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MR Causes
- Degenerative
- MVP
- RHD
- Papillary muscle dysfunction
- CT disease (RA, AS)
- Congenital
- IE
- Ischaemic
- Surgery
- Trauma
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MR - Signs of severity
- Enlarged LV
- Pul. HTN
- HS 3
- Soft HS 1
- LVF
- Small volume pulse
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MR CXR
- LAE - loss of convexity distal to aortic knuckle, double heart shadow and splaying main bronchi
- Increased LV size
- MV calcification
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MR - Indications for surgery
- NYHA 3/4
- LV dysfunction
- Progressive LV dilatation
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MVP - clinical findings
- Mid-systolic click
- Mid- to late-systolic murmur
- Increased with Valsalva (decreases preload)
- Handgrip (Inc. afterload)/ Squatting (Inc. preload) reduce the duration of the murmur
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MVP - Clinical associations
- Marfans
- ASD secundum
- Anorexia nervosa
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AR - Causes
- RHD
- Congenital - Bicuspid AV, VSD
- Seronegative arthropathy - AS
- Marfans
- Aortitis (Seronegative arthropathies/RA/tertiary syphilis)
- Dissecting aneurysm
- Degenerative
- Functional
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AR - Signs of severity
- Collapsing pulse
- Wide PP
- Length of murmur
- HS 3
- Soft HS A2
- Austin Flint murmur
- LVF
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AR - CXR
- LV dilatation
- Valve calcification
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AR - Indications for surgery
- Symptoms - SOBOE
- Worsening LV Fx
- Progressive LV dilatation (LV-ESD > 55mm)
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AS - Causes
- Degenerative senile calcific aortic stenosis
- RHD (rarely isolated)
- Calcific bicuspid AV
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AS - Signs of severity
- Plateau pulse
- Aortic thrill
- Length, harshness, and lateness of the peak of the murmur
- Paradoxical splitting of HS 2
- LV failure
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AS - indications for surgery
- Exertional angina, sob or syncope
- Critical obstruction
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TR - Clinical signs
- JVP - V waves
- RV heave
- PSM LLSE
- *** multiple systolic clicks = Ebsteins abnormality
- Enlarged pulsatile and tender liver
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TR - Causes
- Functional - RVF
- RHD
- IE
- Congenital - Ebsteins anomaly
- RV papillary muscle infarction
- Trauma (steering wheel)
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PS - Clinically
- Peripheral cyanosis
- Low volume pulse
- Giant a waves in JVP
- RV heave
- Thrill over pulmonary area
- Harsh ESM - maximal over pulmonary area on inspiration
- Pre-systolic pulsation of liver
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PS - Signs of severity
- ESM late peaking
- Absence of systolic click
- S4
- RVF
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PS - Causes
- Congenital
- Carcinoid syndrome
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Chronic constrictive pericarditis - Clinically
- Cachectic
- Low BP
- Pulsus paradoxus
- Raised JVP +/- Kaussmauls sign
- Distant HS
- Hepatosplenomegaly, ascites and oedema
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Chronic constrictive pericarditis - Causes
- XRT
- Tumours
- TB
- CT disease
- CRF
- trauma
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HOCM - Clinically
- Sharp, rising and jerky pulse
- JVP - prominent a wave
- Double apex beat
- Late ESM on LSE + PSM from MR + S4
- *** No diastolic murmurs
- Louder with Valsalva, standing and isotonic exercise (jogging)
- Softer with squatting, raising the legs isometric exercise (forceful handgrip)
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HOCM - ECG
- LVH with strain
- Deep q waves
- Conduction defects
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