Valvular Heart Disease, Murmurs Flashcards
What is the etiology for mitral stenosis?
a. rheumatic valve disease (99%)
b. calcification
c. congenital abnormalities
d. medications (ergotamines, pergolide)
What is the pathophysiology of mitral stenosis?
a. A-Fib in 50%
b. high risk of thromboembolism
c. high LA pressure leads to pulmonary congestion
d. Aschoff Bodies
What sounds does mitral stenosis make?
Opening snap and diastolic ruble
What is the presentation of MS?
a. fish mouth
b. hocky stick valves
c. dyspnea/pulmonary edema/thromboembolism
d. hemoptysis in extreme cases
What is the prognosis and treatment of MS?
a. progressive loss of valve area
b. pulmonary congestion, can lead to R heart dysfunction
c. hypertrophy
d. LEFT ATRIAL APPENDAGE CLOT
What is the primary etiology of MR?
a. mitral valve prolapse
b. myxomatous degen. (gel-like valve)
c. infectious endocarditis (staph aureus from IVs or strep viridans if congenital)
d. rheumatic heart disease
e. trauma
f. anoretic drug: fen-phen
g. cleft mitral valve
What is the acute pathophysiology of MR?
Acute:
a. decrease in LV afterload
b. increase in LV preload
c. increased SV
d. press. and vol. overload of LA
What is the secondary etiology of MR?
a. enlarged LV and mitral valve annulus bc of ischemic heart disease
b. papillary muscle of chordae tendinae rupture/malfunction
c. clacification of mitral annulus (women > 60)
What is the chronic pathophysiology of MR?
a. decrease in LV afterload
b. increase in LV preload
c. eccentric LV hypertrophy
d. LA enlargement
What is the sound of MR? What makes it better or worse?
Click during systole (prolapse only!) and the holosystolic murmur.
Squatting makes it quieter.
What is the presentation of MR?
a. pulmonary edema
b. V wave shows increased pressure in LA during systole
What is the prognosis and treatment of MR?
Acute: poorly tolerated
Chronic: prolonged asymptomatic, but CHF, A Fib, and pulmonary hypertension. 5 year survival = 22%
What is the etiology of MVP?
billowing of a leaflet past plane of valve annulus.
What is the pathophysiology of MVP?
thickened, redundant leaflets, stretched chordae and dilated annulus.
What is the sound of MVP?
a click! in systole and a subsequent systolic murmur.
What is the presentation of MVP?
can be same as MR (dilated LA, pulmonary congestion, reduced SV, etc. ), and it occurs in 4-5% of adults
What is the etiology of aortic stenosis?
a. degenerative: calcification, leaflet thickening, inflammatory pathway
b. congenital bicuspid valve (pts. less than 70): 3:1 males to females, in 1% of population
c. rheumatic: most common in world (but not US), causes commissures to fuse and thickens subvalvular apparati
What is the pathophysiology of AS?
a. increased LV afterload
b. LV concentric hypertrophy
c. diastolic LV dysfunction is common
d. valve area of 2cm^2 or smaller
What murmur does AS make?
a systolic crescendo/decrescendo (whoosh!)
How does AS present?
a. late peaking systolic ejection murmur
b. weakened and delayed upstroke of carotid artery pulsations
What is the treatment and prognosis of AS?
angina, syncope, CHF (5, 3, and 2 year survival rate, respectively)
aortic valve replacment
What is the etiology of AR?
a. dilated aortic root
b. Marfan’s
c. endocarditis
d. dissection
e. bicuspid valve issues
f. trauma
g. rheumatic fever
What is the pathophysiology of AR?
a. increased preload
b. increased afterload
c. LV pressure/volume overload
d. LV dilates
e. LV eccentric hypertrophy
What is the murmur associated with AR?
diastolic murmur with absence of S2.
What is the presentation of AR?
Acute: LV normal size but non-compliant
Chronic: increased LV SV, widened pulse pressure, decreased coronary artery perfusion
What is the treatment and prognosis for AR?
a. can have a prolonged asymptomatic period
b. Ab prophylaxis
c. long-standing volume overload can lead to LV dysfunction
What is the etiology of TS?
almost always due to rheumatic heart disease.
What is the pathophysiology of TS?
RA enlargement.
What is the presentation of TS?
results in elevated RA/SVC/IVC pressures; leg edema, hepatomegaly
What is the treatment and prognosis of TS?
It is very RARE!
What is the etiology of TR?
a. function TR 90% of the time
b. endocarditis
c. trauma
d. rheumatic HD
e. carcinoid syndrome (tumor with serotonin)
f. myxomatous degeneration
g. ebstein’s anomaly
h. anoretic drugs
What is the pathophysiology of TR?
RV volume overload
What is the presentation of TR?
elevated RA/SVC/IVC pressures, ascites, leg edema, hepatomegaly
What is the treatment and prognosis of TR?
often tolerated and asymptomatic.
What is the etiology of pulmonic stenosis?
a. common congenital abnormality (Tetralogy of Fallot)
b. congenital rubella syndrome
c. noonan syndrome
What is the pathophysiology of PS?
RV hypertrophy
What is the etiology of PR?
usually secondary to pulmonary hypertension and/or dilated pulmonary artery
What is the presentation of PR?
rarely clinically significant.
