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26 Cards in this Set
- Front
- Back
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Location of aortic stenosis border
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Right sternal border
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What is indicative of a diastolic murmur at left sternal border?
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aortic regurgitation
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What is indicative of systolic murmur at left sternal border?
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hypertrophic cardiomyopathy
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Mitral area murmurs
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systolic-mitral regurgitation
diastolic-mitral stenosis |
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When does Aortic stenosis present?
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often symptomatic later in life (calcification)
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When can aortic stenosis present in younger patients?
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rheumatic disease (thickened leaflets)
bicuspid valve or subvalvular stenosis (membrane) |
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body's solution to aortic stenosis
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concentric hypertrophy (inc wall thickness to dec wall tension)
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Compare concentric hypertrophy v. eccentric hypertrophy causes.
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Concentric=pressure overload
eccentric=volume overload |
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Effects of AS
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LV compliance reduced
-need higher LVEDP -rely more on atrial contraction for LV filling |
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Effect of acute onset a-fib in AS
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can be lethal
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Long-term effects of AS
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back up in inc LAP, which can back up into lungs causing Pulm HTN; can worsen coexisting mitral regurge secondary to inc systolic pressure (afterload)
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PE findings of aortic stenosis
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crescendo-decrescendo murmur during systole, best heard at RUSB
might hear an S4 |
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Presenting sx of AS
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angina (inadequate angiogenesis)
syncope (more likely to occur in inc HR, dec preload) HF (dilated myopathy) |
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Cure for Aortic stenosis
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valve replacement
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What is the severe measure of AS by valve area?
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<1.0 cm2
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major causes of mitral stenosis
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rheumatic disease (younger, after Strep A infection)
-thicken tips, but leaflets pliable in middle Mitral annular calcification (older) -progresses from annulus inward (can also have functional MS, parachute MV, or radiation) |
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What is needed for filling of LV?
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higher LA pressure to create a gradient
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Why does mitral stenosis lead to pulm circulation?
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Atria don't hypertrophy as much (just dilate), which can lead to A-fib earlier.
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2 phases of mitral stenosis
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passive phase (back-up of blood into pulm; reversible)
reactive phase (medial hypertrophy of pulm arterioles, which impedes blood flow and puts strain on RV) |
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Inc risk of A-fib in mitral stenosis
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LA appendage clot due to stasis of flow
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When do MS sx present first?
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exercise, stress, childbirth
can also have palpitations from a-fib, systemic venous distention, and peripheral edema |
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Exam symptoms of MS
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opening snap after S2
low rumble at beginning of diastole best heard at apex |
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3 ways to grade MS
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valve area (dec)
mean gradient (inc) P 1/2 of early inflow (extended) |
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Management of MS
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aim for better filling of LV
-BB, CCB, digitalis also anticoag -warfarin, can use heparin/LMWH |
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Definitive tx of mitral stenosis
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percutaneous balloon commisurotomy (younger, little Ca, may lead to residual ASD or unintended MR)
Valve replacement |
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What often causes pulmonic stenosis?
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usually congenital
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