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Advanced Pathophysiology > Valvular Heart Disease > Flashcards

Valvular Heart Disease Flashcards

1
Q

How are murmurs graded?

A

On a scale of 1-6

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2
Q
  1. Grade I
  2. Grade II
  3. Grade III
  4. Grade IV
  5. Grade V
  6. Grade VI
A
  1. S1, S2 are louder than the murmur
  2. S1, S2 are equal to the murmur
  3. S1, S2 are softer than the murmur
  4. The murmur has a palpable thrill
  5. Hear the murmur without a stethoscope
  6. Hear the murmur without a stethoscope (very rare)
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3
Q

When do you do a workup for a murmur? (Systolic and diastolic).

A

Systolic murmur graded at level 3

Any diastolic murmur

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4
Q

What do you use to diagnose a murmur?

A

Echocardiogram, dilated L atrium.

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5
Q

Mnemonic for recalling which murmurs are systolic

A

MR. ASS
Mitral Regurgitation
Aortic Stenosis
Systolic

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6
Q

Mnemonic for recalling which murmurs are diastolic

A

MS. ARD.
Mitral Stenosis
Aortic Regurgitation
Diastolic

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7
Q

What physiologic processes (2) drive the symptoms for mitral stenosis?

A

Atrial stretch and fluid in the lungs

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8
Q

In mitral stenosis, you see _____ patients than in aortic stenosis

A

Younger 20s-30s

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9
Q

The pathology of Mitral Stenosis is

A

Rheumatic heart disease

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10
Q

Which type of stenosis is due to calcification?

A

Aortic stenosis

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11
Q

Which type of stenosis is due to inflammation of the mitral valve?

A

Mitral stenosis

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12
Q

What type of symptoms will patients with mitral stenosis present with? (Name 2).

A

CHF symptoms

(1) Dyspnea on exertion
(2) Paroxysmal nocturnal dyspnea

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13
Q

Signs of mitral stenosis (Name 2).

A

(1) From CHF symptoms: Crackles

(2) From atrial stretching: a-fib

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14
Q

Describe the auscultation findings of mitral stenosis

A

Blood flows across the mitral valve during diastole, so this is a diastolic murmur.

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15
Q

Where can you hear mitral stenosis the best?

A

Cardiac apex. 5th intercostal space midclavicular line

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16
Q

What is a sign of mitral stenosis on auscultation?

A

Opening snap

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17
Q

What is the treatment for mitral stenosis

A

Balloon valvuloplasty (L heart cath, prior to a-fib or CHF symptoms). You can do a valve replacement but don’t jump to it, it’s open heart surgery and valves don’t last that long.

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18
Q

What are the two diastolic murmurs?

A

MS. ARD.
Mitral Stenosis
Aortic Regurgitation
Diastolic

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19
Q

What are the causes of aortic regurgitation ? (3)

A

Infection, infarction, aortic dissection.

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20
Q

How is aortic stenosis diagnosed?

A

On auscultation, R 2nd intercostal space. Diastolic murmur

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21
Q

What is the treatment for aortic regurgitation?

A

Valve Replacement

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22
Q

What is the acute symptom of aortic regurgitation ?

A

Chest pain

23
Q

What are the chronic symptoms of chest pain? (3)

A

CHF symptoms:

(1) Dyspnea
(2) Chest Pain
(3) Paroxysmal nocturnal dyspnea

24
Q

Describe the murmur for aortic regurgitation .

A

NO OPENING SNAP. Rumbling. Diastolic.

25
Q

What is the other term for aortic regurgitation ?

A

Aortic insufficiency

26
Q

Describe what is going on in aortic stenosis.

A

Stiff aortic valve due to atherosclerosis. The heart responds by dilating which pools blood and you end up with heart failure.

27
Q

Describe the murmur in aortic stenosis.

A

“Crescendo decrescendo.”

28
Q

Where do you auscultate to diagnose aortic stenosis?

A

R sternal border at the base.

29
Q

Blood is trying to LEAVE the ventricle and go to the aorta, this is a

A

Systolic murmur

30
Q

What is the treatment for aortic stenosis?

A

Valve replacement

31
Q

In mitral regurgitation, what is going on with the blood flow in the heart?

A

Blood leaves the ventricle through the mitral valve and the aorta. Dilated atrium. Normal L ventricle. Blood goes back into the lungs. L atrial stretch.

32
Q

Echocardiogram finding in mitral regurgitation

A

Increased EF

33
Q

What causes mitral regurgitation?

A

Infection, infarction.

34
Q

Treatment for acute mitral regurgitation vs Chronic mitral regurgitation.

A

Emergent valve replacement for acute

35
Q

In chronic mitral regurgitation what can you see on the ecg?

A

a-fib

36
Q

Where are aortic murmurs located?

A

Base, right sternal border

37
Q

Where are mitral murmurs located?

A

Apex, 5th intercostal space midclavicular line

38
Q

(1) More blood in the heart = more murmur, how can you hear the murmur more/makes it worse? (2) And what makes you hear it less?

A

(1) Hear it more by squatting or doing a leg lift

(2) Hear it less by doing a valsalva maneuver

39
Q

On a physical exam how do you differentiate a murmur between AS, MS, AR, MR and HCM/mitral valve prolapse.

A

Doing a leg lift/squat with AS, MS, AR, MR will make the murmur sound worse.

40
Q

More blood in the heart, but less murmur…which 2 valve disorders fit into this description?

A

(1) Hypertrophic cardiomyopathy (HCM)

(2) Mitral valve prolapse

41
Q

In HCM

A

Atria is normal, mitral valve is normal. Unilateral septum hypertrophy which covers the aortic opening, leading to L ventricle obstruction. More blood and less murmur because the ventricle is expanded. Loss of the ventricle outlet death

42
Q

Pathology of HCM

A

Sarcomere mutation, young, athlete.

43
Q

Symptoms of HCM

A

SOB, syncope with exertion

44
Q

Risk factor for HCM

A

Family history

45
Q

Describe the murmur sound of HCM.

A

Sounds like aortic stenosis, you’ll hear a systolic murmur BUT “MORE BLOOD MAKES IT BETTER”

46
Q

Treatment for HCM (3)

A 
Avoid dehydration
Beta blockers (slow down heart rate, decrease diastole)
Don't workout or increase HR
47
Q

The other condition besides HCM that has more blood in the heart but less murmur is…

A

Mitral valve prolapse

48
Q

Describe the valves in mitral valve prolapse.

A

Mitral valve leaflets don’t touch because they’re too big. During systole, they’re suppose to close and touch, but they blow through, don’t close properly. But when the ventricle stretches, it closes better so the murmur gets better.

49
Q

The murmur of mitral valve prolapse sounds like

A

Mitral regurgitation, but it’s mitral valve prolapse

50
Q

Pathogensis of mitral valve prolapse.

A

Congenital. Young women.

51
Q

Diagnosis of mitral valve prolapse.

A

Mitral regurgitation, but better with more blood

52
Q

Treatment of mitral valve prolapse.

A

Avoid dehydration

Beta blockers

53
Q

In HCM and mitral valve prolapse your goal is to ____ in diastole.

A

Improve diastolic filling, more time to fill the ventricle.

Advanced Pathophysiology (6 decks)

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