Valvular Heart Diseases - Johnston Flashcards
Name symptoms of mitral stenosis (MS)
- DOE
- Cough orthopne,
- PND, pulmonary edema
- hemoptysis, arterial emboli, a fib
- ortner syndrome: hoarseness d/+ compression of left recurrent laryngeal nerve due to LA enlargement
what are some exam findings of MS?
- malar flush (ruddy cheeks, blue facies.
- increase S1; opening shape after S2
- rumbling diastolic murmur - low pitched; best heart at apex using bell of stet
How is MS treated?
- anticoagulant if in afib
- percutaneous balloon valvuloplasty MVR (replacement)
- diuretics
- digitalis, BB, or CCB for rate control
Pts with MS are at increased risk of RVF why?
Pts can develop increased LA pressure, pulm HTN, pulm edema, hepatomegalia, ascites, peripheral edema
what are some CXR findings for MS
- straight left heart border
- Thick right heart border
- Kerley B lines (lungs)
- Enlarged pulmonary arteries
what are some causes of Mitral regurg?
- MVP (most common) and mitral annular calcification
- ruptured chordae
- endocarditis
- ischemic papillary muscle
- collagen disease
explain the pathophys of mitral regurg
LV volume overload –> LV dilation –> LV dysfunction (volume overload)
what are some signs and symptoms of mitral regurg
- dyspnea
- orthopnea
- PND
- usually asymptomatic for years
what are some physical findings of mitral regurg?
systolic murmur (blowing, prominent at apex; radiates into left axilla)
- loudness of murmur correlates with severity
- decreased S1 or normal; may have a systolic click
How is Mitral regurg treated?
- vasodilators - afterload reduction
- decrease resistance to flow
- ACEI - chronic MR
what are some symptoms of MVP and how is it treated?
asymptomatic to arrhythmias (SVT, PVC, VT) chest pain, syncope
- systolic murmur; may have systolic click
Rx: If hyper adrenergic state (anxious, palpitations; consider BB)
- valve repair favored over replacement
If a pt presents with signs and symptoms of MVP, what must you rule out first?
- hyperthyroid
- collagen abnormalities
Explain the pathyophys of aortic stenosis (AS)
Obstruction leads to pressure overload; LVH, increased LVED pressure–> dystollic LV dysfunction –> syncope, HF
- reduced coronary flow –> angina
Symptoms of AS
- angina
- exertional dyspnea
- syncope
- HF
What are some physical findings of AS?
- narrow pulse pressure; decreased SV and systolic pressure
- delayed pulses - Parvis/tardus
- systolic murmur, harsh, 2nd ICS RSB; radiate into supra sternal notch/carotids
what are you likely to see on EKG with AS?
Left atrial enlargement
- Left Ventricle hypertrophy (w/strain)
How is AS treated?
- percutaneous balloon valvuloplasty - temporary AVR
- Drugs: digitalis, diuretics, nitroglycerin
Avoid vasodilators (increased preload)
what are some causes of aortic regurg?
- HTN
- endocarditis
- Marfans
- Anklyosing spondylitis
- aortic dissection
- syphilis
- collagen
explain the pathophys of acute aortic regurg
- high diastolic LV pressure –> premature mitral closer –> LV ischemia and failure
explain the pathophys of chronic aortic regurg
- decreased SV over time –> hyperdynamic (overload) circulation –> systolic HTN–> presure/volume overload –> concentric LVH
what are some symptoms of aortic regurg
- dyspnea
- orthopnea
- paroxysmal nocturnal dyspnea
- angina
- syncope
what are some physical findings associated with aortic regurg?
- diastolic decrescendo blowing murmur at 2-3 iCS LSB)
- Austin flint murmur
- HTN
- wide pulse pressure
- displaced PMI
- head-bobbing with heart beats (de musset sign)
- corrigan’s pulse: carotid pulse iwth rapid rise and fall
- water hamer pulse
- femoral fbruits
How is aortic regurg treated?
- ARB: decrease afterload to decrease regurg volume
- surgery AoVR when symptomatic or EF < 55%
WHy is a CT of chest performed in patients with aortic regurg
To check for aortic dilation
pt with hepatomegaly, diastolic murmur at LSB that increase with inspiration (carvallo’s sign) and decrease with expiration and valsalva. Prominent A wave in jugular venous pressure graph. Most likely valvular disease involved _
tricuspid stenosis
Pt with pulmonary HTN, hx of MI/RV infarction. Promient V wave in JVP. on PE blowing systolic murmur at LSB that increase with inspiration. most likely diagnosis
tricuspid regurg
