Heart Sounds and Valve Diseases

Question 1

S1

Answer 1

closure of atrioventricular (mitral and tricuspid) vlaves

separation of sounds increases w/ RBBB

Question 2

S2

Answer 2

closure of semilunar (aortic and pulmonic) valves

Aortic occurs before Pulmonic and interval elongates w/ inspiration

Question 3

What makes heart sounds louder?

Answer 3

Stenosis: resistant valves require higher pressure to slam them shut
Tachycardia: shorter filling/ejection phases gives valves less time to retract toward closed position before pressure forces them shut

Question 4

When dampens heart sounds?

Answer 4

Regurgitation dampens sounds

Question 5

Systole occurs between…..

Answer 5

S1 and S2 sounds

Question 6

Clicks, Opening Sounds occur with…..

Answer 6

Stenotic valves, prolapsed valves

Question 7

S3 heart sound

Answer 7

Passive filling sound as high pressure atrial blood crashes into ventricle as soon as AV valve opens

Question 8

S4 heart sound

Answer 8

Active sound as blood crashes against stiff (hypertrophic, reduced compliance) ventricles after atrial contraction

Question 9

What processes cause murmurs?

Answer 9

Turbulent flow from stenotic or regurgitant valves

Question 10

Shape and cause of Systolic Ejection Murmurs

Answer 10

Diamond shape, caused by stenosis of high pressure semilunar valves

Question 11

Shape and cause of Pansystolic Murmurs

Answer 11

constant murmur through systole, caused by AV valve regurgitation

Question 12

Shape and cause of early diastolic murmurs

Answer 12

Decrescendo immediately after S2, caused by regurgitation over high pressure semilunar valves

Question 13

Shape and cause of late diastolic murmurs

Answer 13

Decrescendo mid-systole, caused by stenosis of AV valve, have opening click

Question 14

Describe waves of jugular venous pressure diagram

Answer 14

A wave: atrial contraction forcing venous blood backward
C wave: small pressure created when tricuspid valve closes
V wave: pressure created as atrium fills, relieved w/ tricuspid opening

Question 15

Causes of prominent A waves, V waves, and Y descents

Answer 15

A wave: right ventricle hypertrophy causes atrial blood to crash on stiff wall
V wave: tricuspid regurgitation provides addition volume to atrium, increasing pressure
Y descent: pericardial constriction

Question 16

Causes of Mitral Valve Stenosis (5)

Answer 16

Mostly rheumatic heart disease

Also calcification, obstructing tumor/clot, congenital structure problem, or bad prosthetic valve

Question 17

Pathology of Mitral Stenosis

Answer 17

Increased LA pressure causes pulmonary HTN and LA dilation
Pulmonary HTN leads to right heart failure
LA dilation promotes atrial fibrillation, reduces CO

Question 18

Physical Exam findings in Mitral Stenosis

Answer 18

Symptoms: dyspnea, hemoptysis

Loud S1 sound; late diastolic murmur with opening sound

Question 19

Mitral Stenosis EKG findings

Answer 19

Initially LA enlargement

Later RVH and A-fib

Question 20

Treatment of Mitral Stenosis

Answer 20

Diuretics for congestion
Rate control blood to improve LV filling
Anti-coagulation for A-fib
Surgical replacement

Question 21

Causes of Mitral Regurgitation

Answer 21

Primary: valve defect from prolapse, endocarditis,
Funcitonal: LVH pulls valve apart

Question 22

Mitral Regurgitation Pathology

Answer 22

Increased LA pressure and volume creates reduced cardiac output (some of SV is retrograde)
Chronically causes LA dilation, reduced CO and A-fib

Question 23

Mitral Regurgitation Exam

Answer 23

Low CO symptoms (syncope, dyspnea, etc.)

Apical holosystolic murmur

Question 24

Mitral Regurgitation Treatment

Answer 24

Surgery

In functional, treat LHF (diuretics)

Question 25

Mitral Prolapse

Answer 25

Congenital, mild regurgitation, systolic rumble murmur w/ opening click

Question 26

Aortic Stenosis Causes

Answer 26

``` Bicuspid valve (1-2% of population) promotes stenosis Calcification, Rheumatic ```

Question 27

Aortic Stenosis Pathology

Answer 27

Reduced SV increases LV pressure, leads to LVH, low CO | Much higher systolic pressure gradient narrows pulse pressure

Question 28

Aortic Stenosis Exam

Answer 28

Symptoms: syncope, light headed, dyspnea, angina PE: diamond systolic murmur radiating to carotids, S4, Parvus Tardus EKG: LVH

Question 29

Aortic Stenosis Treatment

Answer 29

Valve replacement | Treat underlying LHF symptoms as necessary

Question 30

Aortic Regurgitation Causes

Answer 30

Calcific, Rheumatic, and aortic dilation

Question 31

Aortic Regurgitation Pathology

Answer 31

Increased LV volume increases SV which increases LV pressure. High pressure causes LVH and pulmonary symptoms. Wide pulse pressure, angina

Question 32

Aortic Regurgitation Exam

Answer 32

Dyspnea, fatigue, low exercise tolerance (Low CO) | Early diastolic decrescendo murmur

Question 33

Tricuspid Stenosis

Answer 33

Rare, from rheumatic fever | Late diastolic decrescendo w/ opening sound, Large A wave in JVP

Question 34

Tricuspid Regurgitation

Answer 34

Functional caused by RVH, Primary from carcinoid Holosystolic mumur that increases w/ inspiration Large V wave in JVP

Question 35

Pulmonic Stenosis

Answer 35

Congenital or carcinoid causes | Diamond systolic mumur w/ opening sound

Question 36

Pulmonic Regurgitation

Answer 36

From pulmonary dilation 2' to pulmonary HTN | Early diastolic decrescendo murmur