Valvular Heart Disease + Murmurs - Dr. Johnston Flashcards
ventricular HD most common reasons
- Myxomatous degeneration (MVP)
2. Congenital (Bicuspid Aortic Valve)
Stenosis and Regurgitation does what to the heart
S : Pressure overload, hypertrophy and HF
R : Volume overload , dilation and arrhythmia
6 causes of Systolic murmur
- Aortic stenosis
- Pulmonary stenosis
- Mitral regurg
- Tricuspid regurg
- VSD
- ASD
5 causes of diastolic murmur
- Aortic regurg
- Pulmonary regurg
- Mitral stenosis
- Tricuspid stenosis
- Atrial Myxoma
murmur grading scale
1-6
1 : barely
2. Faint
3. easy to hear
4. loud + palpable thrill
5. heard with stethoscope barley touching + thrill
6. can hear without stethoscope + palpable thrill
4 causes of ACUTE mitral regurgitation
- Ischemic papillary muscle prob (MI, CAD)
- chordal tendineae rupture
- Infective endocarditis
- Volume overload, high LA P, edema, cadiogenic shock
4 causes of CHRONIC mitral regurgitation
- Mitral valve prolapse
2. Myxomatous / degenerative valve / mitral annular calcification
Mitral regurgitation ascultation
= blowing at apex
= radiates to left axilla
= low S1
= use diaphragm
Mitral Valve Prolapse ascultation
= at apex
= click or murmur increases with Valsalva + standing
tx for mitral prolapse
reassure , if sx give BB
Tricuspid regurgitation auscultation
= blowing left 4th ICS
= increase with inspiration (Carvallo sign)
Tricuspid regurgitation PE ,
prominent V wave in elevated JVP, other then that usually asymptomatic
reasons for TR
= pulmonary htn, disease,
= RV MI
= inferior wall MI
= Pacemaker
Aortic Stenosis triad sx
- SOB
- Angina
- Syncope
Aortic Stenosis ascultation
= crescendo –> decreasendo
= harsh right 2nd ICS
= radiates to sternal notch and carotids
Aortic Stenosis PE
weak pulse, and slow (parvus and tardus)
Aortic Stenosis EKG
downsloping ST segment
Aortic Stenosis associations 3
Aortic aneurysm
Marfans
Turners
Pulmonary Stenosis ascultation
= crescendo –> decrescendo left ICS
= radiated to left shoulder and clavicle
Pulmonary Stenosis associated with what
Tetralogy of Fallot
= Pulmonary Stenosis is usually congenital
Ventricular Septal Defect Auscultation
= Holosystolic murmur LOWER LEFT sternal border
= thrill
= increase with hand gripping (left to right shunt)
Atrial Septal Defect auscultation
= UPPER LEFT sternal border murmur
= splitting of S2
= left to right shunt
4 causes of Mitral stenosis
- Rheumatic Heart Disease
- Strep Group A
- congenital
- MAC (Mitral annular calcification)
Mitral stenosis can cause
Pulmonary htn, A fib, right V failure
Mitral stenosis auscultation
= low pitch BELL
= rumbling at apex
= Increase S1 and S2 + then opening snap
Mitral stenosis sx
= SOB
= palpitations (A fib)
= hoarseness, compression of left laryngeal N (Ortners Syndrome)
Tricuspid Stenosis auscultation
= Left
= increase with inspiration (carvallo sign)
Tricuspid stenosis PE
A wave prominent in JVP
TS associated with
= Rheumatic disease (MS)
= female
Aortic Regurgitation acute 3 causes
- infective endocarditis
- aortic dissection
- chest trauma
Aortic Regurgitation (insufficiency) chronic 4 causes
- calcification degenerative
- Bicuspid valve
- dilated Aortic root
- Rheumatic heart
Aortic Regurgitation causes what
volume overload, left HF
Aortic Regurgitation acute and chronic SX
ACUTE : pulmonary Edema
CHRONIC : dyspnea, orthopnea, angina
Aortic Regurgitation auscultation
= decrescendo 3rd ICS LEFT sternal base (diastole) (Austin Flint)
= can sound like Mitral stenosis
= soft S2
Aortic Regurgitation : DeMusset sign
head bob with beats
Aortic Regurgitation Quincke’s sign
capillary nail pulsations
Aortic Regurgitation : Traube sign
“pistole shot”
= systole and diastole sounds over Femoral A
Aortic Regurgitation : Duroziez sign
= diastolic murmur over Femoral A when compressed with (BELL)
Aortic Regurgitation tx
reduce afterload = ACE Inhibitor, ARB
Pulmonary Regurgitation (insuffiency) auscultation and associations
= decrescendo 2nd ICS LEFT Sternal base (Graham steele) + increased S2 (diastole)
= associated with pulmonary htn
