Lecture 11

mitral stenosis

obstruction to left ventricular inflow at mitral valve

causes of mitral stenosis

RF, congenital, rheumatoid arthritis

Lutembacher syndrome

rheumatic mitral stenosis w/ atrial septal defect

mitral stenosis prevalence

young women

stenosis of mitral valve occurs when

decades after acute rheumatic carditis

pathophysio of mitral stenosis

left atrial p increaes → pul v htn → pul edema → RVF

pulmonary htn develops in mitral stenosis as a result of

* retrograde transmission of left atrial p
* pul a constriction
* interstitial edema
* obliterative changes

symptoms mitral stenosis

typical of LHF - dyspnea, orthopnea, paroxysmal nocturnal dyspnea, hoarsness (Ortner’s), cough, dysphagia, hemoptysis

the only valvulopathy to cause cardiac cirrhosis

mitral stenosis

symptoms of advanced mitral stenosis

embolic episodes from AF - stroke, renal failure

physical exam mitral stenosis

mitral face, apical impulse lat displaced, diastolic thrill, opening snap after S2, diastolic rumble, Graham steel murmur if pul htn, pansystolic tricuspid regurg murmur

imaging of mitral stenosis shows

left atrial enlargement

most accurate imaging for mitral stenosis

transesophageal echo

mitral regurgitation causes

* organic - RF, ruptured chordae tendinae, myxomatous degeneration
* fxnal abnormality - mitral annular dilatation, myocardial dysfxn
* mitral prolapse, endocarditis

acute mitral regurgitation causes

IE, post surgery, tumours

manifestations of acute mitral regurgitation

sudden LHF - dyspnea, fatigue, orthopnea, pul edema

exam of mitral regurgitation

palpation has brisk carotid upstroke, diminished S1, S2 wide split, holosystolic murmur

causes of chronic mitral regurgitation

mitral valve annulus calcification, scleroderma, ruptured chordae tendinae

manifestations chronic mitral regurgitation

palpitations (AF), symptoms of congestive HF (pul congestion, edema)

auscultation of acute vs chronic mitral regurgitation

p2 might be accentuated in chronic is pul htn is present

ecg acute mitral regurgitation

inf or post leads have ischemia

imaging of mitral regurgitation shows

left atrial enlargement

mitral valve prolapse prevalence

young women

causes mitral valve prolapse

hereditary ct disorders - marfan, ehlers-danlos

symptoms mitral prolapse

asymptomatic or

* autonomic dysfxn - anxiety, panic attacks, palpitations
* of mitral regurg - fatigue, dyspnea, orthopnea

general physical featues of mitral prolapse

asthenic, scoliosis, pectus excavatum, hypermobility

physical exam mitral prolapse

mid to late systolic click, followed by high pitched mid-late systolic murmur at apex

ecg mitral prolapse

st segement + T wave abnormalities

imaging mitral prolapse

cardiomegaly, signs of pul congestion if severe

causes aortic stenosis

congenital or acquired (senile degenerative calcification, rheumatic heart diseases)

pathophysio of aortic stenosis

LVH, decrease flow → congestive HF, myocardial ischemia

manifestations aortic stenosis

asymptomatic until angina, syncope, CHF (edema, hepatomegaly, elevated JVP)→ sudden cardiac death

physical exam of aortic stenosis

pulsations of apical impulse, displaced lat and inf, systolic thrill, S2 split, A2 disappearance, P2 accentuated, ejection click, crescendo-decrescendo systolic murmur

ecg of aortic stenosis

left atrial enlargement, LVH

imaging of choice to diagnose aortic stenosis

echo doppler

chronic aortic regurgitation causes

collagen diseases, degenerative aortic valve disease

causes of acute aortic regurgitation

IE, prosthetic valve malfunction, trauma

prevalence aortic regurgitation

men (due to preponderance of underlying conditions)

pathophysio of aortic regurgitation

LV volume overload

* acute - increase pul v p (pul edema, dyspnea)
* chronic - LV enlargement, increased end-diastolic p → MI

symptoms of acute vs chronic aortic regurgitation

acute - dyspnea, rapid HF, chest pain

chronic - asymptomatic, compensatory tachycardiac → palpitations, sudden cardiac death

chronic severe aortic regurgitation physical exam

widened pulse p, corrigan pulse, muller sign (systolic pulsations of uvula), quincke sign (nail pulsations), traube sign (sounds over femoral a), apical beat hyperdynamic, auscultation as S3 gallop and early diastolic murmur

ecg of aortic regurgitation

LVH, left deviation, LV overload (q waves in leads I, aVL, V3)

what imaging diagnoses and quantifies aortic regurgitation

echo, aortic angiography

tricuspid stenosis causes

rheumatic disease, carcinoid heart disease, congenital stenosis, IE

pathophysio tricuspid stenosis

less flow to right ventricle → lungs, obstructed v return → hepatic enlargement, decreased pul flow, peripheral edema

manifestations tricuspid stenosis

gradual → fatigue, peripheral edema, hepatalgia, dyspnea

auscultation tricuspid stenosis

S1 split, tricuspid openign snap, diastolic murmur increasing with inspiration

ecg tricuspid stenossi

right atrial enlargement, AF

tricuspid regurgitation causes

* primary - rheumatic disease, endocarditis, ebstein anomaly
* secondary - diseases causing pul htn

symptoms tricuspid regurgitation

peripheral edema, ascites, hepatalgia, severe → dyspnea, orthopnea

exam of tricuspid regurgitation

jvd, S3 + S4 gallop, pansystolic murmur w/ inspiratory accentuation, ascites, hepatomegaly, peripheral edema, cachexia

lab investigations of tricuspid regurgitation

shows abnormal liver fxn

imaging tricuspid regurgitation

dilated right ventricle, cardiomegaly, elevated right atrial p

pulmonary regurgitation prevalence

physiological

ethiopathogenesis of pulmonary regurgitation

* dilation of pulmonic valve ring (pul htn), acquired (IE, RF), congenital

manifestations pulmonary regurgitation

dyspnea, fatigability, light-headedness, advanced → abd distention, early satiety

exam of pulmonary regurgitation

jvp, RVH, palpable pul a at left upper sternal border, decrescendo early diastolic murmur louder in inspiration, graham steel murmur

imaging of pulmonary regurgitation

cardiomegaly, right sided enlargement