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35 Cards in this Set
- Front
- Back
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ECG findings in valvular HD
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ECG findings generally not specific but often provide clues to the presence or type of VHD
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Echo in valvular HD
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Echocardiography has taken on an extremely important role in the diagnosis and evaluation of severity of VHD
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age related VHD (most common)
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AS
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Etiology of AS
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Calcific, related to aging
Bicuspid-congenital Consider possibility of sub valvular and supra valvular AS |
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Clinical manifestations of AS
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Angina, CHF, syncope
Cause of LVH and diastolic dysfunction |
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Physical Examination in AS
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Diminished, delayed carotid pulses (pulsus parvus et tardus)
Transmitted bruit LV heave Diminished aortic component second heart sound Early systolic murmur, high pitched, course, musical, 2RICS (Late peaking associated with severity) |
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Diff b/w AS and Aortic sclerosis
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presence or absence of gradient
murmur not transmitted to neck |
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Treatment of AS
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Asymptomatic: possibly can wait to treat
Avoid nitrates Surgical valve replacement is only reasonable treatment option Balloon valvuloplasty is at best a temporary fix |
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Pharm treatment for AS.
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No real good pharm for AS
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Etiology of aortic regurgitation
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Rheumatic
Bicuspid aortic valve Endocarditis Aorta dilation (Marfan’s, CMN, aneurysm, dissection, syphilitic) |
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Clinical manifestations of AR
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Dyspnea
Angina |
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Physical findings of AR
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Increased carotid pulse (bisferens pulse)
Displaced PMI Diastolic blow murmur, LSB, possible 2RICS Austin Flint murmur Increased pulse pressure Quinke’s pulse, and similar signs of increased pulse pressure |
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treatment of AR
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Asymptomatic, no sign of LV systolic dysfunction, wait on surgery
Valve replacement |
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What is Quinke's pulse?
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Pink flush in nailbeds from high syst and then white again from low diastolic pressure (overall wide pulse pressure) from AR
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Where is AR murmur, systole or diastole?
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diastole
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What gives second impulse in bisferens pulse?
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Such a high sys pulse causes a percussion wave
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Etiology of Mitral Stenosis
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Rheumatic 99.9%
Congenital-parachute mitral valve Congenital-cor triatriatum Lutenbacher’s (rheumatic MS with congenital ASD) |
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Clinical manifestations of MS
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CHF, dyspnea, orthopnea, right sided chf, fatigue
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Physical Findings of MS
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RV heave
Opening snap Diastolic rumble (don’t confuse with austin flint) Secondary pulmonary hypertension (increased pulmonic second heart sound) Secondary TR (systolic murmur, LSB) AF common |
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Treatment of MS
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Diuretics, treat AF, anticoagulation with AF, AF rate control
Mitral balloon valvuloplasty Open commisurotomy Valve replacement surgery |
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What is opening snap of MS?
What about severity? |
Commisural fusion?
more severe = snap is closer to S2 (earlier in diastole) |
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Diastolic rumble sounds like...
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distant sound of thunder
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Murmur assoc with blood dripping from anterior leaf of aortic valve
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Austin flint
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Etiology of Mitral Regurgitation
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MV ring dilation (CMO)
Leaflet destruction (rheumatic, endocarditis) Supporting apparatus disease (ischemia, infarction) Mitral valve prolapse |
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Cllinical manifestations of MR
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Asymptomatic many years
CHF, dyspnea, orthopnea |
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Physical findingsof MR
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Apical systolic murmur, holosystolic, early, mid late
Systolic click with MVP Diastolic rumble when regurgitation is severe even without MS Displaced PMI |
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Treatment of MR
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ACE-I?
Mitral valve repair Mitral valve replacement |
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Describe murmur of MR
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Holosystolic
loudest at apex with pt rolled on left side |
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Tricuspid Regurgitation etiology
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Most commonly secondary to pulmonary hypertension from left sided problems, or due to lung disease
Endocarditis Fen-phen, methysergide Carcinoid Secondary to right side volume overload (ASD, VSD) |
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Clinical manifestations of TR
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Fatigue, dyspnea, edema, ascites, plural effusions right sided CHF
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Physical findings of TR
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Neck vein distention
Large jugular V waves Early systolic murmur, LSB, increased with inspiration (Cavallo’s sign) |
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Treatment of TR
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In isolation, often left untreated
Treat left sided problem, pulmonary hypertension Tricupid annuloplasty ring |
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Comment on Tricuspid Stenosis?
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Rare
Rheumatic Right sided CHF Diastolic rumble, LSB |
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Comment on Pulmonic Stenosis?
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Congenital
Right sided signs Early systolic murmur, ULSB Don’t confuse with ASD, AS Some cases can be treated with balloon valvuloplasty |
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Comment on Pulmonic Regurgitation?
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Usually secondary to pulmonary hypertension
Diastolic blow, ULSB (Graham Steele murmur) Easy to confuse with AR Treat Pulmonary hypertension |
