Valvular Heart Disease Flashcards
How are murmurs graded?
On a scale of 1-6
- Grade I
- Grade II
- Grade III
- Grade IV
- Grade V
- Grade VI
- S1, S2 are louder than the murmur
- S1, S2 are equal to the murmur
- S1, S2 are softer than the murmur
- The murmur has a palpable thrill
- Hear the murmur without a stethoscope
- Hear the murmur without a stethoscope (very rare)
When do you do a workup for a murmur? (Systolic and diastolic).
Systolic murmur graded at level 3
Any diastolic murmur
What do you use to diagnose a murmur?
Echocardiogram, dilated L atrium.
Mnemonic for recalling which murmurs are systolic
MR. ASS
Mitral Regurgitation
Aortic Stenosis
Systolic
Mnemonic for recalling which murmurs are diastolic
MS. ARD.
Mitral Stenosis
Aortic Regurgitation
Diastolic
What physiologic processes (2) drive the symptoms for mitral stenosis?
Atrial stretch and fluid in the lungs
In mitral stenosis, you see _____ patients than in aortic stenosis
Younger 20s-30s
The pathology of Mitral Stenosis is
Rheumatic heart disease
Which type of stenosis is due to calcification?
Aortic stenosis
Which type of stenosis is due to inflammation of the mitral valve?
Mitral stenosis
What type of symptoms will patients with mitral stenosis present with? (Name 2).
CHF symptoms
(1) Dyspnea on exertion
(2) Paroxysmal nocturnal dyspnea
Signs of mitral stenosis (Name 2).
(1) From CHF symptoms: Crackles
(2) From atrial stretching: a-fib
Describe the auscultation findings of mitral stenosis
Blood flows across the mitral valve during diastole, so this is a diastolic murmur.
Where can you hear mitral stenosis the best?
Cardiac apex. 5th intercostal space midclavicular line
What is a sign of mitral stenosis on auscultation?
Opening snap
What is the treatment for mitral stenosis
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.
What are the two diastolic murmurs?
MS. ARD.
Mitral Stenosis
Aortic Regurgitation
Diastolic
What are the causes of aortic regurgitation ? (3)
Infection, infarction, aortic dissection.
How is aortic stenosis diagnosed?
On auscultation, R 2nd intercostal space. Diastolic murmur
What is the treatment for aortic regurgitation?
Valve Replacement
What is the acute symptom of aortic regurgitation ?
Chest pain
What are the chronic symptoms of chest pain? (3)
CHF symptoms:
(1) Dyspnea
(2) Chest Pain
(3) Paroxysmal nocturnal dyspnea
Describe the murmur for aortic regurgitation .
NO OPENING SNAP. Rumbling. Diastolic.
What is the other term for aortic regurgitation ?
Aortic insufficiency
Describe what is going on in aortic stenosis.
Stiff aortic valve due to atherosclerosis. The heart responds by dilating which pools blood and you end up with heart failure.
Describe the murmur in aortic stenosis.
“Crescendo decrescendo.”
Where do you auscultate to diagnose aortic stenosis?
R sternal border at the base.
Blood is trying to LEAVE the ventricle and go to the aorta, this is a
Systolic murmur
What is the treatment for aortic stenosis?
Valve replacement
In mitral regurgitation, what is going on with the blood flow in the heart?
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.
Echocardiogram finding in mitral regurgitation
Increased EF
What causes mitral regurgitation?
Infection, infarction.
Treatment for acute mitral regurgitation vs Chronic mitral regurgitation.
Emergent valve replacement for acute
In chronic mitral regurgitation what can you see on the ecg?
a-fib
Where are aortic murmurs located?
Base, right sternal border
Where are mitral murmurs located?
Apex, 5th intercostal space midclavicular line
(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?
(1) Hear it more by squatting or doing a leg lift
(2) Hear it less by doing a valsalva maneuver
On a physical exam how do you differentiate a murmur between AS, MS, AR, MR and HCM/mitral valve prolapse.
Doing a leg lift/squat with AS, MS, AR, MR will make the murmur sound worse.
More blood in the heart, but less murmur…which 2 valve disorders fit into this description?
(1) Hypertrophic cardiomyopathy (HCM)
(2) Mitral valve prolapse
In HCM
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
Pathology of HCM
Sarcomere mutation, young, athlete.
Symptoms of HCM
SOB, syncope with exertion
Risk factor for HCM
Family history
Describe the murmur sound of HCM.
Sounds like aortic stenosis, you’ll hear a systolic murmur BUT “MORE BLOOD MAKES IT BETTER”
Treatment for HCM (3)
Avoid dehydration Beta blockers (slow down heart rate, decrease diastole) Don't workout or increase HR
The other condition besides HCM that has more blood in the heart but less murmur is…
Mitral valve prolapse
Describe the valves in mitral valve prolapse.
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.
The murmur of mitral valve prolapse sounds like
Mitral regurgitation, but it’s mitral valve prolapse
Pathogensis of mitral valve prolapse.
Congenital. Young women.
Diagnosis of mitral valve prolapse.
Mitral regurgitation, but better with more blood
Treatment of mitral valve prolapse.
Avoid dehydration
Beta blockers
In HCM and mitral valve prolapse your goal is to ____ in diastole.
Improve diastolic filling, more time to fill the ventricle.
