valvular problems Flashcards
(47 cards)
signs of MR
soft S1, normal s2
s3 added sound
pansystolic murmur
axilla radiation
what are causes of acute MR
think of rupture
Acute MR → Rupture or Sudden Damage
• IHD (Ischemic heart disease) → Papillary muscle rupture (post-MI)
• MVP (Mitral valve prolapse) → Chordae tendineae rupture
• IE or RHD (Infective endocarditis/Rheumatic heart disease) → Valve perforation
pathophysiology of acute Mitral regurg
In acute MR, the valve suddenly becomes incompetent (due to rupture of papillary muscles, chordae tendineae, or valve perforation).
• During systole, blood abnormally regurgitates into the LA instead of going into the aorta.
• The left atrium (LA) is normal-sized and non-compliant, so it cannot handle the sudden extra volume.
• This leads to a sharp increase in LA pressure, which transmits back to the pulmonary veins and capillaries.
what are causes of chronic MR
takes time to develop
• MVP: myxomatous degeneration
(Marfan syndrome)
• Dilated CM: annular dilatation
• RHD
pathophysiology of chronic MR
the left atrium mara7 ekoon ma9doom bcz of chronic long standing regurg so there is time for LA to dilate , inc compliance, and gradually inc pressure
tx of acute mitral regurg
surgical valve replacement
reduce afterload–> ace, arb
diuretics
tx in chronic MR
repair better than replace
mitral valve prolapse
Due to myxomatous degeneration caused by Marfan syndrome
• Pathology: one of the mitral valve leaflets prolapses back into the LA causing mitral regurgitation in some cases
presentation of mvp
Presentation:
o Atypical chest pain
o Palpitations
o O/E mid-systolic click followed by later systolic murmur
-From stand to squat: murmur will decrease in intensity & click will increase
-From squat to stand: murmur will increase in intensity & click will decrease
what are causes of aortic stenosis
Causes:
• Calcification: bicuspid if young, tricuspid if elderly
• Rheumatic heart disease
pathophysiology of aortic stenosis
• Stiff & narrow valve → Harder for blood to pass through → LV has to work harder
• Left ventricular hypertrophy (LVH) → Thickening of LV muscle to handle extra work
• Less blood gets out → Symptoms appear on exertion (because the heart cannot pump more when needed)
• Eventually, the LV fails → Blood backs up → Heart failure (HF) symptoms
signs of AS
🔹 Soft S2 (muffled second heart sound) → The stiff valve does not close properly.
🔹 S4 gallop (atrial kick sound) → The left atrium contracts forcefully against a stiff LV. atria kick vent
Murmur: Classic “Harsh Crescendo-Decrescendo” Sound
🔹 Systolic ejection murmur (SEM) → Blood forcefully passes through the narrow valve.
🔹 Best heard at the right upper sternal border and radiates to the carotids.
how does s4 sound
• “Tennessee” Rhythm → “Le-LUB-DUB” (S4-S1-S2)
• “Ten-” → S4
• ”-nes-” → S1
• ”-see” → S2
🔹 Best heard at the apex with the bell of the stethoscope in late diastole.
what are pulse findings in AS
🔹 Parvus et Tardus → Weak (parvus) and delayed (tardus) carotid pulse because blood struggles to pass through the tight valve.
🔹 Narrow pulse pressure → The difference between systolic and diastolic BP is small because the LV cannot generate a strong output.
what is the cause of carotid bruit
AS
pnemonic for aortic stenosis
•S → Syncope (exertional fainting)
•A → Angina (chest pain from overworked LV)
•D → Dyspnea (heart failure due to LV failure)
pathophysiology of AR
1️⃣ Aortic valve doesn’t close properly → Blood leaks back into LV during diastole.
2️⃣ LV volume overload → LV dilates to accommodate extra blood.
3️⃣ More blood pumped out → Leads to increased stroke volume & widened pulse pressure (high systolic, low diastolic BP).
4️⃣ Over time, LV weakens → Leading to left ventricular failure.
acute vs chronic AR
🩸 Acute AR (Sudden Onset, Medical Emergency! 🔥)
• Infections → Infective endocarditis
• Inflammation → Acute rheumatic fever
• Trauma/Damage → Aortic dissection, MI, failed prosthetic valve
🩸 Chronic AR (Develops Over Years)
• Congenital → Bicuspid aortic valve, Marfan syndrome, Ehlers-Danlos
• Inflammatory Diseases → Rheumatoid arthritis, ankylosing spondylitis, SLE
• Chronic damage → Syphilis, osteogenesis imperfecta
symptoms of AR
✅ Early Stage → Asymptomatic for years
✅ Later Stage → Symptoms of LV failure
• Dyspnea, orthopnea (trouble breathing when lying down)
✅ Acute AR (Severe Emergency!) → Cyanosis & shock
signs of severe AR
Quincke’s pulse → Nailbed capillary pulsations
• Head bobbing → Head moves with each heartbeat (Musset’s sign)
• Hill’s Sign → Popliteal BP > Brachial BP by 60 mmHg
murmurs in AR
• Early Diastolic Murmur (AR EDM) → Best heard when sitting forward, breath held in expiration.
• Austin Flint Murmur → Mid-diastolic murmur due to mitral valve interference from regurgitant jet.
tricuspid stenosis most always caused by
rheumatic fever
what is the most common cause of tricuspid regurg
pul htn
Signs of TR
• Pan systolic murmur, left lower sternal border, high in intensity with inspiration
(take a deep breath — different from VSD)
• Elevated JVP = prominent V-wave with S1 due to increased atrial filling in systole
due to regurgitation of blood back into the atrium
• Pulsatile tender Hepatomegaly (pulsates in systole)
• There may be severe peripheral edema and ascites.
