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56 Cards in this Set
- Front
- Back
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Two main types of Valvular Heart Disease?
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Narrow = Stenosis from pressure overload
Leaky = Regurgitation from Volume overload |
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What causes a murmur?
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Turbulent Blood Flow
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Causes of Systolic Murmurs?
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Aortic Stenosis
Mitral Regurgitation |
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Types of Murmurs w/ Aortic Stenosis vs Mitral Regurgitation
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AS = midsystolic
MR = holosystolic |
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Causes of Diastolic Murmurs?
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Aortic Regurgitation
Mitral Stenosis |
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Unique characteristic of Right-Sided Murmurs?
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They all Increase w/ Inspiration
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How do you check the PMI?
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w/ the patient in the Left Lateral Decubitus Position
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What is more prominent in patients w/ concentric hypertropy than in pts w/ LV dilatation w/o volume overload?
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LV Heave or Lift
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What is a LV Heave/Lift/
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Sustained Outward Movement of an area larger than normal apex, i.e. more than 2-3 cm in diameter
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What is RV Heave/Lift?
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palpable Anterior Systolic Movement in the Left Parasternal Region
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how do you feel for a RV Heave/Lift?
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Proximal Palm or Fingertips w/
Patient lying Supine |
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What does a RV Heave/Lift Represent?
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RV Enlargement
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What sounds are characteristic of Ventricular Systole?
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S1 and S2
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What is going on w/ a Split S2?
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its still just Ventricular Systole, but it occurs when the patient takes a deep breath. The change in pressure causes the pulmonic valve to stay open just a little bit longer so you hear the difference between it closing and the aortic valve closing
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What is the cause of the S3 Sound?
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Ventricular Diastole
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What causes an S4 heart sound?
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It is during ventricular diastole but due to extra forceful atrial contractions
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How do the ventricles receive blood during sinus rhythm?
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3 Filling Phases
First phase can cause S3 Third Phase can cause S4 |
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Other name for the first phase of ventricular filling?
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Rapid Filling Phase
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How much of regular ventricular filling occurs in the rapid filling phase (#1)
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80%
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What happens during the 3rd phase of diastolic Filling?
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the atria contract
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Pathological Causes of an Audible S4
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Systemic HTN
Aortic Stenosis Hypertrophic Cardiomyopathy Ischemic Heart Disease Acute Mitral Regurg Most pts w/ acute MI and sinus rhythm |
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Most likely cause of Aortic Stenosis is patients under 70 yo?
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Biscuspid Aortic Valve (50%)
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Most common cause of Aortic Stenosis in patients over 70 yo?
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Degenerative Calcific AS
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What % of pts w/ a bicuspid aortic valve an associated CV abnormality? what kinds?
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20%
PDA AC |
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Pathology w/ Calcific AS?
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possible Inflammatory changes w/ infiltration of macrophages and T-lymphocytes
Cusps immobilized and stenosis from Ca along flexion lines at bases |
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Incidence of Calcific AS in population over 65?
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2%
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% of Calcific AS patients w/ aortic sclerosis?
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29%
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Risk Factors for Calcific AS?
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DM
Elevated Cholesterol |
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W/ a bicuspid aortic valve, when would symptoms of AS present?
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before 50 yo
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What is the normal aortic valve area?
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3-4 cm^2
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Secondary Effects of AS?
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Increased Afterload
LVH=>LV failure Inc LV Systolic Pressure, LVET, and diastolic pressure |
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Cardinal Sx's of AS?
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Angina (2/3 of pts)
Syncope Dyspnea on exertion Ultimately CHF |
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Other possible Sx's of AS?
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GI Bleedings (angiodysplasia)
Sudden Death Infective Endocarditis |
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Physical Exam Findings in a Patient w/ AS?
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Pulsus Parvus and Tardus
PMI Sustained and displaced laterally and inferiorly Normal S1 and Loud S4 |
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What the crap is Pulsus Parvus and Tardus?
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Parvus = weak/small
Tardus = late =delayed slow-rising carotid pulse |
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Signs of Aortic Stenosis on Auscultation?
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Systolic Ejection Murmur at 2nd RICS radiating to carotids
(can be weak w/ LV failure) |
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Changes in the volume loop for AS?
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increased End Diastolic Volume
Increased Afterload Decreased Stroke Volume |
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When do you see LV eccentric hypertrophy?
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Aortic Insufficiency
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Main pathological feature of Aortic Regurge?
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Volume Overload
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Sx's of Aortic Regurgitation?
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Dyspnea
Hyperdynamic Pulses Diastolic Murmur at LSB Systolic Flor Murmur Austin Flint Murmur Third Heart Sound Displace PMI (lat and inferior) |
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Causes of Mitral Stenosis?
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Rheumatic (#1)
Calcific Congenital Collagen-Vascular Disease |
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% of Rheumatic Heart Disease patients w/ MS? what about MS and MR?
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25% just MS
40% MS and MR |
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Gender and rheumatic MS?
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2/3 are women
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Appearance of heart w/ Mitral Stenosis?
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Enlarged LA
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Sx's of Severe MS?
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Dyspnea on exertion
Orthopnea Paroxysmal Nocturnal Dyspnea |
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MS Sx's can be precipitated by?
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Atrial Fibrillation
Pregnancy |
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Two Syndromes that can be caused by MS?
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Pulmonary Congestion w/ Moderate MS
Pulmonary HTN, Low Cardiac Output w/ Severe MS |
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Physical Findings w/ MS?
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Prominent MItral First Sound
Opening Snap (when LA pressure finally builds up enough) Apical Diastolic Rumble |
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EKG findings w/ MS?
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LA abnormality
Typically Atrial Fibrillation |
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Clinical Presentation of Mitral Regurgitation?
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Chronic:
Dyspnea Easy Fatigue Palpitations Acute: Left Heart Failure Shock |
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Most Common Causes of Mitral Regurgitation?
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Mitral Valve Prolapse (#1)
Coronary Artery Disease Rheumatic Heart Disease |
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Anatomic findings w/ Mitral Regurgitation?
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Enlarged LA and LV
Possible Ruptured Chordae Tendinae |
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Volume curve changes w/ Mitral Regurgitation?
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Increased End Diastolic Volume
Increased Stroke Volume (cause a lot is going back to LA) |
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Why is Acute MR bad bad?
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LA and LV aren't dilated so they can't handle the increased volume. It then backs up into lungs causing inc capillary pressure=>pulmonary edema
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Sx's of MR?
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Dyspnea (pulmonary congestion)
Fatigue (dec forward blood flow) Palpitations (atrial fib) |
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Physical Exam findings w/ MR?
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Holosystolic Murmur at apex radiating to axilla (not affected by resp)
S3 present if HF Displace Apical Impulse (PMI) |
