Cardiology #3 Murmurs, Hyperlipidemia, & Atrial Myxoma Flashcards
(44 cards)
Explain the pathophysiology of aortic regurgitation.
What does this murmur sound like?
Incomplete aortic valve closure –> LV overload –> Heart failure
Diastolic blowing decrescendo murmur at LUSB
What are some symptoms of aortic regurgitation?
-Austin Flint Murmur: retrograde regurgitant jet competing with integrate flow from LA –> LV
-Bounding Pulses
-De Musset Sign: head bob with heartbeat
-Quincke Pulses: fingernail bed pulsations
-Water Hammer Pulse: swift increase and decrease of pulse with wrist elevation
What are the diagnostics done for aortic regurgitation?
Echo: shows dilated LV (thick)
Catheter: definitive
Treatment for aortic regurgitation
-Afterload reduction improves flow: ACE, ARBs, CCB
-Surgery: definitive
Explain the pathophysiology of aortic stenosis
How about some etiologies?
-LV outflow obstruction leads to a fixed CO, LVH, and LV failure eventually
-Degenerative: calcifications, wear and tear
-Congenital: Bicuspid valve (MC if < 70 years old)
-History of rheumatic heart disease
What does the murmur of aortic stenosis sound like?
Systolic crescendo/decrescendo murmur at RUSB radiating to the carotid
-Also has a weak, delayed carotid pulse
Diagnostics for aortic stenosis
-Echo: LVH, thick aortic valve
-EKG: LVH, A-fib
-Catheter is definitive
Treatment for aortic stenosis
-Surgical treatment (AV replacement)
–Mechnical: thrombogenic (needs long term anticoagulant)
–Bioprosthetic: less durable but minimally thrombogenic
–Intraaortic balloon pump: bridge before valve replacement
What are some things that the patient should avoid before valve replacement if they have aortic stenosis?
Physical exertion, venodilators (nitrates), negative inotropes (BB, CCB)
What is mitral stenosis? Where does the blood back up into in this condition?
Explain the pathophysiology.
Obstruction of flow from the LA–>LV due to narrowed mitral orifice.
blood backs up into the LA. LA pressure increases –> pulmonary congestion –> pulmonary hypertension
What is the MC etiology of mitral stenosis?
Symptoms of mitral stenosis.
Rheumatic heart disease
-Dyspnea, hemoptysis, pulmonary hypertension, cough
-A-fib due to LA enlargement
-RHF due to pulmonary congestion
-Mitral facies = flushed cheeks with facial pallor
What does the murmur of mitral stenosis sound like?
What increases the intensity?
Prominent S1, opening snap
Low pitched, mid diastolic rumbling murmur heard best at apex
Increases intensity with left lateral decubitus position
Diagnostics for mitral stenosis
ECG: ______
Echo
CXR: ______
(Definitive):________
ECG: LA enlargement, A-fib, pulmonary hypertension
CXR: LA enlargement
Definitive: catheterization
Treatment for mitral stenosis
-Percutaneous balloon valvuloplasty
-Valve replacement if unable to do balloon
What is mitral regurgitation?
What is the MCC?
Retrograde blood flow from LV–> LA leading to LA dilation and increased pulmonary pressure
MCC: MVP (leaflet etiology)
What does the murmur of mitral regurgitation sound like?
What also increases the intensity?
Blowing holosystolic murmur at apex with radiation to axilla
Increased intensity with left lateral decubitus position
Treatment for mitral regurgitation
-Symptom control (ACE, ARBs) or diuretics
-Surgical repair of valve
What is the pathophysiology of mitral valve prolapse?
Who is this MC in?
Leaflets bulge (prolapse) into the LA
MC in young women
Although most patients are asymptomatic, what symptoms CAN they have with mitral valve prolapse?
Autonomic dysfunction: atypical chest pain, panic attacks, palpitations
What does the murmur for MVP sound like?
Mid-late systolic ejection click at apex
Pulmonic stenosis is _____________ and is almost always _____ as a cause.
RV outflow obstruction
Almost always congenital, disease of the young
What does the murmur for pulmonic stenosis sound like?
Harsh mid-systolic ejection crescendo-decrescendo murmur at the LUSB that radiates to the neck and increases with inspiration
What is the preferred treatment for pulmonic stenosis?
Balloon valvulopalsty
Pulmonic regurgitation is retrograde blood flow that leads to _________.
The murmur with this condition is called a Graham-Steele Murmur. Explain this.
RV overload
brief decrescendo early diastolic murmur at LSUB with full inspiration. Increases with inspiration and decreases with expiration.
