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CMT > Valvular Heart Disorders > Flashcards

Valvular Heart Disorders Flashcards

1
Q

describe normal heart sound S1

A
  1. “lubb”
  2. simultaneous closing of mitral and tricuspid valves
  3. start of systole, end of diastole
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2
Q

describe normal heart sound S2

A
  1. “dubb”
  2. simultaneous closing of aortic and pulmonic valves
  3. end of systole, beginning of diastole
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3
Q

which heart murmur is heard as crescendo-decrescendo in systole?

A

aortic or pulmonary stenosis

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4
Q

which heart murmurs are heard as holosystolic? (same throughout systole)

A

mitral or tricuspid regurgitation

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5
Q

which heart murmurs are heard as a decrescendo in early diastole?

A

aortic or pulmonic regurgitation

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6
Q

which heart murmurs are heard as the same volume toward the end of diastole?

A

mitral or tricuspid stenosis

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7
Q

what all can you use to describe cardiac murmurs?

A
  1. intensity
  2. pitch
  3. quality
  4. timing
  5. shape (change of sound)
  6. location
  7. radiation
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8
Q

describe grade I murmur

A

barely audible

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9
Q

describe grade II murmur

A

audible, but soft

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10
Q

describe grade III murmur

A

easily audible

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11
Q

describe grade IV murmur

A

easily audible + thrill

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12
Q

describe grade V murmur

A

easily audible, w/ a thrill, heard with stethoscope only lightly on the chest

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13
Q

describe grade VI murmur

A

easily audible, w/ a thrill, heard without a stethoscope on chest

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14
Q

order of valve sounds for chest

A

A P Erb’s (P) T M

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15
Q

what is a thrill?

A
  • vibratory sensation felt on the skin
  • indicates turbulent flow
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16
Q

Where do systolic murmurs originate?

A

begin in the ventricle (as the blood is leaving)

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17
Q

which murmurs are systolic?

A
  1. aortic stenosis
  2. mitral regurg
  3. pulmonic stenosis
  4. tricuspid regurg
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18
Q

what can structural things can cause a systolic murmur?

A
  • ventricular septal defect
  • hypertrophic CM
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19
Q

where do diastolic murmurs end?

A
  • in the ventricle
  • the murmur occurs as the blood is coming into the ventricle
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20
Q

which murmurs occur in diastole?

A
  1. mitral stenosis
  2. aortic regurg
  3. tricuspid stenosis
  4. pulmonic regurg
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21
Q

what effect does respiration have on murmurs?

A

right sided murmurs increase with respiration due to increased venous return to the R side of the heart

respiration = right

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22
Q

what effect does abrupt standing having on heart murmurs?

A

most murmurs diminish in intensity w/ standing due to reduced venous return to the heart and subsequently reduced R and L ventricular diastolic volumes

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23
Q

what effect does a squat/leg raises have on murmurs?

A

most murmurs become louder w/ squatting due to increased afterload

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24
Q

what effect does the valsalva maneuver have on murmurs?

