Valvular Heart Disease Flashcards
What does valvular heart disease most commonly arise from?
Degenerative senile calcification
Myxomatous degeneration
Congenital bicuspid aortic valve
What is myomatous degeneration?
Remodeling of collagen and ECM
Thinning if fibrin
Thickening of valve leaflets
What do murmurs result from?
Turbulence across valves and or increase blood flow (anemia, pregnancy)
What is stenosis?
Sclerosis, fibrous, calcification
Impedes forward flow
What does stenosis create?
Pressure overload
What does regurgitation create?
Volume overload
What is regurgitation?
Insufficiency, incompetence
Reversal of flow, valve leaks, fails to close
What are the systolic murmurs?
Mitral regurgitation Tricuspid regurgitation Aortic stenosis Pulmonic stenosis VSD ASD
What are diastolic murmurs?
Aortic regurgitation Pulmonic regurgitation Mitral stenosis Tricuspid stenosis Atrial myxoma PA
What is grade 1 on the murmur scale?
Barely audible
What is grade 2 on the murmur scale?
Faint, soft
What is grade 3 on the murmur scale?
Louder, easily heard
What is grade 4 on the murmur scale?
Very loud with palpable thrill
What is grade 5 on the murmur scale?
Heard with the stethoscope barely touching the chest with thrill
What is grade 6 on the murmur scale?
Can hear without the stethoscope or can hear with stethoscope close to chest: palpable thrill
Which murmur grades do not have a palpable thrill?
1-3
What are causes of acute mitral regurgitation?
Ischemic papillary muscle dysfunction Rupture chordal tendinaeae Infective endocarditis Volume overload (LA pressure, pulmonary edema, RVF/LVF cardiogenic shock)
What are the causes of chronic mitral regurgitation?
Mitral valve prolapse
Myxomatous degeneration
Mitral annular calcification
Where is mitral regurgitation heard?
5th ICS at midclavicular line
What is heard on PE with mitral regurgitation?
Systolic murmur
Blowing at apex
Radiates to left axilla
Reduced S1 use diaphragm
What is mitral valve prolapse?
One or both leaflets prolapse into the left atrium
Which gender is mitral valve prolapse most common in?
Female
What is heard on auscultation with mitral valve prolapse?
Systolic murmur at apex
Click/murmur increase with valsalva and standing
What are symptoms of mitral valve prolapse?
Chest pain
ST
PVCs
Dyspnea
When does the murmur increase with mitral valve prolapse?
Decrease of ventricular volume and chamber size
When does the murmur with mitral valve prolapse decrease?
Squatting
Hand grip
How do you treat mitral valve prolapse?
Reassure
Symptomatic give beta blocker
Is tricuspid regurgitation symptomatic?
No
What is tricuspid regurgitation associated with?
Pulmonary HTN Lung disease RV infarction Inferior wall MI IE Pacemaker
What is heard with tricuspid regurgitation?
Blowing systolic murmur
4th ICS LSB
When does the tricuspid regurgitation murmur increase?
Inspiration
What murmur is the Carvallo sign associated with?
Tricuspid regurgitaion
What is seen on jugular venous pulse with tricuspid regurgitation?
Prominent V wave
What is the etiology of aortic stenosis?
Age related degenerative calcification
Bicuspid aortic valve
Rheumatic heart disease
What is the pathology associated with aortic stenosis?
Pressure overload
Right ventricular hypertrophy
The more severe the aortic stenosis the more narrow the what?
Outflow
The higher the gradient across the aortic valve the lower the what?
Area
What are the symptoms of aortic stenosis?
Dyspnea
Angina
Syncope
What is heard on PE with aortic stenosis?
Systolic murmur Crescendo-decrescendo Harsh 2nd ICS RSB Radiates into sternal notch/cardotids
What heart sound is diminished with aortic stenosis?
S2
What are the pulses in aortic stenosis?
