WCS5 Cardiology Fever and murmur Flashcards
(26 cards)
Valvular stenosis and regurgitation causes what kind of structural chamber changes
stenosis - hypertrophy of proximal chamber, dilation when chamber fails
regurgitation - dilation of chambers on either side of valve
what heart problem is progressive exertional dyspnea indicative of
LHF
what heart problem
is ankle edema, hepatic pain indicative of
RHF
CVS investigations
- ECG
- CXR
- Echo
- exercise testing
- cardiac catheterisation
what does echo assess
- valvular archi
- chamber size
- chamber function
- doppler: valvular gradient, DSE to assess ischemia and contractile reserve
what does exercise testing assess
functional capacity
what does cardiac catheterization assess
- CAD
- pressure gradient
- regurgitant lesions by contrast
chronic rheumatic disease commonest valve involvement
mitral
aortic + mitral
aortic tricuspid
MS> MR+MS> MR
causes of MS
95% rheumatic
5% congenital
complication of MS
PHT
RHF
predisposing structural factors for IE
- valvular (MR>MS, AR>AS, prosthetic, normal in ivdu
- shunts (congenital, postsurgical for VSD, PDA, AV fistula
History of MS
respiratory symptoms (exertional dyspnea, PND)
RHF (edema, hepatic pain)
afib (palpitation, fatigue - cardiac decompensation)
systemic embolization (enlarged LA –> stasis)
why does MS cause afib
dilated LA
how does afib cause cardiac decompensation
afib –> reduced LV filling
afib –> increased ventricular systole (higher rate –> lower diastolic LV filling)
–> lower stroke volume and CO
signs of MS
General exam (RHF, LHF)
- malar flush if PHT
- ankle/sacral edema
- small pulse volume, irregular pulse if afib
- loss of venous a wave if afib
- raised jvp if RHF
Precordium
- nondisplaced tapping apex
- parasternal heave (RVH/ PHT)
- loud S1
- loud P2 with opening snap if PHT
- mid-diastolic rumble at apex best heard with exercise/ left lateral position
Complications
- basal creps
- cold extremities/ stroke (emboli)
Investigations for MS-
- CXR (large LA - straight left heart border; pulmonary edema - Kerley A B lines)
- ECG (P mitrale, AF, RVH)
- Echo (thickened + dooming; parallel diastolic mvt of MV; size of MV opening)
- Cardiac catheterization (CAD asso)
parameters to assess MS severity
- symptoms
- presence of PHT
- duration of murmur
- interval between S2 and OS
what is p mitrale
LA abnormality on ECG, (MS LA enlargement)
A. double humped p wave in II
B. wide and deep negative deflection in V1 p wave
treatment for MS
- diuretics
- digoxin for Afib
- anticoagulation for valvular afib or history of embolisation
- valvuloplasty
- valvotomy
- MV replacement
causes of acute cardiac decompensation in MS
- afib (reduced ventricular filling and thus CO)
- chest infection
- pregnancy (increased intravascular volume)
MR causes
- rheumatic (50%) tgt with MS
- MVP
- ruptured chordae tendinae (degen, collagen disease, IE, active rheumatic heart)
- papillary muscle dysfunction (MI)
- LV dilation
signs of MR
General
- (ankle/sacral edema)
- afib if tgt with MS
Precordial - displaced apex (- systolic thrill) - parasternal heave if PHT (late/MS) - Soft S1 - pansystolic murmur best heard apex, radiating to axilla - S2 buried in systolic murmur - S3 present - S4 if acute regurgitation (acute LV failure in ruptured tendinae --> no time for LV to adapt to increased volume)
Investigations for MR
- ECG (afib, LVH)
- CXR (left heart enlargement, pulmonary edema)
- echo (cause of MR)
- Cardiac catheterization (severity of MR, CAD)
MVP associated syndromes
- secondary ASD
- Turners
- PDA
- WPW
- Marfans
- osteogenesis imperfecta
