Valvular Disease

Question 1

When will the apex beat be tapping?

Answer 1

Mitral stenosis

Question 2

When will the apex beat be displaced and diffuse?

Answer 2

LV dilatation

Question 3

When will the apex beat be heaving and possibly displaced?

Answer 3

LV hypertrophy

Question 4

If there is a parasternal heave to the left of the sternum what does this suggest?

Answer 4

Cor pulmonale or pulmonary hypertension

Question 5

What is the best test for valvular disease?

Answer 5

ECHO

Question 6

What is a murmur?

Answer 6

Audible turbulence of blood flow

Question 7

Where do you listen for the aortic valve?

Answer 7

2nd right intercostal space (parasternal)

Question 8

Where do you listen for the mitral valve?

Answer 8

At the apex

Question 9

What makes the first heart sound?

Answer 9

Mitral and tricuspid valves closing (systole)

Question 10

What makes the second heart sound?

Answer 10

Aortic and pulmonary valves closing (diastole)

Question 11

What are the two types of systolic murmurs?

Answer 11

Pansystolic and ejection systolic

Question 12

What are the two types of diastolic murmur?

Answer 12

Early diastolic and mid diastolic

Question 13

What murmur radiates to the carotids?

Answer 13

Aortic stenosis

Question 14

What murmur radiates to the axilla?

Answer 14

Mitral regurgitation

Question 15

Which grade of murmur indicates a thrill?

Answer 15

IV

Question 16

What does grade VI murmur mean?

Answer 16

It is audible without a stethoscope

Question 17

What type of murmurs are louder with inspiration?

Answer 17

Right sided

Question 18

What murmur can cause 2nd sound splitting?

Answer 18

Aortic stenosis

Question 19

What murmur can cause a third sound?

Answer 19

AR

Question 20

What murmur can cause a 4th heart sound?

Answer 20

Mitral stenosis

Question 21

What murmur can cause systolic clicks?

Answer 21

A continuous murmur

Question 22

What is an innocent murmur?

Answer 22

Tricuspid regurgitation

Question 23

What murmur can a pericardial rub cause?

Answer 23

MR

Question 24

What are innocent murmurs commonly?

Answer 24

Early systolic (never diastolic)

Question 25

What is stenosis?

Answer 25

Valve doesn't open properly

Question 26

What is regurgitation?

Answer 26

Valve doesn't close properly

Question 27

What are causes of aortic stenosis in the >65s?

Answer 27

Calcified valve

Question 28

What is usually the cause of aortic stenosis in the <65s?

Answer 28

Bicuspid valve

Question 29

Can aortic stenosis be rheumatic?

Answer 29

Yes

Question 30

What are symptoms of aortic stenosis?

Answer 30

Breathless, chest pain, dizziness/syncope

Question 31

How would you describe an aortic stenosis murmur?

Answer 31

Early systolic murmur radiating to the carotids

Question 32

What is the treatment for asymptomatic AS?

Answer 32

None- observe

Question 33

What is the treatment for asymptomatic AS with a valvular gradient >40mmHg and LV systolic dysfunction?

Answer 33

Surgery

Question 34

How would you treat a symptomatic case of AS?

Answer 34

Valve replacement or 2nd line balloon valvuloplasty

Question 35

When are mechanical heart valves used?

Answer 35

Younger patients

Question 36

Which type of heart valve replacement requires warfarin?

Answer 36

Mechanical

Question 37

When are bio-prosthetic heart valves used?

Answer 37

Older patients

Question 38

When is a TAVI used instead of a replacement for aortic valve damage?

Answer 38

Patients with co-morbidities or a previous sternotomy

Question 39

What are causes of MR?

Answer 39

Leaflets, chordae rupture, papillary muscle rupture, annular dilatation

Question 40

What are leaflet causes of MR?

Answer 40

Prolapse, rheumatic, myxomatous, endocarditis

Question 41

What are papillary muscle ruptures related to?

Answer 41

Ischaemia

Question 42

What are symptoms of MR?

Answer 42

Breathless, peripheral oedema, fatigue

Question 43

How would you describe the murmur of MR?

Answer 43

Pansystolic murmur radiating to the axilla

Question 44

How can MR be treated medically?

Answer 44

Diuretics and heart failure medication (ACE I's)

Question 45

When are repairs and replacements used for MR?

Answer 45

Repair- prolapse | Replacement- degenerative

Question 46

What is a treatment used for MR in infancy?

Answer 46

Percutaneous clips

Question 47

What is the main and minor causes of MS?

Answer 47

Rheumatoid and rarely congenital

Question 48

What are symptoms of MS?

Answer 48

Breathless, fatigue, palpitations (AF)

Question 49

How would you describe the murmur of MS?

Answer 49

Mid-diastolic rumbling murmur localised to the apex

Question 50

How can MS be treated medically?

Answer 50

Diuretics and treat AF

Question 51

How can MS be treated surgically?

Answer 51

Valve replacement or balloon valvuloplasty

Question 52

What are causes of AR?

Answer 52

Leaflet (endocarditis, connective tissue disease, rheumatic) or annulus (Marfan's or aortic dissection)

Question 53

What is the only symptom of AR?

Answer 53

Breathlessness

Question 54

How would you describe the murmur of aortic regurgitation?

Answer 54

Early diastolic murmur localised to the left sternal edge

Question 55

How can AR be treated medically?

Answer 55

ACE inhibitors

Question 56

When should surgery be given for AR and what should it be?

Answer 56

Valve replacement if symptomatic with LV dilatation

Question 57

What can cause a displaced apex?

Answer 57

Mitral or aortic regurgition

Question 58

Slow rising pulse?

Answer 58

AS

Question 59

Loud S1 and opening snap

Answer 59

MS

Question 60

Wide pulse pressure?

Answer 60

AR

Question 61

Malar flush?

Answer 61

MS

Question 62

Narrow pulse pressure?

Answer 62

AS

Question 63

Low volume pulse?

Answer 63

MS

Question 64

Collapsing pulse?

Answer 64

AR

Question 65

Soft S1?

Answer 65

MR

Question 66

Soft S2?

Answer 66

AS

Question 67

What can cause a forceful displaced apex beat?

Answer 67

AS

Question 68

What can cause a straight left heart border?

Answer 68

MS