence of aortic stenosis
left ventricular hypertrophy. the left atria must also have more forceful contractions to fill the noncompliant thickened left ventricle
what is the murmur of aortic stenosis
harsh crescendo-decrescendo systolic heard best at the right upper sternal border. harsh quality that radiates to the carotids. S4 gallop. S2 single or paradoxically split. aortic ejection click.
what is the clinical presentation of aortic stenosis
angina, syncope, dyspnea from CHF
pulsus tardes et parvus, carotid thrill, systolic ejection murmur in aortic area. aortic ejection click.
what does valsalva do to aortic stenosis
decreases the murmur
what does valsalva do to hypertrophic obstructive cardiomyopathy
increases the murmur
what does valsalva do to mitral regurgitation
decreases
what does squatting do to HOCM
decreases it
what does squatting do to mitral regurgitation.
increases it
what are the systolic murmurs
aortic stenosis, mitral regurgitation, ventricular septal defect, HOCM.
what is aortic regurgitation
this is when there is insufficiency of the aortic valve which allows blood back into the left ventricle after systole.
what are the causes of aortic regurgitation
hypertension and ischemia are the most common. can occur after Infective endocarditis. aortic dissection/trauma, Marfan, rheumatic fever, syphilis
what are the consequences of aortic regurgitation
there is more blood back filled into the ventricle causing fluid overload. left ventricular dilation due to very high left ventricular end diastolic pressure. this can cause pulmonary edema secondary to mitral regurgitation.
what are the clinical signs of aortic regurg
dyspnea, increased pulse pressure due to large stroke volume.
there will be left ventricular hypertrophy.
what is the murmur ind AR
early diastolic decrescendo blowing. systolic flow murmur. best heard on the third left intercostal space with the patient sitting up and leaning forward with breath held in forced expiration.
what are the causes of dilated cardiomyopathy
idiopathic is the most common, alcoholism, permpartum, viral infections, toxins (cobalt/lead/arsenic),
what are the symptoms of dilated cardiomyopathy
systolic heart failure.
what are the treatments for dilated cardiomyopathy
ACEi, BB, spironolactone for reduced mortality.
diuretics and digoxin reduce symptoms
what is the characteristic finding for HOCM
there is unexplained hypertrophy with thickening of the inter ventricular septum.
what are the causes of restrictive cardiomyopathy
amyloidosis, sarcoidosis, hemachromatosis, radiation, scleroderma
what is restrictive cardiomyopathy
the myocardium becomes rigid and noncompliant impeding ventricular filling. and this raises the cardiac filing pressures. it mimics constrictive pericarditis.
what are the clincal findings of restrictive cardiomyopathy
dyspnea, exercise intolerance, weakness, JVD, edema, hepatomegaly, ascites, kussmaul sign.
