Valvular Disease

Question 1

2nd right intercostal space

Answer 1

Aortic area

Question 2

2nd left intercostal space

Answer 2

Pulmonic Area

Question 3

Lower left sternal border at 4th intercostal space

Answer 3

Tricuspid area

Question 4

Midclavicular line at 5th intercostal space

Answer 4

Mitral area (Apex)

Question 5

What are dyspnea, easy fatigability, palpitation, and left sided heart failure symptoms of?

Answer 5

Mitral regurgitation

Question 6

What’s the most common cause of mitral regurgitation?

Answer 6

MVP
Other causes: MI, infectious endocarditis, trauma that ruptures the papillary muscle, chordae tendinae rupture, valve leaflet rupture

Question 7

What happens in chronic mitral regurgitation?

Answer 7

Left atria and left ventricle dilate and hypertrophy, diastolic filling of LV increases
EDV will be more than in a normal person

Question 8

What happens in acute mitral regurgitation?

Answer 8

Left atrial pressure increases from increased volume, leads to increased pulmonary pressure and edema

Question 9

Where would you listen to a mitral regurgitation? What would you expect to hear?

Answer 9

Apex of the heart

Holosystolic murmur that may radiate to the axilla; may hear a S3 (rapid ventricular villing)

Question 10

How would you treat mitral regurg with development of a.fib?

Answer 10

anticoagulation

Question 11

How would you treat mitral regurg with development of heart failure?

Answer 11

Diuretics (lasiks) and beta blockers

Question 12

What’s the most common valvular heart disease coming in hot at 2% of the population?

Answer 12

Mitral Valve Prolapse

Question 13

Young woman with palpitations or chest pain
Young athlete with syncope during practice
Elderly male with syncope

Answer 13

Common presentation of mitral valve prolapse

Question 14

Mid to late systolic Click followed by late systolic murmur

Answer 14

Mitral Valve Prolapse

Question 15

Only murmur that decreases with increased volume

Answer 15

Mitral Valve Prolapse

Question 16

Ways to increase cardiac volume

Answer 16

Passive leg raise
Squatting
Inhalation

Question 17

Ways to decrease cardiac volume

Answer 17

Valsalva maneuver (strain)
Sudden Standing
Exhalation

Question 18

Treatment for symptomatic MVP

Answer 18

Beta blockers

Anti-platelet therapy for those with a hx of emboli

Question 19

Outflow obstruction between left atria and left ventricle

Answer 19

Mitral Stenosis

Question 20

What causes mitral stenosis?

Answer 20

Rheumatic Heart Disease (scarlet fever related to strep)

Question 21

Dyspnea, hemoptysis, palpitations, and fatigue are symptoms of what?

Answer 21

Mitral stenosis

Question 22

In mitral stenosis, what happens to cardiac output?

Answer 22

Eventually drops because there’s less blood going into the ventricle to be pumped out

Question 23

Opening snap of mitral valve diastole

Answer 23

Mitral stenosis

Question 24

How do you treat mitral stenosis?

Answer 24

Control rate with beta blocker or CCB

Question 25

Smoldering lesion that usually doesn't present until 6th-8th decade

Answer 25

Aortic Stenosis

Question 26

Dyspnea, exertional syncope, pulmonary congestion, and fatigue are symptoms of what?

Answer 26

Aortic stenosis

Question 27

What will a murmur in aortic stenosis sound like?

Answer 27

Paradoxically Split | Listen at right second intercostal space

Question 28

Treatment for aortic stenosis

Answer 28

Avoid strenuous activity, diuretics for pulmonary congestion, surgical valve replacement

Question 29

Dyspnea, pulmonary congestion, and chest pain are symptoms of what?

Answer 29

Aortic regurgitation

Question 30

Fatigue and systemic vascular congestion are associated with what?

Answer 30

Tricuspid stenosis

Question 31

What most commonly causes tricuspid stenosis?

Answer 31

Rheumatic heart disease | Can also be from infective endocarditis from IV drug abuse

Question 32

What valve will you hear at the lower left sternal border?

Answer 32

Tricuspid valve

Question 33

What antibiotics are usually given prophylactically?

Answer 33

Amoxicillin | Cephalexin or Clindamycin if ther's a penicillin allergy