Heart Murmurs and Valvular Disease Flashcards Preview

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Flashcards in Heart Murmurs and Valvular Disease Deck (29):
1

aortic stenosis

systolic: between S1 and S2
crescendo-decrescendo
LV>> aortic pressure in systole: causes concentric LVH
loudest: base, radiates to carotids
pulse weak with delayed peak
Sx: syncope, angina, dyspnea on exertion( HF), arrhythmia, sudden death
Cause: calcification of valve (usually age related or early onset in bicuspid aortic valve)

2

mitral regurgitation

systolic: between S1 and S2
holosystolic, high-pitched blowing
loudest: apex to axilla
cause: ischemic heart disease (post-MI), MVP, LV dilation; rheumatic fever, infective endocarditis

3

tricuspid regurgitation

systolic: between S1 and S2
holosystolic, high-pitched blowing
loudest: tricuspid area to right sternal border
cause: RV dilation; rheumatic fever, infective endocarditis

4

mitral valve prolapse

MOST COMMON
systolic: start halfway between S1 and S2 (end)
mid systolic click with late crescendo murmur
loudest: apex (just before S2)
predisposes to infective endocarditis
causes: myxomatous degeneration (Marfan or Ehlers-Danlos), rheumatic fever, chordae rupture
thinned zona fibrosa, expanded zona spongiosa
pregnancy: regurgitation goes into remission due to increased blood volume
rare complication: infective endocarditis

5

ventricular septal defect

systolic: between S1 and S2
holosystolic, harsh
loudest: tricuspid

6

aortic regurgitation

diastolic: after S2
high-pitched blowing early diastolic (long diastolic murmur and hyper dynamic pulse: severe and chronic)
get eccentric hypertrophy
cause: aortic root dilation, bicuspid aortic valve, endocarditis, rheumatic fever
progresses to left HF
Sx: pistol shot, head bobbing, wide PP

7

patent ductus arteriosus

continuous
loudest: left infraclavicular area at S2
causes: rubella, premature

8

mitral stenosis

diastolic: after S2
opening snap, delayed rumbling late diastolic murmur
LA>> LV pressure in diastole
severity increases as interval between S2 and opening snap decreases
cause: rheumatic fever
can progress to LA dilation, RHF

9

S1

mitral and tricuspid close
loudest: at mitral

10

S2

aortic and pulmonary close
loudest: left upper sternal border

11

S3

in early diastole during rapid ventricular filling
increased filling pressure: mitral regurgitation, HF, dilated ventricles (indicates increase in EDV)
normal in children and pregnant women

12

S4

late diastole (atrial kick)
loudest: apex with patient in left lateral decubitus position
high atrial pressure: LVH

13

infective endocarditis

large irregular vegetations on valve cusps (atrial side of AV, ventricular side of semilunar) that can extend to chordae tendon
most mitral valve alone or mitral plus aortic
complications: HF, septic embolism (kidneys, heart, spleen, brain), perforate valve, abscess (check if fever persists after Tx and can perforate septum), fibrosis, calcification
Sx: fever, chills, weakness, dyspnea
signs: murmur, splenomegaly, petechiae
labs: high ESR, anemia, proteinuria
other: osler nodes, subungual splinter hemorrhages, Janeway lesions, Roth spots

14

pathogenesis of infective endocarditis

valvular endothelial injury, platelet and fibrin deposition, microbial seeding, microbial multiplication

15

How do you determine if it is endocarditis?

vegetations: transesophageal echo > transthoracic
Dx: culture (alert lab because some slow growing)

16

most common causes of endocarditis

staph aureus: acute
strep viridans: subacute (weeks)
through dental or central line
other: IV drug abuse, prosthetic valves, lesions of lg. bowel

17

mechanical valves

need lifelong anticoagulation

18

bioprostheses valves

deteriorate: half need replacement in 10 yrs

19

complications of replacement valves

leak, thrombosis, embolism, bleeding, endocarditis
more complications in mechanical valves

20

Libman-Sacks endocarditis

lupus
small-medium vegetations on multiple valves (either/both side)
rarely embolizes

21

Virchow's triad

thrombosis: endothelial injury, abnormal flow, and hyper coagulability

22

carcinoid syndrome

serotonin released from tumor
Sx: flushing, diarrhea, dermatitis, bronchoconstriction
systemic: can get heart disease of endocardium and valves of right heart
white plaque like thickening

23

rheumatic heart disease

fever phase: small, warty vegetations along the lines of closure of valve leaflets

24

marantic endocarditis

nonbacterial thrombotic endocarditis
small, bland vegetations attached to line closure (can be one or many)
precursor to infective endocarditis

25

acute regurgitation

no hypertrophy
cause: ischemia (post-MI), infection, dissection
mitral: sudden rise in V wave (atrial pressure)
Sx: murmur, pulmonary edema without enlargement

26

How is stenosis assessed?

1. tightness
2. pressure gradient on each side of valve
3. Gorlin: CO and pressure gradient determine severity of stenosis
4. flow

27

How is regurgitation assessed?

visualize

28

indications of surgery in infective endocarditis

1. HF unresponsive to medication
2. uncontrolled infection
3. recurrent major embolization

29

When is endocarditis prophylaxis recommended?

dental procedures, surgery (GI or respiratory mucosa)