Symptoms/Diagnosis/Treatment - NACNS

Structural Heart: Valvular disease

Symptoms/Diagnosis/Treatment

Stacie Hanes, APRN-CNS, CCRN, CCRC

Oklahoma Heart Hospital Valve Clinic Manager

shanes@

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DISCLOSURES

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Heart tones/Murmurs



How to accentuate murmurs

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Increase afterload: hand grip

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Increase

AI, MR, VSD

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Decrease

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HOCM

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MVP

Increase preload: squatting

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Increase

AS, MS, AI, MR

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Decrease Preload: Valsalva maneuver, stand quickly

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Decrease

AS, MS, AI, MR, VSD, TR

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Increase

HOCM, MVP

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Special Maneuvers: Left lateral decubitus- accentuate mitral murmurs

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MS, MR

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S3/S4 accentuate

Special Maneuvers: sitting up/lean forward- accentuate Aortic murmurs

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AS, AI

Inspiration: Increase tricuspid murmurs



Aortic Valve

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Trileaflet valve

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Between the LV and Aorta

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1% of the population will have bicuspid AV

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May be true two leaflet AV

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May be three leaflets w/fused leaflets

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May develop aortic aneurysm, early failure of AV

Other malformations can be unicuspid and Quadricuspid

(Braverman, 2019)

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