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Valvular Disorders (:pencil2:for these murmurs, more flow over valve =…

- - - - Path: Rheumatic :<3:
        (inflammation, not calc)
        
        Pt: younger (20-30s)
        
        s/s atrial stretch: Afib
        
        CHF: DOE, PND, crackles
        
        Dx: Auscultation
        
        rumbling Diastolic murmur @ apex (5th IC midclav)
        
        opening snap
        
        Tx: Balloon valvuloplasty
        
        basically angioplasty of valve
        using L heart Cath
        
        Can do valve replacement, but not initial therapy. Pt needs sternotomy, and will need serial replacements over life.
        
        :pencil2:Ideally tx before CHF s/s present. Urgent.
    - - Process: Floppy aortic valve allows diastolic flow to LV. Dilated HF
        
        Path: infx or infarction
        
        or proximal Aortic dissecition
        
        Pt:
        
        acute: Cardiogenic shock, Flash pulm edema
        (AD: tearing CP)
        
        chronic: CHF, CP if blood doesn't enter coronary aa.
        
        Dx: Auscultation
        
        diastole
        
        base, 2nd IC R sternal border
        
        rumbling, no opening snap
        
        Tx:
        Acute: Emergent valve replacement
        Chronic: Urgent/elective valve replacement
        
        :warning:b/c aortic valve replacement may block ostia of coronary aa, consider CABG
        
        1 more item...
      - Aortic Stenosis
        
        Process: Stiff aortic valve, backup dilates LV. Dilated HF
        
        Path: Atherosclerosis ( :glass_of_milk:Ca deposition)
        
        old man :older_man::skin-tone-4: w/ atherosclerosis
        
        Mnemonic: both abbrev. AS
        
        bicuspid aortic valve, younger patient
        
        Pt: CP, HF s/s, syncope
        
        Dx: Auscultation
        
        systolic murmur
        
        base of heart, RSB
        
        crescendo-decrescendo
        
        1 more item...
        
        Mitral Insufficiency
        
        Process: Mitral valves don't come together. Blood leaves thru mitral valve & aorta. Blood in atria causes dilation (afib), lung backup.
        
        may have increased EF, since more blood leaves :<3:
        
        Path: infx or infarction
        
        Pt:
        
        Acute: Cardiogenic shock, flash pulm edema
        
        chronic: CHF, afib
        
        1 more item...
        
        weird murmurs...
        
        HOCM
        
        Process: unilateral septum hypertrophy, covers aortic opening. LV outlet obstruction. However, expanded LV (more volume) uncovers LV outlet.
        
        Genetics: Sarcomere mutations (specifics not important)
        
        1 more item...
        
        MVP
        
        Process: Leaflets of valves don't touch well. During systole they overlap and don't seal. Stretching ventricle lets leaflets seal, thus more volume = improved murmur
        
        1 more item...
        
        Softer: More blood in heart
  - - - Medical management: Preload reduction/diuresis
- - - - III
        
        IV
        
        V
        
        VI
        
        w/o stethoscope
        
        heard half off chest (almost VI)
        
        has Palpable Thrill
        
        S1,S2 < murmur
      - S1,S2 = murmur