Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesPart I Hemodynamics
These are gateway conditions
Microbiology Pathology Pathophysiology
Valve Questions
Location (70)
Murmur v Sound (10)
Systolic v Diastolic (50)
Maneuvers (20) LSB
RUSB
Ao
LUSB
PV
LSB
LLSB Apex (5th IC)
Axilla
MV
The Valves
Mitral(apex S1)
Prolapse(midsystolic click maneuvers)
Regurgitation(systolic rarr axilla)
Stenosis(diastolic opening snap)
A
LV
A
LV
Murmurs Sound
Diastolic (soft) Systolic (harsh)
The Valves
Mitral Stenosis
Location apex (5th IC space midclavicular line)Diastolic
Quality Passive fillingAtrial contraction rarr Low pitch (pressure) rumbleKey features Opening snap and A2OS ratio
Key pathology Calcification of the commissures Aschoff bodies (Rheumatic fever)
The Valves
Mitral Stenosis
Location apex (5th IC space midclavicular line)Diastolic
Quality Passive fillingAtrial contraction rarr Low pitch (pressure) rumbleKey features Opening snap and A2OS ratio
Key pathology Calcification of the commissures Aschoff bodies (Rheumatic fever)
122
1309
The Valves
Mitral Stenosis
LA122
1309
Hg here
1309
The Valves
Mitral Stenosis
LA
1309The pressure in the left ventricle remains normal as the stenotic lesion is lsquoupstreamrsquo
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
PA
LA
1309
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
Disconnect between the PCWP and LV
filling pressures
PA
LA
Normal 1309
Cardiac Cycle
Mitral Stenosis Hemodynamics II
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
These are gateway conditions
Microbiology Pathology Pathophysiology
Valve Questions
Location (70)
Murmur v Sound (10)
Systolic v Diastolic (50)
Maneuvers (20) LSB
RUSB
Ao
LUSB
PV
LSB
LLSB Apex (5th IC)
Axilla
MV
The Valves
Mitral(apex S1)
Prolapse(midsystolic click maneuvers)
Regurgitation(systolic rarr axilla)
Stenosis(diastolic opening snap)
A
LV
A
LV
Murmurs Sound
Diastolic (soft) Systolic (harsh)
The Valves
Mitral Stenosis
Location apex (5th IC space midclavicular line)Diastolic
Quality Passive fillingAtrial contraction rarr Low pitch (pressure) rumbleKey features Opening snap and A2OS ratio
Key pathology Calcification of the commissures Aschoff bodies (Rheumatic fever)
The Valves
Mitral Stenosis
Location apex (5th IC space midclavicular line)Diastolic
Quality Passive fillingAtrial contraction rarr Low pitch (pressure) rumbleKey features Opening snap and A2OS ratio
Key pathology Calcification of the commissures Aschoff bodies (Rheumatic fever)
122
1309
The Valves
Mitral Stenosis
LA122
1309
Hg here
1309
The Valves
Mitral Stenosis
LA
1309The pressure in the left ventricle remains normal as the stenotic lesion is lsquoupstreamrsquo
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
PA
LA
1309
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
Disconnect between the PCWP and LV
filling pressures
PA
LA
Normal 1309
Cardiac Cycle
Mitral Stenosis Hemodynamics II
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Valve Questions
Location (70)
Murmur v Sound (10)
Systolic v Diastolic (50)
Maneuvers (20) LSB
RUSB
Ao
LUSB
PV
LSB
LLSB Apex (5th IC)
Axilla
MV
The Valves
Mitral(apex S1)
Prolapse(midsystolic click maneuvers)
Regurgitation(systolic rarr axilla)
Stenosis(diastolic opening snap)
A
LV
A
LV
Murmurs Sound
Diastolic (soft) Systolic (harsh)
The Valves
Mitral Stenosis
Location apex (5th IC space midclavicular line)Diastolic
Quality Passive fillingAtrial contraction rarr Low pitch (pressure) rumbleKey features Opening snap and A2OS ratio
Key pathology Calcification of the commissures Aschoff bodies (Rheumatic fever)
The Valves
Mitral Stenosis
Location apex (5th IC space midclavicular line)Diastolic
Quality Passive fillingAtrial contraction rarr Low pitch (pressure) rumbleKey features Opening snap and A2OS ratio
Key pathology Calcification of the commissures Aschoff bodies (Rheumatic fever)
122
1309
The Valves
Mitral Stenosis
LA122
1309
Hg here
1309
The Valves
Mitral Stenosis
LA
1309The pressure in the left ventricle remains normal as the stenotic lesion is lsquoupstreamrsquo
