S (S or D)SystoleDiastole

Aortic StenosisMitral Valve ProlapseMitral RegurgitationAortic RegurgitationMitral Stenosis

L (location)2nd ICS (base)(apex)(apex)R 2nd ICS (and L 2nd, 3rd, and 4th ICS)(apex)

I (intensity)Soft or loud; if loud, often have a thrill(sounds blowing)1-31-4

R (radiation)Often to neckL axillary regionDown towards apexNone!

P (position)Pt sitting or leaning forwardCan use Valsalva LLD; squatting (or legs lifted)Pt leaning forward; also when pt holds breath in exhalation LLD

S (shape)Crescendo-decrescendo;Mid-systolicMid-late systolic clickPansystolic or late systolicDecrescendo; earlyDecrescendo-crescendo; mid to late diastolic

*most commonly replaced valve in heart*valvular lesion of sudden death*M>F*S4*antibiotic prophylaxis is no longer recommended*LVH*most common valvular lesion*F>MSerious complications:-MR-IE-sudden cardiac death-cerebrovascular ischemic eventsLVH and LA enlargement*use diaphragm *S3*use diaphragm*PE:1.large bounding pulse2. Corrigan pulse3. Pistol-shot pulse4. Quinckes pulse5. Mussets pulse

*LVH*S4*use bell to auscultate*often associated with opening snap (OS)*Rheumatic fever!!!

Complications:1. pulmonary HTN and HF2. thrombus formation in atrium3. Development of A. fib

Causes1. Calcification of valve associated w/aging2. born w/2 leaflets3. Rheumatic fever1. genetic2. anterior chest deformity (narrow A/P diameter):-scoliosis-kyphosis-joint hypermobility3. Marfans syndrome1. MVP2. Rheumatic Heart Dz3. Connective tissue disorders4. Papillary muscle dysfunction5. Atrial Myxoma6. Infective Endocarditis1. Congenitally bicuspid aortic valve*2. Infective Endocarditis3. Rheumatic fever4. Marfans syndrome*5. Aortic dissection/aortic aneurysm *6. Trauma (*acute causes)1. Rheumatic fever** (nearly all pts with MS have underlying RF)

SymptomsClassic Triad:SyncopeAnginaDyspnea/HF

*exertional syncope*V. fib*usually noneMVP+MR=-palpitations-chest pain-panic attacks-SOBAcute:-dyspnea, fatigue, cough-orthopnea-paroxysmal nocturnal dyspneaChronic:-exercise intolerance-palpitations-A. fibAcute:-dyspnea-SOB-orthopnea-chest discomfortChronic:-compensatory tachycardia-LV dilation-dyspnea-hemoptysis (blood backs up into lungs)

Treatment:-mitral valvotomy-mitral valve replacement