Parvus (weak/small)
Tardus (slow rising, late pulse)
Is the pulse pressure wide or narrow with aortic stenosis?
Narrow
What is seen on the EKG with aortic stenosis?
Left ventricular hypertrophy Strain pattern (down sloping ST segment-T wave)
What is associated with aortic root dilation?
Bicuspid aortic valves
What do people with bicuspid aortic valves have a predisposition to?
Infective endocarditis
Where is bicuspid aortic valve most commonly heard?
LSB or apex
75% of bicuspid aortic valves turn into what?
Aortic stenosis
What connective tissue disorders is bicuspid aortic valve associated with?
Marfans
Turner’s syndrome
What is heard with pulmonic stenosis?
Systolic murmur Crescendo-decrescendo 2-3 ICS LSB Radiates to left shoulder-clavicle
What conditions is pulmonic stenosis associated wtih?
Tetralogy of Fallot PS VSD RVH Overriding aorta
What is heard with VSD?
Holosystolic murmur
Left lower sternal border with thrill
Left-to-right shunt/murmur
Increases with handgrip
What is heard with ASD?
Systolic murmur
Upper LSB with fixed splitting of S2
Left-to-right shunt
What is the etiology of mitral stenosis?
Rheumatic heart disease
Group A streptococci
Congenital
Mitral annular calcification
What does a decreased MVA area lead to?
Pulmonary HTN
AVF
LAE
A fib.
What are the symptoms of mitral stenosis?
Dyspnea
Orthopnea
Palpitations
Hoarseness (compression of left laryngeal nerve (Ortner’s syndrome)
What is Ortner’s syndrome?
Compression of left laryngeal nerve seen in mitral stenosis
What is heard on PE in mitral stenosis?
Diastolic murmur
Low pitch (use bell)
Rumbling at apex
Inc. S1 and S2 followed by opening snap
What is seen on ECG in mitral stenosis?
Left atrial enlargement if in sinus rhythm A. Fib RVH RAD if associated with pul HTN Anticoagulated if in A fib
What is the etiology of tricuspid stenosis?
Rheumatic disease
Carcinoid syndromes
SLE
Right atrial myxomas
What gender is tricuspid stenosis most common in?
Females
What is heard in tricuspid stenosis?
Diastolic murmur
4th ICS
LSB
Increases on inspiration
What is seen on jugular wave in tricuspid stenosis?
Prominent A wave
What is seen on ECG in tricuspid stenosis?
Right atrial enlargement (tall peaking of P waves)
What are the acute causes of aortic regurgitation?
Infective endocarditis
Aortic dissection
Chest trauma
What are the chronic causes of aortic regurgitation?
Calcific degeneration
Bicuspid aortic root
Rheumatic heart disease
What is the pathology associated with aortic regurgitation?
Volume overload
LVH
Left heart failure
What are the acute symptoms of aortic regurgitation?
Pulmonary edema from infective endocarditis
What are the chronic symptoms of aortic regurgitation?
Dyspnea
Orthopnea
Angina
What is heard with aortic regurgitation?
Diastolic decrescendo murmur 2rd ICS LSD Can mimic mitral stenosis (Austin Flint) Soft S2
What is seen on PE with aortic regurgitation?
Wide pulse pressure DeMusset sign Quincke's sign Traube sign Duroziez's sign
What is the treatment for aortic regurgitation?
ACEi
ARB
What is the DeMusset sign?
Head bobs with beats
What is the Quincke’s sign?
Capillary nail pulsation
What is the Traube sign?
“Pistol shot” (systolic and diastolic) sounds over femoral artery
What is Duroziez’s sign?
Diastolic murmur over femoral artery when compressed with bell of stethoscope
What is heard in pulmonary regurgitation?
Diastolic
Decrescendo
2nd ICS
LSD (Graham Steele)
What is pulmonary regurgitation associated with?
Pulmonary HTN
Increased S2