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
PA
LA
1309
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
Disconnect between the PCWP and LV
filling pressures
PA
LA
Normal 1309
Cardiac Cycle
Mitral Stenosis Hemodynamics II
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
RUSB
Ao
LUSB
PV
LSB
LLSB Apex (5th IC)
Axilla
MV
The Valves
Mitral(apex S1)
Prolapse(midsystolic click maneuvers)
Regurgitation(systolic rarr axilla)
Stenosis(diastolic opening snap)
A
LV
A
LV
Murmurs Sound
Diastolic (soft) Systolic (harsh)
The Valves
Mitral Stenosis
Location apex (5th IC space midclavicular line)Diastolic
Quality Passive fillingAtrial contraction rarr Low pitch (pressure) rumbleKey features Opening snap and A2OS ratio
Key pathology Calcification of the commissures Aschoff bodies (Rheumatic fever)
The Valves
Mitral Stenosis
Location apex (5th IC space midclavicular line)Diastolic
Quality Passive fillingAtrial contraction rarr Low pitch (pressure) rumbleKey features Opening snap and A2OS ratio
Key pathology Calcification of the commissures Aschoff bodies (Rheumatic fever)
122
1309
The Valves
Mitral Stenosis
LA122
1309
Hg here
1309
The Valves
Mitral Stenosis
LA
1309The pressure in the left ventricle remains normal as the stenotic lesion is lsquoupstreamrsquo
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
PA
LA
1309
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
Disconnect between the PCWP and LV
filling pressures
PA
LA
Normal 1309
Cardiac Cycle
Mitral Stenosis Hemodynamics II
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
The Valves
Mitral(apex S1)
Prolapse(midsystolic click maneuvers)
Regurgitation(systolic rarr axilla)
Stenosis(diastolic opening snap)
A
LV
A
LV
Murmurs Sound
Diastolic (soft) Systolic (harsh)
The Valves
Mitral Stenosis
Location apex (5th IC space midclavicular line)Diastolic
Quality Passive fillingAtrial contraction rarr Low pitch (pressure) rumbleKey features Opening snap and A2OS ratio
Key pathology Calcification of the commissures Aschoff bodies (Rheumatic fever)
The Valves
Mitral Stenosis
Location apex (5th IC space midclavicular line)Diastolic
Quality Passive fillingAtrial contraction rarr Low pitch (pressure) rumbleKey features Opening snap and A2OS ratio
Key pathology Calcification of the commissures Aschoff bodies (Rheumatic fever)
122
1309
The Valves
Mitral Stenosis
LA122
1309
Hg here
1309
The Valves
Mitral Stenosis
LA
1309The pressure in the left ventricle remains normal as the stenotic lesion is lsquoupstreamrsquo
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
PA
LA
1309
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
Disconnect between the PCWP and LV
filling pressures
PA
LA
Normal 1309
Cardiac Cycle
Mitral Stenosis Hemodynamics II
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
The Valves
Mitral Stenosis
Location apex (5th IC space midclavicular line)Diastolic
Quality Passive fillingAtrial contraction rarr Low pitch (pressure) rumbleKey features Opening snap and A2OS ratio
Key pathology Calcification of the commissures Aschoff bodies (Rheumatic fever)
The Valves
Mitral Stenosis
Location apex (5th IC space midclavicular line)Diastolic
Quality Passive fillingAtrial contraction rarr Low pitch (pressure) rumbleKey features Opening snap and A2OS ratio
Key pathology Calcification of the commissures Aschoff bodies (Rheumatic fever)
122
1309
The Valves
Mitral Stenosis
LA122
1309
Hg here
1309
The Valves
Mitral Stenosis
LA
1309The pressure in the left ventricle remains normal as the stenotic lesion is lsquoupstreamrsquo
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
PA
LA
1309
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
Disconnect between the PCWP and LV
filling pressures
PA
LA
Normal 1309
Cardiac Cycle
Mitral Stenosis Hemodynamics II
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
The Valves
Mitral Stenosis
Location apex (5th IC space midclavicular line)Diastolic
Quality Passive fillingAtrial contraction rarr Low pitch (pressure) rumbleKey features Opening snap and A2OS ratio
