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CMT > Valvular Heart Disorders > Flashcards

Valvular Heart Disorders Flashcards

1
Q

describe normal heart sound S1

A
  1. “lubb”
  2. simultaneous closing of mitral and tricuspid valves
  3. start of systole, end of diastole
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2
Q

describe normal heart sound S2

A
  1. “dubb”
  2. simultaneous closing of aortic and pulmonic valves
  3. end of systole, beginning of diastole
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3
Q

which heart murmur is heard as crescendo-decrescendo in systole?

A

aortic or pulmonary stenosis

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4
Q

which heart murmurs are heard as holosystolic? (same throughout systole)

A

mitral or tricuspid regurgitation

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5
Q

which heart murmurs are heard as a decrescendo in early diastole?

A

aortic or pulmonic regurgitation

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6
Q

which heart murmurs are heard as the same volume toward the end of diastole?

A

mitral or tricuspid stenosis

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7
Q

what all can you use to describe cardiac murmurs?

A
  1. intensity
  2. pitch
  3. quality
  4. timing
  5. shape (change of sound)
  6. location
  7. radiation
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8
Q

describe grade I murmur

A

barely audible

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9
Q

describe grade II murmur

A

audible, but soft

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10
Q

describe grade III murmur

A

easily audible

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11
Q

describe grade IV murmur

A

easily audible + thrill

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12
Q

describe grade V murmur

A

easily audible, w/ a thrill, heard with stethoscope only lightly on the chest

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13
Q

describe grade VI murmur

A

easily audible, w/ a thrill, heard without a stethoscope on chest

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14
Q

order of valve sounds for chest

A

A P Erb’s (P) T M

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15
Q

what is a thrill?

A
  • vibratory sensation felt on the skin
  • indicates turbulent flow
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16
Q

Where do systolic murmurs originate?

A

begin in the ventricle (as the blood is leaving)

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17
Q

which murmurs are systolic?

A
  1. aortic stenosis
  2. mitral regurg
  3. pulmonic stenosis
  4. tricuspid regurg
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18
Q

what can structural things can cause a systolic murmur?

A
  • ventricular septal defect
  • hypertrophic CM
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19
Q

where do diastolic murmurs end?

A
  • in the ventricle
  • the murmur occurs as the blood is coming into the ventricle
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20
Q

which murmurs occur in diastole?

A
  1. mitral stenosis
  2. aortic regurg
  3. tricuspid stenosis
  4. pulmonic regurg
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21
Q

what effect does respiration have on murmurs?

A

right sided murmurs increase with respiration due to increased venous return to the R side of the heart

respiration = right

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22
Q

what effect does abrupt standing having on heart murmurs?

A

most murmurs diminish in intensity w/ standing due to reduced venous return to the heart and subsequently reduced R and L ventricular diastolic volumes

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23
Q

what effect does a squat/leg raises have on murmurs?

A

most murmurs become louder w/ squatting due to increased afterload

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24
Q

what effect does the valsalva maneuver have on murmurs?

A
  • most murmurs decrease in intensity during a valsalva maneuver
  • except for mitral valve prolapse
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25
Q

what effect does the sustained hand grip have on murmurs?

A
  • can help differentiate between AS and MR
  • AS: murmur decreases
  • MR: murmur increases
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26
Q

what echo progression?

A
  1. TTE (mod disease)
  2. TEE (sx or severe disease)
  3. if surgery is needed: heart cath (examines coronary arteries)
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27
Q

what will an echo tell you about the heart?

5

A
  1. EF
  2. chamber size
  3. aortic root enlargement
  4. estimates RVSP
  5. Valve (pressure across valve, rest/mean/peak; claculation of valve size)
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28
Q

Aortic Stenosis

describe a normal valve

A
  • 3-4 cm with little to no pressure difference across the valve
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29
Q

Aortic Stenosis

describe aortic stenosis

A
  • narrowing of the aortic valve which narrows the LV outflow tract
  • the LV then has to generate a higher systolic pressure to increase LV wall stress
  • in response, there is LVH
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30
Q

Aortic Stenosis

3 ways it can occur

A
  1. calcific degeneration
  2. age related
  3. congenital: unicuspid or bicuspid
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31
Q

Aortic Stenosis

describe calcific degeneration

A

calcium deposition at the fusion of the valve leaflets

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32
Q

Aortic Stenosis

who is most affected with age related?

A

12% of pts aged 75+

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33
Q

Aortic Stenosis

what happens with congenital unicuspid or bicuspid valves?