A
  • most murmurs decrease in intensity during a valsalva maneuver
  • except for mitral valve prolapse
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25
what effect does the sustained hand grip have on murmurs?
* can help differentiate between AS and MR * AS: murmur decreases * MR: murmur increases
26
what echo progression?
1. TTE (mod disease) 2. TEE (sx or severe disease) 3. if surgery is needed: heart cath (examines coronary arteries)
27
what will an echo tell you about the heart? | 5
1. EF 2. chamber size 3. aortic root enlargement 4. estimates RVSP 5. Valve (pressure across valve, rest/mean/peak; claculation of valve size)
28
# Aortic Stenosis describe a normal valve
* 3-4 cm with little to no pressure difference across the valve
29
# Aortic Stenosis describe aortic stenosis
* narrowing of the aortic valve which narrows the LV outflow tract * the LV then has to generate a higher systolic pressure to increase LV wall stress * in response, there is LVH
30
# Aortic Stenosis 3 ways it can occur
1. calcific degeneration 2. age related 3. congenital: unicuspid or bicuspid
31
# Aortic Stenosis describe calcific degeneration
calcium deposition at the fusion of the valve leaflets
32
# Aortic Stenosis who is most affected with age related?
12% of pts aged 75+
33
# Aortic Stenosis what happens with congenital unicuspid or bicuspid valves?
* fusion of R or L coronary cusps * 1-2% of population * male predominated
34
# Aortic Stenosis risk factors | 6
1. HTN 2. hypercholesterolemia 3. smoking 4. DM 5. age 6. congenital defect
35
# Aortic Stenosis signs & sx | 6 components
1. can be asx 2. SAD (syncope, angina, dyspnea) 3. HF 4. fatigue 5. reduced exercise tolerance 6. sudden death
36
# Aortic Stenosis PE findings | 4 components
* harsh crescendo-decrescendo systolic murmur heard best at the R upper sternal border * S1 unaffected, S2 diminished (can disappear) * diminished and delayed carotid upstroke * pulses parvus et tardus
37
# Aortic Stenosis diagnostic options
1. TEE 2. CXR 3. EKG
38
# Aortic Stenosis what will TEE tell you? | 3 generalities
give info on valve area, peak velocity, mean transvalvular pressure gradient
39
# Aortic Stenosis what can be seen on CXR?
* usually normal * possible cardiomegaly or calcification
40
# Aortic Stenosis what can be seen on EKG?
* can be normal * LVH or LAE
41
# Aortic Stenosis what is survival rate at 2 and 5 yrs after sx onset?
1. 50% at 2 yrs 2. 20% at 5 yrs
42
# Aortic Stenosis tx for asx pts
1. preventing CAD (BP control, glucose control, cholesterol control, exercise, smoking cessation, NSR) 2. if sx of HF develop, manage w/ diuretics (caution)
43
# Aortic Stenosis surgical treatment
1. Aortic valve replacement (only definitive tx for severe symptomatic aortic stenosis)
44
# Aortic Stenosis replacement options
1. bioprosthetic tissue vs mechanical 2. can do ascending aortic aneurysm repair at same time
45
# Aortic Stenosis describe bioprosthetic tissue valves | 3 components
1. last an avg of 10-15 yrs 2. surgical or transcatheter (bovine or porcine) 3. long term OACs not required
46
# Aortic Stenosis describe mechanical valve replacement
1. lasts forever essentially 2. preferred for younger pts 3. requires lifelong anti-coags
47
# Aortic Stenosis if getting valve replaced, no matter which method, prophylaxis is required for what?
endocarditis
48
# Aortic Stenosis what is TAVR
transcatheter aortic valve replacement
49
# Aortic Stenosis who gets TAVR | 3 risk factors
* age > 70 y/o * LV EF: < 40% * CKD
50
# Aortic Stenosis 2 types of TAVR
1. Balloon aortic valvuloplasty (edwards) 2. Self expanding (medtronic)
51
# Pulmonary Valve Stenosis who usually has these?
1. rare 2. usually congential
52
# Pulmonary Valve Stenosis signs & sx | 5
1. mild/mod: asx 2. DOE 3. CP 4. R sided HF 5. exertional syncope
53
# Pulmonary Valve Stenosis PE findings | 3 components
1. palpable parasternal lift due to RVH 2. hepatic congestion, hepatosplenomegaly 3. peripheral edema
54
# Pulmonary Valve Stenosis describe the murmur? | 2
* crescendo-decrescendo systolic murmur * +/- thrill at the supraclavicular notch and LUSB
55
# Pulmonary Valve Stenosis what will you see on echo?
thickened leaflets, RVH
56
