Valvular Heart Disease Flashcards
Aortic stenosis vs aortic regurgiation clinical profile
Aortic stenosis vs aortic regurgiation physical exam findings
Compensated vs Decompensated aortic regurgitation
Murmurs result from the following mechanisms:
- Flow across a partial obstruction
- Increased flow through normal structures
- Ejection into a dilated chamber
- Regurgitant flow across an incompetent valve
- Abnormal shunting of blood from one vascular chamber to a lower-pressure chamber
Murmur timing
systolic, diastolic, or continuous
Systolic murmur grading
Diastolic murmur grading
High-frequency murmurs are caused by ___ and best appreciated with ___.
High-frequency murmurs are caused by high-pressure gradient flow and best appreciated with the diaphragm.
Low-frequency murmurs are caused by ___ and best appreciated with ___.
Low-frequency murmurs are caused by low pressure gradient flow and best appreciated with the bell.
Crescendo–decrescendo murmur
Rises and then falls in intensity
‘Diamond shaped’ on echocardiogram
Typical murmur description format
“A grade III/VI high-pitched, crescendo–decrescendo systolic murmur, heard best at the upper-right sternal border, with radiation toward the neck.”
Classification of systolic murmurs
Why do some murmurs crescendo-decrescendo?
The sound follows the flow:
The increase in flow due to increase in pressure from contraction causes the crescendo. At the apex, the pressure is maximal. Then, as pressure decreases (due to the increased felt effect of aterload), the flow decreases.
Aortic stenosis pressure/sound diagram
How can one tell how severe aortic stenosis is from cardiac exam?
Paradoxically, it does not correlate to the intensity of the murmur.
Rather, the more severe the stenosis, the later the peak moves in systole
Classification of diastolic murmurs
Murmur of a ventricular septal defect
A form of pansystolic murmur which may be distinguished from AV regurgitation murmurs by:
- It’s location (4th to 6th left intercostal space)
- It’s lack of radiation
- It’s lack of increase in intensity with inspiration
How does one evaluate the severity of a ventricular septal defect?
Paradoxically, the murmur gets less intense the greater the flow is! This is because these defects are less turbulent.
The loudest, most turbulent VSDs are actually the safest and least worrisome. It is if a patient has a history of known VSD and it suddenly seems to soften or disappear on cardiac exam that you should be worried.
If a diastolic murmur occurs early in diastole, it is probably ___. If it occurs mid-diastole, it is probably ___.
If a diastolic murmur occurs early in diastole, it is probably aortic or pulmonic regurgitation. If it occurs mid-diastole, it is probably mitral or tricuspid stenosis.
Non-pathologic mid-to-late diastolic murmurs
May occur simply due to increased flow across a normal mitral or tricuspid valve.
Peri-pathologic mid-to-late diastolic murmurs
Hyperdynamic states may also produce a benign disatolic murmur (the murmur itself is benign, the condition may or may not be):
- Fever
- Anemia
- Hyperthyroidism
- Exercise stress
Classification of continuous murmurs
Most common valvular heart disease
Aortic valve stenosis
Most common causes of aortic valve stenosis
- Congenital bicuspid aortic valve
- Aortic valve degeneration (calcification)
- Rheumatic fever (type III hypersensitivity post-Streptococcus pyogenes infection)
