Valvular Heart Disease - Johnston Flashcards
Stenosis leads to ____
Hypertrophy
Regurg/Insufficiency leads to ____
Dilation
Mitral Stenosis
Rheumatic heart disease
Major Jones Criteria for RHD
- Carditis (myo, peri)
- Migratory polyarthritis
- SubQ nodules
- Sydenham’s chorea
- Erythema marginatum
Jones minor criteria for RHD
- Fever
- Arthralgia
- Increased sed rate or CRP
- Leukocytosis
- Prolonged PR interval
- Elevated ASO or anti-DNase B
How to Dx RHD
2 major
1 major and 2 minor
Pathophysiology of aortic stenosis (results of it)
- LV pressure –> LVH –> diastolic LV dysfunction –> syncope, HF
- Reduced coronary flow –> angina
Symptoms of aortic stenosis
- Angina
- Syncope
- Exertional dyspnea
- Heart failure
Exam findings for aortic stenosis
- Systolic ejection murmur radiating to suprasternal notch and carotids (2nd ICS RSB)
- Narrow pulse pressure
- Delayed pulses (carotid, peripheral)
ECG - aortic stenosis
- Left atrial enlargement
- LVH (w/ strain)
Pharma therapy for aortic stenosis
Avoid what?
- Digitalis, diuretics, nitroglycerin
- Avoid vasodilators (increased pre-load)
Surgical treatment for AS
- Percutaneous balloon valvuloplasty, temporary valve replacement
Causes of aortic regurgitation (7)
- HTN (increased aortic pressure)
- Endocarditis
- Marfan’s (aortic root dilation)
- Ankylosing spondylitis
- Aortic dissection
- Syphilis (aortic root dilation)
- Collagen vascular disease
Pathophysiology (results) of ACUTE aortic regurgitation
High diastolic LV pressure –> premature mitral closure –> LV ischemia and failure
Pathophysiology (results) of CHRONIC aortic regurgitation
Decreased SV over time –> hyperdynamic (overloaded) circulation –> systolic HTN –> pressure/volume overload –> concentric LVH
Symptoms of aortic regurg.
- Dyspnea
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Angina
- Syncope
Exam findings for aortic regurg
- Diastolic blowing murmur (2-3 ICS LSB)
- HTN
- Wide pulse pressure
- Displaced PMI
- Rhythmic movement of head w/ heart beats (DE MUSSET SIGN)
- Decreased breath sounds
- Kyphosis and decreased lumbar ROM
Why do you want a chest X-ray is suspected aortic regurg?
To check for aortic dilation
- Prominent A wave in jugular venous pressure graph
- Hepatomegaly
- Diastolic murmur (LSB) that increases with inspiration
Tricuspid stenosis
Prominent V wave in JVP graph, blowing systolic murmur (LSB) that increases with inspiration
Tricuspid regurgitation
Tricuspid regurg. is associated with what causes?
- Pulmonary HTN
- RV infarction
- Others
Pulmonary HTN, diastolic blowing murmur (2nd LSB)
Pulmonic regurgitation
- Systolic murmur with ejection click (2-3 ICS LSB) that radiates to L shoulder and increases on inspiration
- Angina, syncope
Pulmonary stenosis
Causes of mitral stenosis
- RHD
- Annular calcification
Pathophysiology (results) of MS
- Increased LA pressure, decreased LV output (looks like LV failure) –> volume overload + sympathetic response
- Increased RV pressure + pulmonary HTN –> SYMPTOMS –> RVH
Symptoms of mitral stenosis
- Dyspnea
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Hemoptysis
- Hoarseness
- Edema
- Ascites
- MALAR RASH
Exam findings for mitral stenosis
- Diastolic rumble after an opening snap (apex)
- Loud S1
- LAE on EKG (P-mitrale)
Chest X-ray findings for mitral stenosis
- Straight left heart border
- Thick right heart border
- Kerley B lines (lungs)
- Enlarged pulmonary arteries
Pharma treatment for mitral stenosis
- Diuretics (volume overload)
- Anticoagulation for A. fib
- Digitalis, BB, or CCB for rate control (sympathetic response)
Causes of mitral regurg.
- MVP
- Ruptured chordae
- Endocarditis
- Ischemic papillary muscle (MI)
- Collagen disease
- Other
Pathophysiology (results) of mitral regurg.
- LV volume overload –> LV dilation –> LV dysfunction (volume overload)
Symptoms of mitral regurg.
- Dyspnea
- Orthopnea
- PND
Exam findings for mitral regurg.
- Holosystolic apical murmur radiating to axilla
- S3
- Displaced PMI
Pharma treatment for ACUTE mitral regurg.
Vasodilators
