Sounds
Difference between mitral regurgitation and tricuspid regurgitation and where each are best heard
Mitral regurgitation- blowing holosystolic murmur best heard at apex (can also hear mid systolic click)
Tricuspid regurgitation- blowing holosystolic murmur best heard at LSB (can increase with leg raising or exercise)
MC cause of pulmonic stenosis
Tetraology of Fallot
initial symptom of aortic stenosis
decline in functional capacity and DOE
what is the typical final or ultimate tx in patients with valve disorders
valve repair or valve replacement
what is always that best diagnostic of choice for valve disorders
TTE!
Name 2 mid systolic murmurs (bonus if you describe each)
aortic stenosis- crescendo decrescendo
MVP- mid to late systolic ejection click (sounds like billowing of leaflets into LA followed by high pitched mid systolic murmur best heard at apex)
MC cause of Mitral Regurgitation
MVP
symptoms of MVP
can be asymptomatic but can also see chest pain, palpitations, anxiety/fatigue, pain attacks, orthostasis and syncope/pre-syncope
When should you repeat testing for aortic regurgitation
TTE every 2-5 years if stable (6-12 months if severe)
Which valve disorder has a poor prognosis without a valve replacement surgery
Name 3 diastolic murmurs (bonus if you describe 2 of them)
pulmonic regurgitation
mitral stenosis- prominent loud S1 followed by opening snap (apex) and early mid diastolic rumble (LLD position)
aortic regurgitation- soft, high pitched, diastolic decrescendo murmur
Which murmur is known as the sequelae of rheumatic fever
Mitral Stenosis
symptoms associated with aortic regurgitation
What do you need to do for patients after a valve replacement surgery
put them on life long anticoags!
What testing is necessary in someone with pulmonic stenosis and why
R heart cath to rule out other pulmonary issues and better evaluate pulmonary vasculature
how does isometric handgrip effect sound of valve disorders (bonus if you name what peds disorder and myopathy disorder are affected by this)
increase sound of AR, MR, MS and VSD while decrease sound of AS, MVP and HOCM
causes of aortic regurgitation
HTN! congenital bicuspid valves and infective endocarditis
specific PE features seen with mitral stenosis
mitral facies- rosy cheeks
Ortner's phenomenon- voice hoarseness
Tx of mitral stenosis (procedure)
comissurotomy "cleaning up the valves"
who do we typically see MVP occur in
young healthy women :(
What are two special murmurs with specific names and what valve disorder are they associated with (bonus if you can describe how they sound)
Austin Flint murmur- can see in severe cases of aortic regurgitation (mid to late low pitched diastolic mitral murmur)
Graham Steel mumur- can see in pulmonic stenosis IF the PS was caused by pulmonary HTN (high pitched decrescendo)
What murmurs can be associated with Marfans syndrome (bonus if you tell me what they sound like!)
MVP- mid to late systolic ejection click followed by high pitched mid systolic murmur
Pulmonic regurgitation- diastolic murmur
What arrhythmia are patients with MS often predisoposed to
AFib
What medications can help prevent surgery in patients with aortic regurgitation (3)
vasodilators such as nifedipine, beta blockers and ACE inhibitors
what murmur is almost never found as the underlying cause and is always found with other issues (bonus if you say what is sounds like)
tricuspid regurgitation- blowing holosystolic murmur best heard at LSB