Valvular Heart Disease Flashcards
what are the most common etiologies of VHD?
myxomatous degeneration (MVP) congenital (bicuspid aortic valve)
what causes a murmur?
turbulent blood flow across a valve or increased blood flow
what are the systolic murmurs (S1)?
MR TR AS PS VSD ASD
what are the diastolic murmurs (S2)?
AI/AR PI/PR MS TS atrial myxoma
1/6 murmur
barely audible
2/6 murmur
faint, soft
3/6 murmur
easily heard with a stethoscope
4/6 murmur
very loud with palpable thrill (vibration)
5/6 murmur
heard with stethoscope barely touching the chest with thrill
6/6 murmur
can hear without stethoscope or can hear with stethoscope close to chest
palpable thrill
what are the causes of MR?
ischemic papillary muscle dysfunction (CAD or MI) ruptured chordae tendinae infective endocarditis volume overload MVP
what is heard on auscultation with MR?
systolic murmur
blowing at apex
radiates to left axilla
what is heard on auscultation with MVP?
systolic murmur at apex with click/murmur increased with standing
what are the causes of TR?
pulm HTN lung disease RV infarction inferior wall MI pacemaker
what is heard on auscultation with TR?
blowing, systolic murmur at the 4th ICS LSB
increases with inspiration (Carvallo sign)
what causes AS?
degenerative calcification or bicuspid leaflets
pressure overload
LVH
what is heard on auscultation with AS?
systolic murmur crescendo-decrescendo harsh 2nd ICS RSV radiates into sternal notch/carotids diminished S2
what causes pulmonic stenosis?
congenital only
what is heard on auscultation with PS?
systolic murmur
crescendo-decrescendo
2-3 ICS LSB
radiates to left shoulder/clavicle
what is heard on auscultation with VSD?
holosystolic murmur
left lower sternal border with thrill
increases with handgrip
what is heard on auscultation with ASD?
systolic murmur
upper LSB with fixed splitting of S2
what causes mitral stenosis?
rheumatic heart disease
congenital
mitral annular calcification
what is heard on auscultation with MS?
diastolic murmur
low pitch
rumbling at apex
increased S1 and S2 (P2) followed by opening snap
what causes tricuspid stenosis?
rheumatic heart disease
what is heard on auscultation with TS?
diastolic murmur
LSB
increases with inspiration (Carvallo sign)
what causes aortic insufficiency/regurgitation?
infective endocarditis aortic dissection chest trauma calcific degeneration dilated aortic root rheumatic heart disease
what is heard on auscultation with AI/AR?
diastolic decrescendo murmur 3rd ICS LSB can mimic MS Soft S2 (A2)
what other signs are associated with AI/AR?
DeMusset’s sign - head bob with beats
Quincke’s sign - capillary nail pulsations
Traube sign - “pistol shot” over femoral artery
Duroziez’s sign - diastolic murmur over femoral artery when compressed with stethoscope
what causes pulmonary insufficiency/regurgitation?
Pulm HTN
what is heard on auscultation with PI/PR?
diastolic decrescendo murmur
2nd ICS
LSB
