lecture 19 brickner
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| 3 causes of aortic stenosis | dystrophic calcification of an old but o/w nl valve, rheumatic heart dz, calcification of a congenital bicuspid aortic valve
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| hemodynamic changes as a result of aortic stenosis | in order to obtain nl flow and BP systemically, LV must hypertrophy to pump harder, which creates a large pressure gradient btwn the aorta and LV. leads to dec diastolic filling due to stiffness of LV = CHF
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| sx of aortic stenosis and related survival rates | 2 yrs survival after onset of CHF, 3 after syncope and 5 after angina
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| PEx findings of pt with AS | S4 gallop, paradoxical split of S2 (LV takes longer to pump out), diamond-shaped SEM that peaks mid-to-late systole, possible ejection click; pulsus parvus et tardus (carotids) in severe AS
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| possible EKG findings of pt with AS | LVH with or without repol abnormalities (these are non-specific really)
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| most common indications for AS repair | symptomatic with any level of stenosis, severe stenosis of <1.0 sq cm/sq m area
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| etiology of MS | almost always due to rheumatic heart dz (can occur up to 30 yrs later), fibrosis and calcification leads to fusion of valvular commissures (like pinching sides of mouth and talking only through pursed lips)
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| hemodynamic changes as results of MS | LA dilates after pressure rises (may cause a-fib), LV is underfilled and low stroke volume (especially when HR is inc), poss PA inc leading to RVH or enlargement
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| manifestations of MS | pt usually notices sx when tachycardic (exercising, anxious, etc) b/c diastolic/filling period is shorter, SOB due to passive pulm congestion, fatigue from low CO, a-fib from LAE/LAH
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| PEx of pt with MS | opening snap and low-pitched diastolic rumble with presystolic accentuation due to atrial contraction, loud S1 unless MV is too stenotic to close at all, parasternal lift from RVH, intense P2
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| CXR and EKG findings of pt with MS | CXR: straightening of L heart boder, upward displaced L bronchus, maybe pulm congestion // EKG: LA overload or a-fib
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| requirements for balloon valvuloplasty or surg therapy for MS | must be symptomatic with MV area < 1.2 sq cm
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| distinguishing murmur of pulmonic stenosis | harsh SEM auscultated over upper left sternal border usually with a thrill, gets louder with inspiration (as do most R sided abnormalities)
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| distinguishing murmur of tricuspid stenosis | mid diastolic murmur due to flow through stenotic valve, auscultated over lower left sternal border, may hear opening snap and split S2, worsens with inspiration
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