Aortic Stenosis |
Slow-rising, low vol pulse Narrow pulse pressure Undisplaced, sustained (heaving) apex Ao thrill ESM to carotids Soft S2 |
Absent/soft A2 Delayed A2 Delayed ESM Narrow pulse pressure Slow-rising pulse Thrill/heave LVF S4 |
LVF, IE, Conduction dis |
Congenital, Degenerative (calcified), Bicuspid, Rheumatic |
LVH, LBBB, LAD |
Normal +/- calcified valve |
Valve area < 0.5 cm² |
Asymptomatic: None, unless gradient > 50 mmHg or worsening ECG (6/12 review, ppx Abx) Symptoms: ARV +/- CABG |
VSD, HOCM, PS, MR, Flow murmur |
Listen for MS as they tend to reduce signs of each other |
Aortic Regurgitation |
Collapsing, large vol pulse Wide pulse pressure Displaced, hyperkinetic apex Ao thrill Early diastolic murmur (LLSE), Mid-systolic flow |
Loud, short EDM Soft S2 S3 Wide pulse pressure LVF Austin Flint Hill's sign (SBP legs > arms) |
LVF |
Congenital, Acute, Chronic Valv, IE, RhF, CTD (RA), Ao root Trauma, Dissect, Dilatation (HTN, Marfan's) |
LVH, TWI |
Cardiomegaly, wide mediastinum |
LVESD > 55mm |
Acute: AVR Chronic: Symptoms prior to LV dysfunction, or pulse pressure > 100, ECG changes, LV enlarged on CXR |
Mixed AoV Disease (AR/AS) Pulse: collapsing/slow-rising Apex: thrusting/heaving Thrill: absent/present SBP: high/low Pulse pressure: wide/narrow |
Mixed MV Disease (MR/MS) Pulse: sharp, short/small vol Apex: thrusting/tapping S1: soft/loud S3: present/absent |
Mitral Stenosis |
Malar flush, Small vol pulse +/- AF, Undisplaced, tapping apex, RV heave Loud S1 (mobile valve only), OS (after S2 mobile valve only) |
Longer MDM OS nearer A2 PHT |
PHT, IE, Pulmonary oedema, CVA (thromboembolic), Haemoptysis/hoarseness |
Rheumatic Fever, Congenital, Rare (SLE, Lt atrial myxoma, RA, Carcinoid) |
P-mitrale, AF, RVH |
Large LA, calcified valve |
Valve < 1 cm²/m² |
Medical: Warfarin, Digoxin, diuretics (reduce preload), ppx Abx Surgery: Valvuloplasty, Valvotomy, MVR |
Austin Flint, Carey-Coombs (RhF), Lt atrial myxoma |
Malar flush: MS, SLE, acne rosacea, dermatomyositis, carcinoid, erysipelas |
Mitral Regurgitation |
Small vol pulse +/- AF, Displaced thrusting apex, Apex thrill RV heave, Soft S1 Split S2 (early closure of AoV) Loud P2 (PHT) PSM to axilla S3 |
Displaced apex (?size LV) Signs of LVF |
IE, Pulmonary oedema |
Congenital, Acute: IE, Acute MI Chronic: IHD, Rheumatic Fever, CTD, MVP, Valvotomy, Amyloid, HCM |
P-mitrale, AF, LVH |
Cardiomegaly, pulm oedema |
LVEF < 55% |
Medical: Diuretics, ACE inhibitors, Warfarin, ppx Abx Surgery: MV repair or MVR |
TR, VSD, AS |
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