A
  • fusion of R or L coronary cusps
  • 1-2% of population
  • male predominated
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34
Q

Aortic Stenosis

risk factors

6

A
  1. HTN
  2. hypercholesterolemia
  3. smoking
  4. DM
  5. age
  6. congenital defect
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35
Q

Aortic Stenosis

signs & sx

6 components

A
  1. can be asx
  2. SAD (syncope, angina, dyspnea)
  3. HF
  4. fatigue
  5. reduced exercise tolerance
  6. sudden death
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36
Q

Aortic Stenosis

PE findings

4 components

A
  • harsh crescendo-decrescendo systolic murmur heard best at the R upper sternal border
  • S1 unaffected, S2 diminished (can disappear)
  • diminished and delayed carotid upstroke
  • pulses parvus et tardus
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37
Q

Aortic Stenosis

diagnostic options

A
  1. TEE
  2. CXR
  3. EKG
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38
Q

Aortic Stenosis

what will TEE tell you?

3 generalities

A

give info on valve area, peak velocity, mean transvalvular pressure gradient

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39
Q

Aortic Stenosis

what can be seen on CXR?

A
  • usually normal
  • possible cardiomegaly or calcification
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40
Q

Aortic Stenosis

what can be seen on EKG?

A
  • can be normal
  • LVH or LAE
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41
Q

Aortic Stenosis

what is survival rate at 2 and 5 yrs after sx onset?

A
  1. 50% at 2 yrs
  2. 20% at 5 yrs
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42
Q

Aortic Stenosis

tx for asx pts

A
  1. preventing CAD (BP control, glucose control, cholesterol control, exercise, smoking cessation, NSR)
  2. if sx of HF develop, manage w/ diuretics (caution)
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43
Q

Aortic Stenosis

surgical treatment

A
  1. Aortic valve replacement (only definitive tx for severe symptomatic aortic stenosis)
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44
Q

Aortic Stenosis

replacement options

A
  1. bioprosthetic tissue vs mechanical
  2. can do ascending aortic aneurysm repair at same time
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45
Q

Aortic Stenosis

describe bioprosthetic tissue valves

3 components

A
  1. last an avg of 10-15 yrs
  2. surgical or transcatheter (bovine or porcine)
  3. long term OACs not required
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46
Q

Aortic Stenosis

describe mechanical valve replacement

A
  1. lasts forever essentially
  2. preferred for younger pts
  3. requires lifelong anti-coags
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47
Q

Aortic Stenosis

if getting valve replaced, no matter which method, prophylaxis is required for what?

A

endocarditis

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48
Q

Aortic Stenosis

what is TAVR

A

transcatheter aortic valve replacement

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49
Q

Aortic Stenosis

who gets TAVR

3 risk factors

A
  • age > 70 y/o
  • LV EF: < 40%
  • CKD
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50
Q

Aortic Stenosis

2 types of TAVR

A
  1. Balloon aortic valvuloplasty (edwards)
  2. Self expanding (medtronic)
51
Q

Pulmonary Valve Stenosis

who usually has these?

A
  1. rare
  2. usually congential
52
Q

Pulmonary Valve Stenosis

signs & sx

5

A
  1. mild/mod: asx
  2. DOE
  3. CP
  4. R sided HF
  5. exertional syncope
53
Q

Pulmonary Valve Stenosis

PE findings

3 components

A
  1. palpable parasternal lift due to RVH
  2. hepatic congestion, hepatosplenomegaly
  3. peripheral edema
54
Q

Pulmonary Valve Stenosis

describe the murmur?

2

A
  • crescendo-decrescendo systolic murmur
  • +/- thrill at the supraclavicular notch and LUSB
55
Q

Pulmonary Valve Stenosis

what will you see on echo?

A

thickened leaflets, RVH

56
Q

Pulmonary Valve Stenosis

what will you see on EKG?

3

A

+/- R atrial dilation, RVH

57
Q

Pulmonary Valve Stenosis

tx

2

A
  1. percutaneous balloon valvuloplasty
  2. pulmonary valve replacement
58
Q

Mitral Regurgitation

risk factors

5

A
  1. mitral valve prolapse
  2. ischemia/infarct
  3. cardiomyopathies
  4. rheumatic heart disease
  5. mitral annular calcification
59
Q

Mitral Regurgitation

signs & sx in acute MR

A
  • sudden onset SOB
  • orthopnea
  • lower extremity edema
  • cardiogenic shock
60
Q

Mitral Regurgitation

signs & sx of chronic MR

A
  1. asx for years followed by:
  2. DOE
  3. exercise intolerance
  4. palpitations possible (a fib) due to L atrial dilation
61
Q

Mitral Regurgitation

PE findings

A
  1. high-pitched blowing holosystolic murmur
  2. heard best at apex, may radiate to axilla
  3. could hear S3
62
Q

Mitral Regurgitation

what will echo show?