Key pathology Calcification of the commissures Aschoff bodies (Rheumatic fever)
122
1309
The Valves
Mitral Stenosis
LA122
1309
Hg here
1309
The Valves
Mitral Stenosis
LA
1309The pressure in the left ventricle remains normal as the stenotic lesion is lsquoupstreamrsquo
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
PA
LA
1309
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
Disconnect between the PCWP and LV
filling pressures
PA
LA
Normal 1309
Cardiac Cycle
Mitral Stenosis Hemodynamics II
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
The Valves
Mitral Stenosis
LA122
1309
Hg here
1309
The Valves
Mitral Stenosis
LA
1309The pressure in the left ventricle remains normal as the stenotic lesion is lsquoupstreamrsquo
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
PA
LA
1309
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
Disconnect between the PCWP and LV
filling pressures
PA
LA
Normal 1309
Cardiac Cycle
Mitral Stenosis Hemodynamics II
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
The Valves
Mitral Stenosis
LA
1309The pressure in the left ventricle remains normal as the stenotic lesion is lsquoupstreamrsquo
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
PA
LA
1309
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
Disconnect between the PCWP and LV
filling pressures
PA
LA
Normal 1309
Cardiac Cycle
Mitral Stenosis Hemodynamics II
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
PA
LA
1309
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
Disconnect between the PCWP and LV
filling pressures
PA
LA
Normal 1309
Cardiac Cycle
Mitral Stenosis Hemodynamics II
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Lungs
lt10 mmHg rarr 25 mmHg
PV
RV
Nl 255
PCWP
Mitral Stenosis Hemodynamics I
Disconnect between the PCWP and LV
filling pressures
PA
LA
Normal 1309
Cardiac Cycle
Mitral Stenosis Hemodynamics II
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Cardiac Cycle
Mitral Stenosis Hemodynamics II
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Stenosis Hemodynamics II
120
80
10
EDV
Pressures
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
EDV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
What happens to the LA mm Hg curve with mitral stenosis
The atrium has to contract and eject blood into the LV
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure risesA2OS decreases
LA
This Curve is the Language of Mitral Stenosis
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
LA pressure rises rarr A2OS decreases
A2 OS
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
A2OS ratio narrows with worsening MSReflects elevating LA pressures Negative Prognosticator
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Stenosis Hemodynamics II
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
A2 OS
What correlates best with severity of MSMurmur grade or A2OS ratio
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
AV Close
IsovolRelax
IsovolCont
AV Open
Rapideject
Rapidfilling
MV Open
MV Close
120
80
10
Bro if they ask you which point on the graph corresponds to the murmur point here
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Stenosis Hemodynamics III
Pressure
Volume
Hi Vol Low HgEDV
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
EDV
LV Pressure-Volume Loop
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
SV = EDV - ESV
EF = (EDV ndash ESV)EDV
EDV
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Stenosis Hemodynamics III
Pressure
Volume
IsovolumetricContraction
IsovolumetricRelaxation
AoOpen
AoClose
Rapid ejection
ESV
MVOpen
Rapid Filling MVClose
StrokeVolume
EDV
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Mitral Valve Stenosis
LocationDiastolicHemodynamics
PCWPCardiac CyclePressure Volume CurveOpening Snap
PathologyMicrobiology (Rheumatic Fever)Complications (A fib and derivatives)
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter
Cardiology
the Sounds
Howard J Sachs MDwww12DaysinMarchcom
E-mail Howard12daysinmarchcom
Mitral Stenosis and DerivativesOpening Chapter