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Mitral stenosis
2) Complications of MS
A) Acute left atrial failure, acute pulmonary edema, pulmonary
hypertention, CCF, atrial fibrillation, atrial flutter,
ventricular or atrial premature beats, embolic manifestation,
infective endocarditis, haemoptysis, ortner’s syndrome.
5) Causes of MS
A) Congenital: parachute mitral valve.
Acquired: Rheumatic MS, Carcinoid syndrome, collagen
vascular disorder, endomyocardial fibrosis,
mucopolysaccharidosis.
7)Ortner’s syndrome.
The closer the opening snap to the second sound, the more
severe is the obstruction.
Mitral regurgitation
A)
features Acute MR Chronic MR
Symptoms Sudden onset Gradual onset of
dyspnoea , PND, symptoms
orthopnoea
Apex beat unremarkable Displaced and
dynamic
First heart sound soft Normal / soft
murmur Early/holosystolic holosystolic
Fourth heart heard Not heard
sound
ECG Normal except in LA enlargement,
acute MI AF, LVH
Radiology Heart size normal cardiomegaly
A) MR, VSD, TR
Features MR TR VSD
Site Apex Left parasternal Left parasternal
5th or 6th 3rd or 4th
intercostal space intercoastal
space
Conduction To axilla Localised Localised
Accentuation In expiration In inspiration In inspiration
with respiration
5) Complications of MR
A) a. Acute LVF
b. Infective endocarditis
c. CCF
hoarseness of voice
AORTIC STENOSIS
1) Severity of grading of AS
2) Causes of AS
Atherosclerotic AS.
3) Cardinal signs of AS
AORTIC REGURGITATION
1) Causes for AR
A) – Rheumatic
- Traumatic
- Infective endocarditis
- Bicuspid aortic valve
- Atherosclerotic
- Dissection of aorta
- Syphlitic
- Marfans syndrome
- Ankylosing spondylosis
- Rheumatic arthritis.
A)
FEATURES ACUTE AR CHRONIC AR
Onset Early, sudden Late, insedious
Pulse pressure Near normal wide
Systolic pressure Normal / decreased Increased
Diastolic pressure Normal / decreased Markedly decreased
LV impulse Normal/ Hyperdynamic
hyperdynamic
Auscultation Soft/absent S1, Normal S1 & P2. S3
increased P2 , S3 not heard, AR
heard. AR murmur murmur is long &
short & medium high pitched
pitched
Peripheral arterial absent present
signs
ECG Normal LV Enlarged LV
Chest Xray Normal Enlarged LV with
prominent aortic
root.
3) Differences between Rheumatic and Syphylitic AR.
A)
FEATURES RHEUMATIC AR SYPHILITIC AR
History Rheumatic fever syphilis
Angina Less common common
A2 Normal/ soft Loud tambour like
Diastolic murmur Third space to left of Second space to
site sternum right of sternum
Peripheral signs of Not well marked Very well marked
AR
Other valvular common Never present
lesions
VDRL Negative Positive
X ray Negative Positive calcification
calcification of confined to
aortic valve may be ascending aorta.
seen when Irregularity of aortic
associated with AS shadow seen.
6) Complications of AR
A) - Acute LVF
- Infective endocarditis
- CCF
- Arrhythmias
- Heart block
-
1) Difference between pericardial rub and murmur.
Pericardial rub Murmur
In cardiac cycle Does not coincide Coincides with systole or
diastole
character scratchy Blowing/rumbling/musical
conduction no May conduct
variability present Not present
audibility superficial deep
Variability of Not present present
heart sound
Pressure of Alters the Doesn’t alter the intensity.
stethoscope intensity
A)
A)
CAROTID ARTERY PULSE JUGULAR VENOUS PULSE
Seen internal to the Seen in triangle formed by two
sternomastoid heads of SCM & clavicle.
Better palpable Better visible
Predominant outward movement Predominant inward movement
One peak per heart beat Two peaks per heart beat
No variation with posture or Variation with posture,
respiration respiration, abdominal
compression.
Not obliterable Obliterable
A) – heard at apex
- Mid diastolic murmur
- Low pitched, soft rumbling murmur
- Well localized to apex
- Best heard with bell of stethoscope
- Heard in sever AR with AS.
A) - heard at apex
- Mid diastolic murmur
- Low pitched soft murmur
- Well localized to apex
- Best heard with bell of stethoscope
- Heard in Rheumatic carditis
9) Gibson’s murmur
e) Pulsus Alternans : When alternate pulse waves are weak, ie, of low
volume in a patient with acute LVF.
f) Pulsus Bigemini : Clinically, two beats and a pause thereafter recur
repeatedly in a regular fashion. Found in digitalis toxicity and 3:2 heart
block.
b. pericardial effusion.
c. dextrocardia
d. Dilated cardiomyopathy.
3. emphysema
5. constrictive pericarditis
6. pericardial effusion.