# Pulmonary Valve Stenosis what will you see on EKG? | 3
+/- R atrial dilation, RVH
57
# Pulmonary Valve Stenosis tx | 2
1. percutaneous balloon valvuloplasty 2. pulmonary valve replacement
58
# Mitral Regurgitation risk factors | 5
1. mitral valve prolapse 2. ischemia/infarct 3. cardiomyopathies 4. rheumatic heart disease 5. mitral annular calcification
59
# Mitral Regurgitation signs & sx in acute MR
* sudden onset SOB * orthopnea * lower extremity edema * cardiogenic shock
60
# Mitral Regurgitation signs & sx of chronic MR
1. asx for years followed by: 2. DOE 3. exercise intolerance 4. palpitations possible (a fib) due to L atrial dilation
61
# Mitral Regurgitation PE findings
1. high-pitched blowing holosystolic murmur 2. heard best at apex, may radiate to axilla 3. could hear S3
62
# Mitral Regurgitation what will echo show? | 4 components, general
1. regurgitant volume 2. EF 3. L atria size 4. L ventricular size, PA pressure, R ventricular function
63
# Mitral Regurgitation what is purpose of BNP
early identifier or L ventricular dysfunction
64
# Mitral Regurgitation purpose of CXR
differentiates acute vs chronic MR
65
# Mitral Regurgitation purpose of tx?
reduce afterload
66
# Mitral Regurgitation which meds? | 3
1. vasodilators (hydralazine, ACE) 2. diuretics 3. OACs (only if a fib)
67
# Mitral Regurgitation surgery indications for acute severe MR
* urgent surgery * stabilize pt w/ vasodilator to help decrease pulm pressure and maximize forward flow
68
# Mitral Regurgitation surgery indications for chronic severe MR
* elective surgery * chronic early surgery is indicated in asx pts with EF < 60% or LV dilation with reduced contractility (> 40cm after contraction)
69
# Mitral Regurgitation surgical options
1. mitral valve repair 2. mitral valve replacement 3. percutaneous approach repair
70
# Mitral Valve Prolapse overview
* floppy valve * mitral valve leaflets protrude into the L atrium during systole * most common cause of MR in the US
71
# Mitral Valve Prolapse signs & sx | 4 components
1. asx 2. non-specific CP, dyspnea, fatigue, palpitations 3. +/- pectus excavatum, scoliosis 4. mid systolic click +/- sysolic murmur
72
# Mitral Valve Prolapse what will you see on echo?
1. >2 mm displacement of one or both mitral leaflets into the L atrium during systole 2. increased leaflet thickness and redundant leaflets and chordae
73
# Mitral Valve Prolapse medication tx
1. afterload reduction 2. BB for palpitations w/ PACs or PVCs
74
# Mitral Valve Prolapse surgical tx
1. mitral valve repair 2. mitral valve replacement
75
# Tricuspid Regurgitation primary disease
any disease process that causes derangements of the tricuspid apparatus
76
# Tricuspid Regurgitation secondary (functional) disease
anatomoically normal valve w/ R ventricular dilation from an outside cause
77
# Tricuspid Regurgitation which conditions can cause tricuspid regurg? | 5
1. mitral stenosis 2. pulm HTN 3. COPD 4. CM 5. L sided HF
78
# Tricuspid Regurgitation signs and sx
* usually asx * can have sx of R sided HF * if severe: congestive hepatopathy, bowel edema
79
# Tricuspid Regurgitation describe the murmur
* pansystolic murmur that increases with inspiration (Carvallo Sign) * heard best at the 3rd or 4th ICS along the LSB
80
# Tricuspid Regurgitation diagnostics | 2
* echo * EKG (incomplete RBBB)
81
# Tricuspid Regurgitation medication tx
1. diuretics (afterload reducing agents) 2. aldosterone antagonist if ascites
82
# Tricuspid Regurgitation surgery options | 2
1. tricuspid annuloplasty 2. valve replacement
83
# Aortic Regurgitation caused by abnormalities of what?
* aortic root * ascending aorta * valve leaflets
84
# Aortic Regurgitation pathophys
* reversal of flow from the aorta into the LV (diastolic regurgitation of LV stroke volume --> LV volume overload)
85
# Aortic Regurgitation Chronic causes | 2
* bicuspid valve * dilated CM
85
# Aortic Regurgitation Acute Causes | 6
* infective endocarditis * Marfan's * Aortic dissection * Acutve proesthetic vavle dysfunction * inflammatory disease * dilated CM
86
# Aortic Regurgitation Sx | 4
1. exertional dyspnea 2. fatigue 3. atypical chest pain 4. eventual LV dilation/failure
87