4 components, general

A
  1. regurgitant volume
  2. EF
  3. L atria size
  4. L ventricular size, PA pressure, R ventricular function
63
Q

Mitral Regurgitation

what is purpose of BNP

A

early identifier or L ventricular dysfunction

64
Q

Mitral Regurgitation

purpose of CXR

A

differentiates acute vs chronic MR

65
Q

Mitral Regurgitation

purpose of tx?

A

reduce afterload

66
Q

Mitral Regurgitation

which meds?

3

A
  1. vasodilators (hydralazine, ACE)
  2. diuretics
  3. OACs (only if a fib)
67
Q

Mitral Regurgitation

surgery indications for acute severe MR

A
  • urgent surgery
  • stabilize pt w/ vasodilator to help decrease pulm pressure and maximize forward flow
68
Q

Mitral Regurgitation

surgery indications for chronic severe MR

A
  • elective surgery
  • chronic early surgery is indicated in asx pts with EF < 60% or LV dilation with reduced contractility (> 40cm after contraction)
69
Q

Mitral Regurgitation

surgical options

A
  1. mitral valve repair
  2. mitral valve replacement
  3. percutaneous approach repair
70
Q

Mitral Valve Prolapse

overview

A
  • floppy valve
  • mitral valve leaflets protrude into the L atrium during systole
  • most common cause of MR in the US
71
Q

Mitral Valve Prolapse

signs & sx

4 components

A
  1. asx
  2. non-specific CP, dyspnea, fatigue, palpitations
  3. +/- pectus excavatum, scoliosis
  4. mid systolic click +/- sysolic murmur
72
Q

Mitral Valve Prolapse

what will you see on echo?

A
  1. > 2 mm displacement of one or both mitral leaflets into the L atrium during systole
  2. increased leaflet thickness and redundant leaflets and chordae
73
Q

Mitral Valve Prolapse

medication tx

A
  1. afterload reduction
  2. BB for palpitations w/ PACs or PVCs
74
Q

Mitral Valve Prolapse

surgical tx

A
  1. mitral valve repair
  2. mitral valve replacement
75
Q

Tricuspid Regurgitation

primary disease

A

any disease process that causes derangements of the tricuspid apparatus

76
Q

Tricuspid Regurgitation

secondary (functional) disease

A

anatomoically normal valve w/ R ventricular dilation from an outside cause

77
Q

Tricuspid Regurgitation

which conditions can cause tricuspid regurg?

5

A
  1. mitral stenosis
  2. pulm HTN
  3. COPD
  4. CM
  5. L sided HF
78
Q

Tricuspid Regurgitation

signs and sx

A
  • usually asx
  • can have sx of R sided HF
  • if severe: congestive hepatopathy, bowel edema
79
Q

Tricuspid Regurgitation

describe the murmur

A
  • pansystolic murmur that increases with inspiration (Carvallo Sign)
  • heard best at the 3rd or 4th ICS along the LSB
80
Q

Tricuspid Regurgitation

diagnostics

2

A
  • echo
  • EKG (incomplete RBBB)
81
Q

Tricuspid Regurgitation

medication tx

A
  1. diuretics (afterload reducing agents)
  2. aldosterone antagonist if ascites
82
Q

Tricuspid Regurgitation

surgery options

2

A
  1. tricuspid annuloplasty
  2. valve replacement
83
Q

Aortic Regurgitation

caused by abnormalities of what?

A
  • aortic root
  • ascending aorta
  • valve leaflets
84
Q

Aortic Regurgitation

pathophys

A
  • reversal of flow from the aorta into the LV (diastolic regurgitation of LV stroke volume –> LV volume overload)
85
Q

Aortic Regurgitation

Chronic causes

2

A
  • bicuspid valve
  • dilated CM
85
Q

Aortic Regurgitation

Acute Causes

6

A
  • infective endocarditis
  • Marfan’s
  • Aortic dissection
  • Acutve proesthetic vavle dysfunction
  • inflammatory disease
  • dilated CM
86
Q

Aortic Regurgitation

Sx

4

A
  1. exertional dyspnea
  2. fatigue
  3. atypical chest pain
  4. eventual LV dilation/failure
87
Q

Aortic Regurgitation

physical exam of murmur

A
  • blowing decrescendo murmur
  • radiates to the apex
  • LUSB w/ pt sitting & leaning forward
88
Q

Aortic Regurgitation

when would you hear an Austin Flint murmur?

