Cardiology Valves, Murmurs, Congenital Defects

surgery

definitive treatment of valvular disorders?

q 3-5 years

How often do you need to get a surveillance echo in mild valvular disorders?

q 1-2 years

How often do you need to get a surveillance echo in moderate valvular disorders?

q 6-12 months

How often do you need to get a surveillance echo in severe valvular disorders?

closure of AV valves

S1 sound indicates what?

Closure of AP valves

S2 sound indicates what?

systolic

Between S1 and S2 = ?

Diastolic

Between S2 and S1 = ?

mitral stenosis

pulmonic regurg

aortic regug

tricuspid stenosis

What are the Diastolic Murmurs?

Hint: "MS. PRARTS Died"

mitral regug

aortic stenosis

pulmonic stenosis

tricuspid regurg

MVP

ASD

VSD

Hypertrophic Cardiomyopathy

What are the systolic murmurs?

- all other ones not included in "MS. PRARTS Died"

inspiration

Right sided murmurs increase with __________.

expiration

Left sided murmurs increase with _________

2nd RICS

Location of aortic stenosis murmur.

carotids

aortic stenosis radiates to where?

sit, lean forward

Tip to hear aortic stenosis?

aortic stenosis

Which murmur?

mid-systolic

crescendo-decrescendo

2nd-4th LICS

location of aortic regurg murmur.

aortic regurg

Which murmur?

high pitch

blowing

sitting

lean forward

full exhale

Tip to hear aortic regurgitation.

aortic regurg

Which murmur is associated with the Austin Flint murmur and bounding pulses from wide pulse pressure?

aortic regurg

Which murmur?

diastolic

decrescendo

to apex and RSB

Where does aortic regurg murmur radiate to?

apex

Where is mitral stenosis best heard?

mitral stenosis

Which murmur?

low pitch

LLD, full exhale

Tips to hear mitral stenosis?

mitral stenosis

Which murmur has these associated findings?

S1 accentuated

Opening SNAP follows S2

mitral stenosis

Which murmur?

Mid-diastole

apex to left axilla

Where is mitral regurg best heard?

mitral regurg

Which murmur?

med-high pitch

blowing

mitral regurg

Which murmur has the associated finding of prolonged apical impulse?

mitral regurg

tricuspid regurg

Which two murmur are pansystolic?

LLSB

Where is tricuspid regurg best heard?

R sternum and xiphoid

Where does tricuspid regurg radiate to?

tricuspid regurg

Which murmur is medium and blowing and increases slightly with inspiration?

tricuspid regurg

Which murmur often as an elevated JVP associated with it?

2nd-3rd LICS

Where is tricuspid stenosis best heard?

left shoulder and neck

Where does tricuspid stenosis radiate to?

tricuspid stenosis

Which murmur has a medium and harsh pitch with middiastolic decrescendo-crescendo?

hint: sounds similar to mitral stenosis

tricuspid stenosis

Which murmur has early pulmonic ejection sound associated with it?

diastolic

Tricuspid stenosis is a systolic or diastolic murmur?

increase, decrease

Most murmurs __________ with rapid squatting and ___________ with valsalva or standing.

increase

Most regurgitant murmurs __________ with hand grip maneuver.

decrease, increase

MVP and HCM __________ with rapid squatting and ____________ with valsalva or standing.

decrease

MVP and HCM and aortic stenosis _________ with hand grip maneuver.

stage A

Which stage of valvular disease?

Pts at risk for valvular disease

Stage B

Which stage of valvular disease?

Pts with progressive VHD (mild to mod severity) and asx

Stage C

Which stage of valvular disease?

Asx patients with severe VHD

normal, abnormal

Stage C1 valvular disease has severe valve lesion, asympomatic, and ________ LV function

Stage C2 valvular disease has severe valve lesion, asymptomatic, and __________ LV function.

Stage D

Which stage valve disease?

Symptomatic from VHD

tissue valve

Which valve is this?

Last 10-15 yrs

Bovine or Porcine

Long term anticoag not needed

Daily ASA 81 mg

mechanical valve

Last 10000 years

Made of titanium ir pyrolytic carbon

Warfarin anticoag REQUIRED

2.0-3.0

What is the INR range for a patient with an aortic mechanical valve replacement?

