Thank you very much kind sir... I've spent the last week cursing our Cardiology course lecturers for their stupid way in complicating this topic... I almost lost hope that I would understand it... you are a life saver... your work is much appreciated on my heart apex :)
I have learned so much from your videos and really appreciate your jokes & anecdotes. You are great at simplifying difficult concepts. Your charts and summaries are also so useful, I actually think you should just post the charts somewhere so we can use them as study tools! Thank you again!
45:28 His reaction was priceless.😂😂🤣🤣 As if he got tired of these findings for the Mitral Valve Prolapse. Oh man I really wish I could hug you right now.
First I want to say I am an IM resident and want to tell you I love your videos. Excellent for quick reference for studying and pimp questions! I do have one question. When talking about Aortic Stenosis you mention that it is the only valvular dz that does require ppx abx. My question is in what situation? Is that before replacement? Or is it preoperative for high risk surgeries for endocarditis? I could be wrong, but I thought that any valve replacement with prosthetic material is grounds for ppx abx. Thank you.
Your videos are game changing! Serious, to the poin,t with need to know information! Just one clarification with MS and ABx prophylactic....it IS required for those with a prosthetic value and not for those with a native valve, per Current 2016.
Someone to please share the major differences he mentions on this video compared to the old version of the same topic because there’s no sound on this one
50:43 I guess squatting does the deal here for the same reason it does in ToF: Increasing the peripheral vascular resistance = incr. BP => incr. flow; in ToF this decreases the right to left shunt (BF so fast, blood just surpasses the shunt and rather enters the lungs), while in MVP the additional blood helps attenuate the clickedy click sound Please correct me if I am wrong :-)
Since the impingement of the recurrent laryngeal nerve occurs due to left atrial enlargement, could it be possible to find the same sign with mitral regurgitation as that also is associated with LAE? Thanks!
Excellent question, thank you for asking. Google says yes: "[...] case reports have described other cardiovascular associations, including left atrial enlargement due to mitral regurgitation or atrial myxoma, severe pulmonary hypertension and congenital heart disease [...]" Source: bjcardio.co.uk/2012/03/ortners-syndrome-an-unusual-cause-of-cough/
Can anyone please explain the rationale of the abx prophylaxis in MVP + MR? In the video it is stated that regurgitant flow is the reason necessitating prophylaxis; Why do the indications differ between sole MR and MVP+ MR?
Hi Paul, You mentioned that there is a displaced apical impulse with Aortic Stenosis. Shouldn't it be with Aortic Regurgitation? With Aortic Stenosis the hypertrophy is concentric and with Aortic Regurgitation the hypertrophy is eccentric. Thereby making LVH in Aortic Regurgitation consistent with a finding of a displaced PMI.
With aortic stenosis you have to consider the severity of it. If the stenosis is very severe to a point where almost no flux of blood can go through it, then there's an increase of blood volume left in the left ventricule, which will cause an eccentric hypertrophy. This explains why you might find a displaced apical impulse. Up until this stage, the problem is pressure, not volumes, hence concentric hypertrophy, and in this case, the apical impulse can be found in the 5th intercostal space, like it should. Hope I clarified your and whoever has this same doubt. Cheers.
Is there any case where valsalva will increase aortic regurgitation? I am reviewing a question I got wrong on a practice exam and the correct answer was that an AR murmur will INCREASE with valsalva.
I'm not 100% sure on this, but the Valsalva Maneuver increases the intrathoracic pressure, which at first forces the blood out from the pulmonary circulation and into the left chamber's of the heart, thus increase the stroke volume, which in turn might explain why the regurgitation my increase.