# Aortic Regurgitation physical exam of murmur
* blowing decrescendo murmur * radiates to the apex * LUSB w/ pt sitting & leaning forward
88
# Aortic Regurgitation when would you hear an Austin Flint murmur?
severe aortic insufficiency
89
# Aortic Regurgitation describe austin flint murmur
* audible at the apex * middle to late diastolic rumble low picthed mitral murmur * due to the partial closing of the anterior leaflet of the mitral valve by the regurgitant jet
90
# Aortic Regurgitation other PE findings | 3
1. displaced PMI lateral to the midclavicular line in the 5th ICS 2. diastolic thrill- 2nd LICS 3. wide pulse pressure
91
# Aortic Regurgitation describe water hammer pulse
* collapsing pulse * rapid swelling and falling arterial pulse * palpate radial or brachial arteries
92
# Aortic Regurgitation Hill's sign
* popliteal cuff systolic pressure exceeding brachial pressure by more than 60 mmHg w/ pt in recumbent position
93
# Aortic Regurgitation Muller's Sign
visible systolic pulsations of the uvula
94
# Aortic Regurgitation De Musset's sign
head bobbing w/ each heartbeat
95
# Aortic Regurgitation Becker's sign
pulsations of the retinal arteries and pupils
96
# Aortic Regurgitation rosenbach's sign
systolic pulsations of the liver
97
# Aortic Regurgitation gerhard's sign
systolic pulsations of the spleen
98
# Aortic Regurgitation Dx
* echo * ekg (LVH)
99
# Aortic Regurgitation tx if mild | 5
* vasodilators (hydralazine) * diuretics * BB * CCB * ACE
100
# Aortic Regurgitation tx if severe
* aortic valve replacement * aortic root replacement
101
# Pulmonary Regurgitation commonly due to?
dilation of the valve ring due to pulmonary HTN or dilation of the pulm arteries
102
# Pulmonary Regurgitation sx | 3
* largely asx * r sided heart failure * DOE
103
# Pulmonary Regurgitation describe murmur
* brief low-pitched diamond-shaped diastolic murmur heard best at the 3-4 LICS * diastolic murmur increases w/ inspiration * 2nd heart sound may be split
104
# Pulmonary Regurgitation dx- what & what does it indicate?
echo- RV size and function indicate severity
105
# Pulmonary Regurgitation Tx options | 4
1. Diuretics 2. Vasodilators 3. tx of underlying disease 4. pulm valve replacement
106
# Mitral Stenosis describe
obstruction of blood flow from the LA to the LV due to a narrowed mitral opening
107
# Mitral Stenosis most commonly the result of what?
rheumatic fever
108
# Mitral Stenosis sx if severe | remember: if mild, can be asx for long time
* DOE (most common) * Ortner's Syndrome (dilated LA impinges on laryngeal nerve) = hoarseness * PND, orthopnea, palpitations * cough, hemoptysis
109
# Mitral Stenosis describe the murmur
* low pitched, rumbling, mid-diastolic * best heard L lateral decubitus position w/ bell * OPENING SNAP!! (extra diastolic sound)
110
# Mitral Stenosis PE
* thrill in the L lateral decubitus position * Malar Rash (pink-purple patches on the cheek)
111
# Mitral Stenosis Dx | 3 & what they'd show
* Echo: EF, LAE * EKG: broad, notched P, LAE * CXR: LAE, calcified mitral valve
112
# Mitral Stenosis non surgical tx
* percutaneous mitral balloon commissurotomy * diuretics (loops) * BBs * If in a fib, give warfarin w/ INR goal 2-3
113
# Mitral Stenosis surgical tx
* surgical tissue valve replacement * mechanical valve replacement
114
# Tricuspid Stenosis describe
blood backs up into the RA
115
# Tricuspid Stenosis sx
* FATIGUE * r sided HF * "a wave" into the juglar veins
116
# Tricuspid Stenosis describe the murmur
* low pitched, diastolic murmur * LLSB, 3-4th ICS * increases w/ inspiration
117
# Tricuspid Stenosis Dx
* echo: thickened leaflets, smaller tricuspid valve orifice * EKG: RAE
118
# Tricuspid Stenosis medical tx | 2- 1 med, 1 lifestyle
* intensive sodium restriction * diuretics
119
# Tricuspid Stenosis surgical options | 2
* tricuspid valvuloplasty or replacement * bioprosthetic valve
120
what does MR PASS / MVP mean?
* mitral regurg * pulmonary/aortic stenosis are systolic * so is mitral valve prolapse
121
what does MS PAID mean
* mitral stenosis * pulmonic aortic insufficiency are diastolic
122
which murmurs radiate to: * axilla? * carotids?
* MR * AS
123
which murmur has an opening snap?
MS

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