murmurs

Question 1

mitral stenosis etiology

Answer 1

rhematic fever

immune mediated damage to mitral valve leading to fish mouth shaped orifice

Question 2

mitral stenosis pressure

Answer 2

increased LA pressure (and size)
increased pulmonary venous pressure

leads to pulmonary congestion

Question 3

mitral stenosis exacerbation

Answer 3

anything that increases flow across mitral valve: exercise, tachy

Question 4

mitral stenosis long term (2)

Answer 4

pulomnary HTN (leading to RHF)
A fib due to increase LA size and pressure

Question 5

mitral stenosis symptoms

Answer 5

exertional dyspnea, orthopnea, PND
palpitations
hemoptysis

Question 6

mitral stenosis murmur

Answer 6

low pitched DIASTOLIC rumble with S2 followed by opening snap
closer S2 and opening snap = worse
Loud S1

Question 7

mitral stenosis tx

Answer 7

beta blocker: decrease HR and CO
diuretics for pulm congestion and edema
balloon valvuloplasty

Question 8

aortic stenosis etiology

Answer 8

calcification of valve - early in abnl bicuspid, later for tricuspid
rheumatic fever

Question 9

aortic stenosis remodeling

Answer 9

increased LV hypertrophy, causing obstruction to LV outflow

late: increaed LV, LA

Question 10

aortic stenosis severe

Answer 10

CO decreases causing angina with exertion
LV dilation and dysfunction
pulls apart mitral valve annulua apart, causing MR

Question 11

aortic stenosis symptoms

Answer 11

angina, syncope or HF

many are asymptomatic

Question 12

aortic stenosis murmur

Answer 12

hard cresendo-decresendo SYSTOLIC murmur radiating to carotids
softer with valsalva - less flow across valve
second right intercostal space
soft S2
parvus et tardus: delayed carotid upstrokes (weak and slow rising carotid pulse)
precordial thrill

Question 13

aortic stenosis tx

Answer 13

valve replacement is treatment of choice

Question 14

aortic regurg etiology

Answer 14

inadequate closure of aortic valve causing regurg blood flow into LV
infective endocarditis, trauma, aortic dissection
bicuspid valve, marfan, ehlers-danlos, ankylosing spondylitis, SLE
syphilitic aortisis, osteogenica imperfecta

Question 15

aortic regurg pressure

Answer 15

LV dilation and hypertrophy to maintain stroke volume and prevent diastolic pressure from increasing
Increased LV end diastolic volume and pressure, leading to pulmonary congestion
Causing increased LV and pulmonary pressures (late)

Question 16

aortic regurg murmur

Answer 16

DIASTOLIC decresendo murmur

INCREASES with increased SVR, eg handgrip, causes backflow through incompetent valve

Question 17

aortic regurg symptoms

Answer 17

dysnea on exertion, PND, orthopnea
palpitations, angina
cyanosis and shock in acute AR
widened pulse pressure (high SBP with low DBP)
water hammer pulse : rapidly increasing pulse that decreases in late systole
displaced PMI

Question 18

handgrip effect, squatting

Answer 18

increases SVR

Question 19

aortic regurg tx

Answer 19

afterload reduction (salt restriction, ACEi, arterial dilators), vasodilators, salt restriction
Surgery is definative
Acute AR: medical emergency, emergent replacement

Question 20

mitral regurg etiology

Answer 20

acute: endocarditis (staph a), papillary muscle rupture, chordae tendineae rupture, inferior MI with papillary muscle displacement
chronic: MVP, rheumatic fever, marfan, cardiomyopathy

Question 21

mitral regurg pressure - acute

Answer 21

increase in LA pressure with normal LA size and compliance causing back flow into pulomnary circ leading to acute pulm edema
increased LV end diastolic volume and filling pressure
decreased CO with hypotension and shock

Question 22

mitral regurg pressure - chronic

Answer 22

gradual elevation of LA pressure in setting of dialted LA and LV with increased LA compliance
LV dysfunction
pulm htn from chronic backflow

Question 23

mitral regurg murmur

Answer 23

HOLOSYSTOLIC at apex radiates to axilla

soft S1, wide S2, S3 gallop

Question 24

mitral regurg tx

Answer 24

afterload reduction with vasodilators

valve replacement or repair before LV dilates too much

Question 25

mitral regurg sympotoms

Answer 25

dysnea on exertion, PND palpitations pulm edema Afib

Question 26

tricuspid regurg etiology

Answer 26

usu RV dilation, due to LV failure, RV infarction, inferior wall MI, cor pulmonale, pulm HTN endocarditis in IVDU epstein anomoly - downward displacement of valve into RV

Question 27

tricuspid regurg symtpoms

Answer 27

usu asymp, signs of RVF (ascities, hepatomegaly, edema, JVD), pulsitile liver afib

Question 28

tricuspid regurg mumur

Answer 28

Blowing holosystolic at LLSB | louder with inspiration, reduced with expiration or valsalva

Question 29

valsalva effect, standing

Answer 29

reduces preload, reduces LV size increases HOCM and MVP decreases AS, pulmonic stenosis, and triC regurg

Question 30

MVP etiology

Answer 30

myxomatous degeneration of valve leaflet or chordae tendineae Marfan, osteogenesis imperfecta, Ehlers Danlos most common cause of MR in developed countries

Question 31

MVP symptoms

Answer 31

most asymp, palpitations and chest pain | rare TIA

Question 32

MVP murmur

Answer 32

Mid-late SYSTOLIC murmur, with mid systolic click increses with standing and valsalva because LV size is reduced allowing murmur and click to occur sooner squatting decreases because LV size is increased

Question 33

MVP tx

Answer 33

usu nothing, beta blockers for chest pain

Question 34

HOCM murmur (intraventricular septal hypertrophy)

Answer 34

(cresendo-decresendo) SYSTOLIC ejection murmur without carotid radiation louder with valsava - less blood to push wall apart softer with handgrip, squating - more blood to push walls apart

Question 35

VSD murmur

Answer 35

holosystolic with LATE diastolic rumble | can see LV overload, and pum htn from increased RV volumes

Question 36

PDA murmur

Answer 36

communication iwth aorta and pulmonary artery continuous machine like murmur rubella closure - indomethacin patent - prostaglandin during transposition

Question 37

ASD murmur

Answer 37

wide split S2 and soft mid systolic at LUSB | increased flow across pulmonary vasculature

Question 38

coarctation of aorta

Answer 38

narrowing of constriction of aorta HTN in UE, with hypotension in LE midsystolic murmur heard in back figure of 3

Question 39

nitrates

Answer 39

vasodilate, decrease LV volume, wall stress

Question 40

Tetralogy of fallot

Answer 40

Harsh Crescendo descendo systolic murmur at left upper eternal Border with single s2