Cardiac Murmurs & Valve Probz

Question 1

Heart valves are made up of what type of tissue?

Answer 1

Cartilage (which is why it doesn’t heal well)

Question 2

What does each problem with a valve reduce?

Answer 2

Cardiac output

Question 3

What is the function of the chordae tendineae?

Answer 3

They are connective tissue that connect papillary muscle to the mitral & tricuspid valves

Question 4

Which side of the heart has more frequent damaged valves?

Answer 4

the left side because of the high pressure blood

Question 5

The AV node sits between what three heart valves? Why is this concerning with valvular disease?

Answer 5

Tricuspid, mitral, and aortic

valve damage could then lead to arrhythmias from AV node conduction problems

Question 6

How do you get a gallop heart sound?

Answer 6

valves are not closing at the same time

ex: “lub” S1 sound is really sounds like “lub-bub”- mitral and tricuspid valves closing at different times

Question 7

Rubbing heart sound occur during what part of the cardiac cycle?

Answer 7

Can hear it throughout most of the cycle

Question 8

What are four types of abnormal heart sounds?

Answer 8

Gallops, Rubs, Clicks, Murmurs

Question 9

What is a “click” heart sound? when could you hear a click?

Answer 9

it is a sharp snapping sound that is present when valves are opening or closing
From MVP or mechanical valve

Question 10

What two parts of the heart are you listening to when you ascultate over the right 2nd intercostal space? What valve problem is there with a loud murmur? How about a soft murmur?

Answer 10

Right atrium and aorta
Loud- aortic stenosis
Soft- tricuspid regurgitation

Question 11

What two heart parts are you listening to over the upper left sternal border? What are the two valve problems you could hear here?

Answer 11

pulmonic artery and left atrium

stenotic pulmonary valve and mitral valve regurgitation

Question 12

What heart part are you listening to over the lower left sternal border? What two valve problems could you hear here?

Answer 12

right ventricle

stenotic tricuspid valve or regurgitant pulmonic valve

Question 13

What heart part are you listening to over the apex? what two valve problems could you hear here?

Answer 13

left ventricle

mitral stenosis or aortic regurgitation

Question 14

“lub” begins the _______ phase and “dub” begins the _____ phase of the cardiac cycle

Answer 14

systolic

diastolic

Question 15

What is the measurement of a stenotic aortic valve?

Answer 15

less than 1 cm squared in diameter

Question 16

What are the four systolic heart murmur sounds?

Answer 16

aortic stenosis, pulmonic stenosis, mitral regurg, tricuspid regurg

Question 17

What are the four diastolic heart murmur sounds?

Answer 17

mitral stenosis, tricuspid stenosis, aortic regurg, pulmonic regurg

Question 18

What is a thrill heart sound?

Answer 18

its vibration on skin

Question 19

What are the six stages of grading heart sounds?

Answer 19

1) . not very audible; very faint
2) . barely audible but not easily heard
3) . heard easily but no thrill
4) . loud with a thrill or thrust over pericardium
5) . very loud, heard with stethoscope tilted on chest
6) . extremely loud, heard without stethoscope

Question 20

what is often the first symptom of decreased cardiac output?

Answer 20

body compensates with increased HR - tachycardia

Question 21

If a patient has a transmural MI (infarction that involves the whole thickness of the heart muscle), what can happen to the mitral valve?

Answer 21

MI can cause papillary muscle to pull away from the cardiac muscle
this leads to mitral valve prolapse

Question 22

what are the three most common types of acquired valvular disease?

Answer 22

Rheumatic (more common outside US), Infective, Calcific (degenerative or autoimmune)

Question 23

What are some late symptoms and signs of decreased CO?

Answer 23

symptoms: peripheral edema, productive cough, dyspnea at rest, severely dec activity
signs: CHF (dyspnea, heart sounds, breath sounds, peripheral edema), EKG ST change

Question 24

What is left ventricle remodeling that occurs during left ventricular hypertrophy? what can LVH cause?

Answer 24

remodeling is rounding of the Ventricle muscle so that valve leaflets cant meet & we get regurgitation
LVH can cause diastolic dysfunction (which leads to CHF)

Question 25

Define insufficiency of a valve versus regurgitation?

Answer 25

insufficiency is valve isn’t functioning properly (not opening or closing)
regurgitation is the improper blood flow FROM the insufficiency

Question 26

What is the most common etiology of mitral regurgitation?

Answer 26

annular dilatation associated with decreased left ventricle function

Question 27

What are four main etiologies for Aortic insufficiency?

Answer 27

rheumatic
endocarditis
annular dilation (due to connective tissue disorder)
disruption of valve commissures from dissection

Question 28

what is the most common cause of tricuspid valve disease?

Answer 28

mitral valve disease (increased pulmonary pressures dilate the right ventricle and cause annular dilation of the tricuspid valve); occurs in about 10-50% of people

Question 29

How do you get pulmonic regurgitation?

Answer 29

From increased pulmonic pressures (can be from MV disease, COPD, other pulmonary disease)

Question 30

What are the two etiologies for aortic stenosis?

Answer 30

calcific (infective or degenerative) and congenital (bicuspid or unicuspid)

Question 31

Why do you not want to stent a stenotic valve?

Answer 31

Calcium deposits from the calcification can break off from the valve & travel in the blood (becomes embolus)

Question 32

What is the medical treatment for valvular problems?

Answer 32

Treat underlying disease for prevention

Question 33

What size is the mitral valve compared to the aortic valve? what size is a stenotic MV

Answer 33

its twice the size (about 4-5 cm); stenotic size is less than 2 cm

Question 34

what are two indications for surgery for mitral regurgitation?

Answer 34

symptomatic patient that’s limiting life activities and decreased LV function

Question 35

What measure of heart function are you losing with Atrial fibrillation?

Answer 35

lose ejection fraction because atria aren’t contracting properly & amount of blood leaving the ventricles is decreased

Question 36

What are the two types of valve repairs? What are the three replacement options?

Answer 36

repairs: leaflet excision & suturing, annulus ring placement
replacement: prosthetic, mechanical, implantable

Question 37

What are two possible indications for tricuspid valve repair/replacement?

Answer 37

1) . tricuspid regurg from mitral valve problems

2) . symptoms of severe right heart failure

Question 38

Four indications of Aortic valve repair or replacement?

Answer 38

Severe aortic stenosis (<1 cm squared)
severe aortic insufficiency
endocarditis
ascending aortic dissections

Question 39

What is a catheter balloon valvuloplasty used for? it is a definitive therapy for what patient population?

Answer 39

used as a “bridge” procedure until valve surgery

used as definitive therapy in pts who aren’t surgical candidates

Question 40

What patient population will undergo a TAVR procedure?

Answer 40

non open heart surgical candidate who has severe aortic stenosis (pt cant have bicuspid AV)