4th Year Valvular Heart Disease

Question 1

grading of murmurs?

Answer 1

1-6

Question 2

grade 1 murmur

Answer 2

slightest possible murmur, frequently overlooked

Question 3

grade 2 murmur

Answer 3

slight murmur

should not be missed

Question 4

grade 3 murmur

Answer 4

moderate murmur

no palpable thrill

Question 5

grade 4 murmur

Answer 5

loud murmur with palpable thrill

Question 6

grade 5 murmur

Answer 6

very loud murmur with easily palpable thrill

Question 7

grade 6 murmur

Answer 7

extremely loud murmur, can be heard with the stethoscope not even on the chest wall

Question 8

presentation of aortic stenosis

Answer 8

low volume pulse
forceful displaced apex
ejection systolic murmur radiating to carotids (crescendo decrescendo), slow rising pulse

Question 9

classic triad in aortic stenosis?

Answer 9

angina
syncope
heart failure

Question 10

murmur in aortic stenosis

Answer 10

ejection systolic murmur radiating to the carotids (crescendo decrescendo)

Question 11

what is aortic sclerosis

Answer 11

senile degeneration of the valve

Question 12

management of aortic stenosis

Answer 12

diuretics
nitrates
beta blockers
replacement

Question 13

features of aortic regurgitation

Answer 13

collasping pulse
wide pulse pressure
early diastolic murmur left sternal edge

Question 14

what signs are associated with aortic regurgitation?

Answer 14

Corrigan’s sign (carotid pulsation)
Qunicke’s sign (capillary pulsations in nailbed)
Traube’s sign (pistol shots over femoral arteries)
de Musset’s sign (head nodding in time with pulse)

Question 15

management of aortic regurgitation

Answer 15

symptoms (nifedipine/ACEI) and surgery

Question 16

murmur in aortic regurgitation

Answer 16

early diastolic murmur left sternal edge

Question 17

features of mitral stenosis

Answer 17

AF
malar flush
tapping
undisplaced apex beat
mid-diastolic murmur localised to apex heard best on left

Question 18

murmur in mitral stenosis

Answer 18

mid-diastolic rumbling localised to apex (heard best when patient on their left side)

Question 19

JVP waves in mitral stenosis

Answer 19

prominent a waves and raised JVP

Question 20

management of mitral stenosis

Answer 20

mitral valvotomy or replacement

Question 21

features of mitral regurgitation

Answer 21

pansystolic murmur radiating to axilla
jerky pulse
displaced apex
3rd heart sound
pulmonary oedema

Question 22

murmur in mitral regurgitation

Answer 22

pansystolic murmur radiating to the axilla

Question 23

murmur in tricuspid regurgitation

Answer 23

pansystolic murmur at lower sternal edge in inspiration

Question 24

presentation of tricuspid regurgitaiton

Answer 24

venous congestion
reduced CO
murmur
increased JVP with prominent v waves

Question 25

murmur in tricuspid stenosis

Answer 25

diastolic murmur at left sternal edge in inspiration

Question 26

murmur in pulmonary regurgitation

Answer 26

pulmonary hypertension with decrescendo murmur in early diastole at left sternal edge

Question 27

what is pulmonary stenosis associated with?

Answer 27

carcinoid syndrome

Question 28

features of pulmonary stenosis

Answer 28

``` a wave 4th heart sound left parasternal heave thrill ejection systolic murmur in LUSE ```

Question 29

management of pulmonary stenosis

Answer 29

balloon valvuloplasty

Question 30

grades of severity of pulmonary stenosis

Answer 30

``` MILD= <50mmHg MODERATE= 50-80mmHg SEVERE= >80mmHg ```

Question 31

what causes mitral valve prolapse?

Answer 31

myxomatous degeneration

Question 32

what is mitral valve prolapse associated with?

Answer 32

females rheumatic heart disease IHD

Question 33

presentation of mitral valve prolapse

Answer 33

mid-late systolic click | high pitched late-systolic murmur

Question 34

management of mitral valve prolapse

Answer 34

symptoms repair or replace risks MR and IE