Valve Defects /Cardiac Cycle

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Valve Defects /Cardiac Cycle UNM School of Medicine CV/Pulmonary/Renal Block scwood@salud.unm.edu

Normal Cardiac Cycle and Heart Sounds Refer to this normal cardiac cycle when studying the abnormal cycles in the following slides View the PowerPoint in slide show mode in order for sound files to work. Click here for normal heart sounds

Aortic regurgitation 1 Diastolic decrescendo murmur Pressure gradient = aortic pressure - left ventricular Pressure Pressure gradient decreases during Diastole as aortic pressure falls and LV pressure rises due to filling Note the large pulse pressure due to rapid “runoff” of blood to circulation plus back into ventricle. Blood begins filling ventricle before Mitral valve opens (back flow from Aorta).

Aortic regurgitation 2 There can also be a systolic murmur due to large stroke volume and turbulent flow During ejection EDM – early diastolic murmur AFM – Austin Flint murmur – mitral leaflet displacement & turbulent back flow http://content.nejm.org/cgi/content/full/359/10/e11

Aortic stenosis Murmur intensity depends on pressure gradient across aortic valve; LV pressure – aortic pressure. P increases, then decreases, resulting in crescendo – decrescendo systolic murmur. The time for left ventricular systole will be prolonged (while the time for left ventricular diastole is shortened).

Mitral regurgitation Murmur depends on pressure difference across the mitral valve P = LV – LA pressure P remains large and relatively constant during ejection resulting in a holosystolic murmur. LA pressure increases due to backflow across incompetent valve

Mitral Stenosis Murmur intensity depends on pressure difference across mitral valve. P = LA – LV Highest at the beginning, resulting in diastolic decrescendo murmur with a rise in pressure (crescendo) just before systole as atria contracts

Online resources http://www.texasheart.org/education/cme/explore/events/eventdetail_5469.cfm http://www.merck.com/mmpe/resources/multimedia/name/audio.html

Practice Question: The cardiac cycle and murmur of a patient in the cardiac cath lab is shown below. The valve defect in this patient is: Aortic regurgitation Aortic stenosis Mitral regurgitation Mitral stenosis