Valvular Heart Disease and Murmurs Flashcards
(30 cards)
2 most common causes of valvular heart disease
Myxomatous degeneration
Congential (bicuspid aortic valve)
What kind of overload is associated with stenosis vs. regurg?
Stenosis - pressure overload, hypertrophy and HF
Regurg - volume overload, dilation
Which murmurs are systolic?
MATPAV
Mitral regurg Aortic stenosis Tricuspid regurg Pulmonic stenosis ASD VSD
Which murmurs are diastolic?
PAMTA
Pulmonic insufficiency/regurg Aortic insufficiency/regurg Mitral stenosis Tricuspid stenosis Atrial myxoma
Grading scale for murmurs
1 - barely audible
2 - faint, soft
3 - louder, easy heard
4 - very loud w/ palpable thrill
5 - heard w/ steth barely touching the chest with thrill
6 - can be heard w/o steth w/ palpable thrill
Causes of acute MR regurg murmur (4)
Ischemic papillary m.
ruptured chordae tendinae
IE
Vol overload
Causes of chronic MR regurg murmur
MVP
Myxomatous degeneration
What does a murmur associated with a PE sound like? (4)
Systolic
Blowing at apex
Radiates to left axilla
Reduced S1
MVP has what effect on the morphology of the valve?
What are the SX?
What does it sound like?
It’s sound increases with…
What should you do?
Redundant tissue w/ myxomatous degeneration
Usually ASX
Mid-systolic click
Increases with decreased ventricular vol
Reassure or give BB is symptomatic
Tricuspid regurg is usually…
When should you be worried?
What does it sound like?
What is noted on the jugular venous pulse?
Common, ASX and functional.
If associated with pulm HTN, lung disease, RV infarct, MI, IE or pacemaker.
Blowing systolic murmur at 4th ICS at LSB. Increases on inspiration (Carvallo sign).
Prominent V wave
Aortic stenosis is most commonly caused by:
What happens to the heart as a consequence?
SX?
Degenerative calcification
Volume overload -> LVH
DOE, angina and syncope
How does an aortic stenosis murmur sound?
What heart sound is diminished?
The pulses will be parvus and tarvus. What does that mean?
What pattern is seen on ECG?
Crescendo-decrescendo, harsh at 2 ICS at RSB and radiated to sternal notch/carotids.
Diminished S2
Parvus - weak/small
Tarvus - slow rising, late
LVH, strain pattern (down sloping of ST segment - T wave)
Bicuspid aortic valve is associated with what outcomes?
Where is it heard best?
How many develop aortic stenosis?
What diseases?
Aortic root dilation (aneurysms), IE
LSB or apex
75% develop aortic stenosis
Marfans and Turner syndrome
What is the cause of pulmonary stenosis?
What does it sound like? Where is it heard best?
What might it be associated with?
Congenital
Crescendo-decrescendo. 2-3 ICS at LSB, radiating to axilla/clavicle.
ToF
VSD murmur sounds like:
Where is it heard best?
Increases with…
Holosystolic murmur with thrill.
Left lower SB
Inc with handgrip
ASD murmur is heard best at?
What heard sound is most affected?
Upper LSB
Fixed splitting of S2
Causes of mitral stenosis (3)
RHD - grp A Strep.
Congenital
Annular calcification
SX of mitral stenosis (5)
DOE Orthopnea Palpitations AFib Hoarseness
What does a mitral stenosis murmur sound like?
Where is it heard best?
What happens to the ECG?
Low pitched with an increased S1 and S2 followed by an opening snap.
LAE if in sinus rhyth
Tricuspid stenosis is usually from:
Associated with? More common in?
It increases with…
What happens to the jugular venous graph?
What happens on ECG?
RHD
Associated with mitral stenosis; females
Inspiration (Carvallo sign)
Prominent A wave (atrial contraction)
RAE
Aortic insufficiency/regurg is acutely caused by: (3)
Chronic aortic insufficiency/regurg? (4)
On pathology there is…
SX for acute vs. chronic:
IE, aortic dissection, chest trauma
Calcific degenration, BAV, dilated aortic root, RHD
Vol overload*; LVH
Acute - pulmonary edema from IE
Chronic - dyspnea, orthopnea, angina
Aortic insufficiency/regurg murmur sounds like…
Where is it heard best?
It is associated with DeMusset, Quincke’s, Traube and Duroziez signs. What are they?
What is given as an Rx?
Diastolic decrescendo murmur
3rd ICS, LSB
DeMussett - head bob with beats
Quincke’s - capillary nail pulsations
Traube - “pistol shot” sounds over femoral a.
Duroziez - diastolic murmur over the femoral a.
ACE-I or ARB to decrease afterload
Pulmonary insufficiency/regurg sounds like:
Where is it heard best?
Associated with…
Decrescendo murmur
2nd ICS at LSB
Pulm HTN; increased S2
Crescendo-decrescendo murmur
2-3rd ICS at LSB
Pulmonary stenosis
