6: Vulvular heart disease Flashcards Preview

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Flashcards in 6: Vulvular heart disease Deck (35):
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Left side of the valves are more susceptible to disease

due to higher pressure

1

S1

Mitral and Tricuspid

2

S2

Aortic and Pulmonary

3

S2 Splitting-

Physiological- during inspiration
Fixed- ASD or VSD (Higher: ASD, Lower: VSD)
Wide split- Pulmonary HTN, Right branch block
Reverse- Aortic stenosis, Systemic HTN

4

S3

Turbulence

5

S4

Blood hitting non-compliant ventricle wall

6

Aortic stenosis- info

Systolic murmur
Causes
1: congenital (Unicuspid/Bicuspid valve) (3-4th)
2: Rheumatic fever (valves fuse together) (4-5th)
3: calcification (7-8th decade)

Concentric hypertrophy on LV-> LV failure

7

Aortic stenosis- sx

1: angina (1: increased demand, decreased supply to coronary arteries. 2: Mechanical compression of coronary arteries by hypertrophied LV. 3: Calcium embolus. 4: Pre-existing coronary artery disease)
2: syncope at exertion (since CO cannot go up to meet the demand of exertion)
3: Dyspnea (Left heart failure)

8

AS- exams

Apical impulse- shifted, and strong*
Weak delayed peripheral pulse* (Pulsus parvus tardus)
Soft single S2-> paradoxical split (reverse)
S4

9

AS- murmur

L: Left 2nd ICS
I: 1--6
P: medium pitch
Q: Harsh
R: radiate to neck
S: crescendo- decrescendo
T: btw S1- S2
There is ejection click (calcification) [right before the murmur]
Murmur louder on expiration (Exception: hypertrophic cardiomyopathy, Mitral collapses) (Squating increase blood on both sides, Valsalva decrease blood on both sides)

10

AS- severity

1: Pressure gradient across valve >70
2: Orifice <0.8cm2
3: paradoxical split
4: the murmur moves late/ closer to the S2

11

AS- complication

Left heart failure (CHF)
V-fib

12

AS- dx

Eco-cardiogram (exam of choice)
EKG (show LV hypertrophy; left axis deviation [V5, V6: Tall R. V1, V2: Deep S. the SUM of tall R and deep S should be more than 35 boxes])*

13

AS- tx

Valvular replacement (best results out of all 4 valve disease)
Balloon aortic valvuloplasty
Ross's operation (give pulmonary valve to aorta and give prostatic to pulmonary since pts own valve lasts longer)

14

Mitral stenosis- info

Diastolic murmur
Pressure buildup in left atrium-> hypertrophy of LA
Pulmonary HTN-> hemoptysis*
RVF* (whereas AS leads to LVF)

15

MS- causes

Rheumatic fever- MCC*
Congenital
SLE
Calcification
Rheumatic arthritis

16

MS- sx

L atrium hypertrophy compress local structures-> Ortner's syndrome (hoarseness of voice)*
Dysphasia
A-fib-> mural thrombus-> cerebral embolus*
sx of RVF (JVD, Liver cirrhosis, hemoptysis)
Central cyanosis
S1- delayed and loud*
Palpitations- A-fib

17

MS- murmur

L: 5th ICS mid clavicular
I: 1-6
P: low pitch
Q: Rumble
R: no radiation
S: decrescendo
T: diastolic

PSA; Pre-systolic accentuation (atrial contraction)

18

MS- severity

Smaller the gap btw S2 and murmur, more severe it is.
Orifice: <1cm: severe

19

MS- Right heart regurge**

1: Tricuspid regurge (louder in inspiration): Corvello's sign
2: pulmonary valve regurge (blowing decrescendo murmur): Graham Steel sign

20

MS- exam

EKG-
-A-fib
-Bi-fib p wave (delay of LA p wave on LEAD II. on LEAD V1: RA is positive and LA is negative peaks on p wave)

21

MS- tx

Correction is better than replacement on surgery-> thus repair the existing M valve first*

23

MR- cause

any of 5 things can be damaged
Annulus
Leaflet
Chorda tendenie
Papillary muscle
Myocardium

24

MVP- cause

Myxomatous degeneration; type 3 collagen degenerates-> posterior leaflet is more affected (posterior valve is supplied by single artery; R coronary)

25

MR- heart sound

S3
S1- gets barried in murmur (No lov for MR)
Wide split of S2

26

MR- murmur

L: Mitral area
I: 1-6
P: high pitch
Q: blowing
R: axilla
S: platau
T: systolic

27

MVP- murmur

1- multiple click
similar to AS murmur
Crescendo-Decrescendo
Gets louder on valsalva, quieter on squating (to Ddx with AS)

28

MR- exam

Eco-cardiogram

29

MR- tx

symptomatic
Mvalve repair

30

Aortic regurgitation- info

Eccentric hypertrophy by volume overload (much more than MR)
Extreme shift of apical impulse
Pulmonary HTN

31

AR- sx

Pulse pressure: wide
Systole is very high, Diastole is very low
1: Corrigan pulse: strong pulse that rapidly collapses like water hammer
2: de Musset sign: each heart beat, pts head bob
3: Quinckie's sign: Capillary pulsations when light is transmitted through the pts fingertip
4: Traube sign: pistol shot on femoral artery with stetho

32

AR- cause

Takayasu
Syphyllus
Ankylosing spondilitis

33

AR- murmur

L
I: 1-6
P: high pitch
Q: blowing or musical
R: no
S: decrescendo
T: diastolic

Austin Flint murmur: the regurg blood hits anterior leaflet of Mitral valves

34

Hand-grip exercise**

1: increase systemic resistance
2: increased left ventricular filling
Murmurs
AR: louder
AS: quieter
MR/ MS: louder
MVP/hypertrophic cardiomyopathy: quieter

39

Mitral regurgitation- info

During systolie, blood regurge back into LA
1: Acute; Pressure build up in LA-> RVF (IE, RF, MI)
2: Chronic; blood all comes back into LV (S3)-> volume overload-> eccentric hypertrophy of LV (Myxomatous degeneration-> mitral valve prolapse, Calcification, RF)