chapter 11 - adult valvular heart disease Flashcards
(48 cards)
describe the murmur grading scale
I (one) - softer than can be heard with a stethoscope
II - just loud enough to be heard when stethoscope is just placed on the chest.
III- louder than grade II
IV - very loud murmur
V - can be heard when the stethoscope is a few millimeters off the chest wall
IV- murmurs that can be heard with the naked ear
what is an organic systolic murmur and which grade of murmur is usually organic
it is indicative of disease. grade II systolic murmur can be either normal (innocent) or abnormal (organic). grade III systolic murmur is always organic
what is a thrill
palpable vibration that can accompany a murmur
In HCM, a short _______ can sometimes be heard that is ____ when the patient stands
short grade III systolic murmur, louder when standing
when should an UWer be concerned about a grade II murmur that the physician is not aware of or is not concerned (has not investigated)
when there is a family history of hypertrophic cardiomyopathy (HCM)
what condition can cause childhood murmur and usually requires aortic valve replacement by age 50
bicuspid aortic valve
what is the clinical clue (Symptom) to diagnosing a bicuspid aortic valve
systolic ejection click
do grade I or II diastolic murmurs indicate disease
yes, can indicate significant disease
where is a murmur of aortic stenosis usually heard
systolic- upper sternum radiating to carotid
where is a murmur of aortic regurgitation usually heard
diastolic - left sternal edge, high pitch, decrescendo
where is the murmur of mitral stenosis usually heard
diastolic - rumbling, apex, with opening snap
where is the murmur of mitral regurgitation usually heard
systolic- blowing, apex, radiating to axilla
where is the murmur of VSD usually heard
systolic - 3rd and 4th intercostal space next to sternum
where is the murmur of MVP usually heard
late systolic - click, apex, not left sternal border
what are the characteristics of innocent/normal murmurs
left sternal edge location, grade I or II (III in children only), loudest supine but reduced or absent sitting, systolic/short/mid-systolic, may increase the same as organic murmurs, no abnormal heart sounds or clicks, nil TTE
is an EKG any help in deciding whether a murmur is normal or not
no
when is TEE preferred over TTE
when patient has barrel chest, extreme obesity, emphysema, intra cardiac factors, or aortic root disease - TEE would provide better visualization
what is a normal LVEF
55-65%
how much does the EF increase with exercise
usually 5%
what is mild, moderate, severe LV impairment (percentages)
mild 45-55%.
moderate 35-34%.
severe <35%.
if the echo report indicates mild regurg in all 3 valves, the valves are likely _______
normal
aortic sclerosis is associated with an increased risk of _______
CAD and stroke
50% of individuals with aortic sclerosis have ________
bicuspid aortic valve
what are the most common causes of valvular aortic stenosis
- congenital abnormal valve, either bicuspid or unicuspid, with calcification. 2. normal tri-leaflet (tricuspid) valve with degenerative changes, eventual calcification, and fibrosis. 3. rheumatic valve disease