2.5-3.5

ASA 81 mg daily

What is the INR range for a patient with a mitral mechanical valve replacement?

what is also needed to be given?

endocarditis prophylaxis

What is indicated for both replacement valve options?

rheumatic heart disease

What is the MCC of mitral stenosis?

10-20

Mitral stenosis has a latency period and develops about ___________ years after rheumatic fever.

dyspnea on exerction

What is the most common symptom of severe mitral stenosis?

Afib

50% of patients with mitral stenosis develop _________ and experience palpitations.

hoarsness (ortner's syndrome)

What is another unique symptom associated with mitral stenosis?

mitral stenosis

Which murmur has the opening snap?

mitral stenosis

Which murmur has the Graham Steel murmur associated with it?

Afib (COMMON)

LAE (P mitrale)

What will be seen on ECG in mitral stenosis?

echo

What is the TOC for mitral stenosis?

mild

Mild, mod, severe finding of echo in mitral stenosis?

> 1.5 cm2

moderate

Mild, mod, severe finding of echo in mitral stenosis?

1.0-1.5 cm2

severe

Mild, mod, severe finding of echo in mitral stenosis?

< 1.0 cm2

diuretic therapy (loop)

beta blockers or non-DHP CCbs (heart rate control)

warfarin (for afib or left atrial thrombus)

What is medical tx for mitral stenosis?

balloon valvotomy

surgery

Other tx for mitral stenosis?

maze procedure

left atrial appendage

Which mitral valve replacement surgery should be considered in a patient with mitral stenosis if afib is present?

MVP (mitral valve prolapse)

What is the MCC of mitral regurgitation?

afib

Patients with mitral regurg often experience palpitation and possible __________.

axilla

Mitral regurg radiates to where?

surgery

IABP (intra-aortic balloon pump)

What is tx for acute mitral regurgitation?

LA or LV enlargement

What will be seen on CXR in mitral regurgitation?

diuretics and BBs

vasodilators (acute ONLY)

anticoag (a-fib)

What is the medical tx for mitral regurg?

acute

Vasodilators should only be used in _______ mitral regurg and are not helpful in chronic mitral regurg.

emergent surgery, elective surgery

What is the surgical reccomendation for acute cause of mitral regurg?

what about chronic cause?

more than mild MR

new evidence that early mitral repair may improve symptoms

When do you refer pts with mitral regurg?

< 60%

You should perform serial exams and echo in mitral regurg if the patient has a LVEF that is < ________%, increase in end-systolic dimensions, has pulmonary HTN, or new onset afib.

mitral valve prolapse

Which murmur has a mid-systolic click and possible skeletal deformities?

degenerative or calcific aortic stenosis

What is the most common cause of aortic stenosis?

aortic stenosis

Most common murmur ever?

65 yrs

Aortic stenosis is seen in 25% of patients older than _________ years old and 35% of those older than 70.

younger, older

Degenerative causes of aortic stenosis is often seen in ___________ patients, while calcification cause of aortic stenosis is often seen in ___________ patients.

syncope

angina

dyspnea

Symptoms of aortic stenosis?

Hint: SAD

DOE and exercise intolerance

What is the most common symptom of mild aortic stenosis?

delayed carotid upstroke

Aortic stenosis will often have __________________ aka "Parvus et Tardus"

echo with doppler

What is TOC to dx aortic stenosis?

LVH

What will usually be seen on ECG in aortic stenosis?

enlarged cardiac silhouette

What will be seen on CXR in aortic stenosis?

treat HTN and ASCVD (do not reduce preload too much)

What is the tx of aortic stenosis?

surgery (SAVR)

transcutaneous (TAVR/TAVI)

What is the tx for symptomatic (stage D) or severe AS (stage C) with reduced LVEF or very severe AS.

aortic regurg

Which murmur is associated with bounding pulses?

aortic regurg

Which murmur is associated with chronic bicuspid valve dx, marfan syndrome, calcific valve dx, and RHD?

aortic dissection

blunt trauma

endocarditis

What are causes of acute aortic regurg?

aortic regurg

Which murmur is associated with water-hammer pulse or corrigan pulse?

aortic regurg

Which murmur is associated with quinke pulses?

"Quinke in the Pinky"

aortic regurg

Which murmur is associated with de musset sign ("head bob" with each mulse)?

ACEi/ARB or DHP CCB

What is the tx for mild to moderate but asymptomatic (stage B) aortic regurgitation?

surgery

What is the tx for severe aortic regurgitation?