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