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33 Cards in this Set
- Front
- Back
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Murmurs louder with inhalation
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- R sided
- increase venous return |
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Murmurs louder with exhalation
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- L sided
- compressing heart and lungs |
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Most accurate test valvular disease
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- catheterization
- echo most used/first |
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Biphasic p wave
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LA hypertrophy
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p pulmonale
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- large p wave
- RA hypertrophy |
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Mitral Stenosis - treatment
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balloon dilation
(fibrotic tissue) |
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Aortic stenosis - Treatment
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surgical replacement
(calcification) |
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Regurgitant lesions - Treatment
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- Vasodilators: ACEI/ARB, nifedipine, hydralazine
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Hydralazine - adverse effects
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- SLE
- reflex tachycardia - taken several times a day |
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Timing of surgical valve replacement
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- before heart has dilated too much
- aortic regurg: 55 mm - mitral regrug: 40 mm |
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How to assess ventricular size for valve replacement
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** End-systolic diameter
- EF - if end-systolic diameter increased --> replace valve |
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Asymptomatic mitral stenosis
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No treatment!
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Unique features mitral stenosis
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- Dysphagia: LA presses on esophagus
- Hoarseness: LA presses on recurrent laryngeal - A fib and stroke - Hemoptysis --> back flow blood in lungs |
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Mitral stenosis - physical findings
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- diastolic rumble and opening snap --> worse - earlier snap (increased LA P)
- worse with squatting and leg raise (increased venous return) |
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CXR: LA hypertrophy
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- straightening L heart border
- elevation L main bronchus - second bubble behind heart |
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Most common presentation aortic stenosis
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angina
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Aortic stenosis murmur
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- diamond shaped, systolic
- 2nd R intercostal space - radiates to carotids |
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Where do mitral murmurs radiate?
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axilla
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Effect of valsalva and standing on aortic stenosis
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less venous return --> less murmur
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Effect of handgrip on aortic stenosis
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increased afterload --> softens murmur (less blood ejected)
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ECG - LV hypertrophy
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S V1 & R V5 > 35mm
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Causes of mitral regurgitation
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- HTN
- Infection - Infarction * any heart dilation |
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Mitral regurg murmur
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- pansystolic
- radiates to axilla - obscures S1, S2 |
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Affect of handgrip on mitral stenosis
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increases afterload --> worsens murmur
(also worsens AR) |
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Which L sided murmurs do NOT increase with expiration?
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MVP
HOCM |
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Best initial therapy regurgitant lesions
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Vasodilators:
ACEIs, ARBs * decreases rate of progression (digoxin and diuretics only control symptoms) |
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When does mitral regurg need valve replacement?
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LVESD > 40
EF < 60% |
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Aortic regurgitation - physical findings
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- wide pulse pressure
- waterhammer pulse - Quinke pulse (pulsations in nail bed) Hill sign (BP in legs 40 mmHg more than arms) - head bobbing |
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Aortic regurgitation - Murmur
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- Diastolic, decrescendo
- lower left sternal border |
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Aortic regurgitation - valsalva, standing
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decrease venous return --> softer
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Aortic regurgitation - hand grip
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increases afterload --> worsens
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When should valve be replaced in aortic regurgitation?
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- acute rupture in MI
- EF < 55% - LVESD > 55 mm |
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Symptomatic MVP - Treatment
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BBs
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