A

severe aortic insufficiency

89
Q

Aortic Regurgitation

describe austin flint murmur

A
  • audible at the apex
  • middle to late diastolic rumble low picthed mitral murmur
  • due to the partial closing of the anterior leaflet of the mitral valve by the regurgitant jet
90
Q

Aortic Regurgitation

other PE findings

3

A
  1. displaced PMI lateral to the midclavicular line in the 5th ICS
  2. diastolic thrill- 2nd LICS
  3. wide pulse pressure
91
Q

Aortic Regurgitation

describe water hammer pulse

A
  • collapsing pulse
  • rapid swelling and falling arterial pulse
  • palpate radial or brachial arteries
92
Q

Aortic Regurgitation

Hill’s sign

A
  • popliteal cuff systolic pressure exceeding brachial pressure by more than 60 mmHg w/ pt in recumbent position
93
Q

Aortic Regurgitation

Muller’s Sign

A

visible systolic pulsations of the uvula

94
Q

Aortic Regurgitation

De Musset’s sign

A

head bobbing w/ each heartbeat

95
Q

Aortic Regurgitation

Becker’s sign

A

pulsations of the retinal arteries and pupils

96
Q

Aortic Regurgitation

rosenbach’s sign

A

systolic pulsations of the liver

97
Q

Aortic Regurgitation

gerhard’s sign

A

systolic pulsations of the spleen

98
Q

Aortic Regurgitation

Dx

A
  • echo
  • ekg (LVH)
99
Q

Aortic Regurgitation

tx if mild

5

A
  • vasodilators (hydralazine)
  • diuretics
  • BB
  • CCB
  • ACE
100
Q

Aortic Regurgitation

tx if severe

A
  • aortic valve replacement
  • aortic root replacement
101
Q

Pulmonary Regurgitation

commonly due to?

A

dilation of the valve ring due to pulmonary HTN or dilation of the pulm arteries

102
Q

Pulmonary Regurgitation

sx

3

A
  • largely asx
  • r sided heart failure
  • DOE
103
Q

Pulmonary Regurgitation

describe murmur

A
  • brief low-pitched diamond-shaped diastolic murmur heard best at the 3-4 LICS
  • diastolic murmur increases w/ inspiration
  • 2nd heart sound may be split
104
Q

Pulmonary Regurgitation

dx- what & what does it indicate?

A

echo- RV size and function indicate severity

105
Q

Pulmonary Regurgitation

Tx options

4

A
  1. Diuretics
  2. Vasodilators
  3. tx of underlying disease
  4. pulm valve replacement
106
Q

Mitral Stenosis

describe

A

obstruction of blood flow from the LA to the LV due to a narrowed mitral opening

107
Q

Mitral Stenosis

most commonly the result of what?

A

rheumatic fever

108
Q

Mitral Stenosis

sx if severe

remember: if mild, can be asx for long time

A
  • DOE (most common)
  • Ortner’s Syndrome (dilated LA impinges on laryngeal nerve) = hoarseness
  • PND, orthopnea, palpitations
  • cough, hemoptysis
109
Q

Mitral Stenosis

describe the murmur

A
  • low pitched, rumbling, mid-diastolic
  • best heard L lateral decubitus position w/ bell
  • OPENING SNAP!! (extra diastolic sound)
110
Q

Mitral Stenosis

PE

A
  • thrill in the L lateral decubitus position
  • Malar Rash (pink-purple patches on the cheek)
111
Q

Mitral Stenosis

Dx

3 & what they’d show

A
  • Echo: EF, LAE
  • EKG: broad, notched P, LAE
  • CXR: LAE, calcified mitral valve
112
Q

Mitral Stenosis

non surgical tx

A
  • percutaneous mitral balloon commissurotomy
  • diuretics (loops)
  • BBs
  • If in a fib, give warfarin w/ INR goal 2-3
113
Q

Mitral Stenosis

surgical tx

A
  • surgical tissue valve replacement
  • mechanical valve replacement
114
Q

Tricuspid Stenosis

describe

A

blood backs up into the RA

115
Q

Tricuspid Stenosis

sx

A
  • FATIGUE
  • r sided HF
  • “a wave” into the juglar veins
116
Q

Tricuspid Stenosis

describe the murmur

A
  • low pitched, diastolic murmur
  • LLSB, 3-4th ICS
  • increases w/ inspiration
117
Q

Tricuspid Stenosis

Dx

A
  • echo: thickened leaflets, smaller tricuspid valve orifice
  • EKG: RAE
118
Q

Tricuspid Stenosis

medical tx

2- 1 med, 1 lifestyle

A
  • intensive sodium restriction
  • diuretics
119
Q

Tricuspid Stenosis

surgical options

2

A
  • tricuspid valvuloplasty or replacement
  • bioprosthetic valve
120
Q

what does MR PASS / MVP mean?

A
  • mitral regurg
  • pulmonary/aortic stenosis
    are systolic
  • so is mitral valve prolapse
121
Q

what does MS PAID mean

A
  • mitral stenosis
  • pulmonic aortic insufficiency
    are diastolic
122
Q

which murmurs radiate to:
* axilla?
* carotids?

A
  • MR
  • AS
123
Q

which murmur has an opening snap?

A

MS

CMT (72 decks)

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