Valvular heart disease Flashcards by Melissa Ring

What are the most common causes for valvular heart disease

Mitral regurge
Aortic stenosis

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What is the most common cause for valvular disease in developing countries

Rheumatic heart disease

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Where are congenital murmurs typically found

Aortic or pulmonic valve

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What are some acquired murmurs

rheumatic fever
syphillis
endocarditis
cardiomyopathy
aortic aneurysm

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What are complications that occur with valvular diseases

heart failure
stroke
clots
arrhythmias
death

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What is occurring in the valve when regurgitation is occurring

leaflets don’t close properly and the blood back flows
**Generally from prolapse

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What is occurring in the valve with stenosis s

Leaflets become thick /stiff from calcium deposit and may even fuse together

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What is valvular atresia

valve isn’t formed
-solid tissue prevents blood flow between chambers

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When are right sided murmurs louder

During inspiration
**(Rinspiration)

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When are left sided murmurs louder

expiration

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What murmurs get louder when after load is increased

aortic regurge
mitral regurge
VSD

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What murmurs get quieter when after load is decreased

HOCM
Mitral prolapse
aortic stenosis

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Which murmurs get louder when preload is increased

aortic stenosis
mitral stenosis

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What murmurs get quieter with increasing preload

HOCM
Mitral prolapse

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Which murmurs get loud with decreasing preload

HOCM
Mitral prolapse

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Which positions will accentuate mitral murmurs

Mitral stenosis
**Causes S3 & S4 to accentuate

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What murmur will get louder when the patient is sitting up and leaning forward

aortic regurge

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What are common presenting valvular disease symptoms

chest pain
abdominal swelling
SOB
dizziness

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What is the most common type of heart murmur

Innocent murmur

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What causes innocent murmurs

rapid ejection of blood across the valve (Common in hyperkinetic state)

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What are examples of hyperkinetic states

pregnancy
fever
anemia
rapid growth

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Which characteristics make a murmur pathologic

Diastolic murmur
Holo- or late systolic
continuous
Grade >3

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which murmurs do you hear mid systolic

innocent / functional
aortic stenosis
HOCM

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Which murmurs do you hear late systolic

Mitral prolapse

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Which murmurs are holosystolic

MR TR VSD

What is one of the most common and most serious valve diseases

Aortic stenosis

What are some of the aortic stenosis symptoms

breathlessness chest pain /pressure /tightness fainting palpitations decline in activities / ADL

What type of murmur does aortic stenosis have

systolic crescendo - decrescendo narrow pulse pressure on BP

What is the treatment of aortic stenosis

valve replacement

When is treatment of aortic stenosis indicated

once symptoms begin OR when LV dysfunction occurs

What is aortic regurge

leakage of the aortic valve each time to LV relaxes

What causes aortic regurge

valvular calcifications endocarditis aorta-dilation

What is the most common cause of chronic aortic regurge in children

ventricular septal defect

When will you hear aortic regurge best

while patient is supine

What type of murmur is aortic regurge

diastolic **decrescendo murmur

What is corrigans pulse

wide pulse pressure

When is corrigans pulse seen

severe aortic regurge

When do you hear an Austin-flint murmurs

severe aortic regurge **Heard at the apex of the heart

What is occurring in mitral regurge

volume overload which causes LV remodeling

What are some mitral regurge symptoms

LE edema SOB **Especially on exertion when laying down

What type of murmur is mitral regurge

holosystolic

Where will a mitral regurge murmur radiate

axilla or left sternal border

What effects does mitral regurge have on the body

slow progressive symptoms of heart failure and, if afib develops - palpitations

What is the treatment for mitral regurge

symptomatic patients and patients meeting echo criteria get a valve replacement / repair

What are some causes of mitral regurge

endocarditis MI HOCM trauma age

What is the most common cause of isolated MR

Mitral prolapse

What is heard with mitral valve prolapse

mid to late sharp systolic click (S1 / S2 normal)

How is mitral prolapse treated

does not usually require treatment **Beta blockers can help with sx

What patient populations experience mitral stenosis

age 15-40 in developing nations

How will mitral stenosis present

hemoptysis LE edema palpitations chest discomfort

What is the pathophys of mitral stenosis

pressure build up in the LA and sent back to lungs = congestion and SOB

What generally causes mitral stenosis

rheumatic fever annular calcification

What will mitral stenosis sound like

Loud S1 with snappy-hallmark

Where is mitral stenosis heard best

At the apex of lungs with patient in left lateral decub

When are prophylactic abx agains endocarditis indicated with mitral stenosis

patients who have had a valve replacement

When are symptoms first noticed with pulmonary stenosis

while exercising

What is the general cause of pulmonary stenosis

congenital heart defect

When is pulmonary stenosis usually diagnosed

childhood

What are the complications associated with pulmonary stenosis

RVH Right HF Arrhythmia Increased risk of infective carditis

What is the treatment for pulmonary stenosis

valvuloplasty

what does pulmonary stenosis sound like

increased S2 splitting crescendo-decrescendo systolic

What is the most common cause of pulmonary insufficiency

pulmonary hypertension or tetralogy of fallot

How will pulmonary insufficiency found

high pitched early decrescendo murmur ends before S1

How do you treat pulmonary insufficiency

directed at cause -valve replacement is not usually needed

What is the cause of tricuspid stenosis

rheumatic fever

What else is seen when a patient has tricuspid stenosis

tricuspid regurge mitral stenosis

How will a tricuspid stenosis sound

Mid-diastolic rumble with pre systolic accentuation

Why are liver enzymes elevated with tricuspid stenosis

passive hepatic congestion

What is the treatment for tricuspid stenosis

diuretics aldosterone antagonists

What generally causes tricuspid insufficiency

secondary to leaflet tethering from annular dilation and/or papillary muscle displacement

What is the best imaging for evaluating RV size and function

cardiac MRI

What will tricuspid insufficiency sound like

holosystolic with patient sitting upright

What are the best initial treatments for valvular disease

no smoking more active healthy weight balanced diet less alcohol manage stress

What medications are beneficial in valvular disease

diuretics blood thinners anti-arrhythmics abx (chronic / prophylaxis)

Valvular heart disease Flashcards

(74 cards)