Valvular HD and Murmurs

Question 1

stenosis causes ___ by ____

Answer 1

causes hypertrophy and HF from pressure overload

Question 2

regurg causes ___ by ____

Answer 2

causes dilation from volume overload

Question 3

list the systolic murmurs

Answer 3

MR
TR
AS
PS
VSD
ASD

Question 4

list the diastolic murmurs

Answer 4

AR
MS
PR
TS
Atrial Myxoma

Question 5

list the 6 grades of murmurs

Answer 5

1. barely audible
2. faint, soft
3. louder, easily heard
4. very loud w/ palpable thrill (vibration)
5. heart w/ stethoscope barely touching chest w/ thrill
6. can heart w/o stethoscope or can hear w/ stethoscope close to chest, palpable thrill

Question 6

acute causes of mitral regurg

Answer 6

• ischemic papillary muscle dysfunction
• rupture chordal tendinae
• infective endocarditis
• volume overload

Question 7

chronic causes mitral regurg

Answer 7

• MVP
• myxomatous degeneration
• mitral annular calcification

Question 8

PE for mitral regurg

Answer 8

• systolic murmur
• blowing at apex
• radiates to left axilla

Question 9

demographic for MVP

Answer 9

females > males 7:1

Question 10

sx/PE for MVP

Answer 10

• range from asymptomatic to having CP
• SVT
• PVCs
• dyspnea
• systolic murmur at apex
• may have click/murmur increase w/ valsalva and standing

Question 11

how does decreased ventricular volume and chamber size affect MVP murmur

Answer 11

increases it

Question 12

sx of tricupsid regurg

Answer 12

asymptomatic

Question 13

auscultation for tricuspid regurg

Answer 13

blowing systolic mumur at 4th ICS LSB, increases on inspiration (Carvallo sign)

Question 14

when is tricuspid regurg significant

Answer 14

when associated w/:

• pulmonary HTN
• lung dz
• RV infarction
• inferior wall MI
• pacemaker
• infectious endocarditis

Question 15

how does tricuspid regurg affect jugular venous pulse

Answer 15

makes prominent V wave

Question 16

two etiologies of AS

Answer 16

• degenerative calcification

- bicuspid (genetic)

Question 17

sx AS

Answer 17

• dyspnea
• angina
• syncope

Question 18

PE for AS

Answer 18

• harsh systolic mumur, crescendo-decrescendo, 2nd ICS RSB
• radiates to sternal notch/carotids
• diminished S2
• Pulsus parvus et tardus (weak and slow pulse)
• narrow pulse pressure (140/100)

Question 19

ECG for AS

Answer 19

LVH, strain pattern (down sloping of ST segment - T wave)

Question 20

what genetic conditions is bicuspid aortic valve related to

Answer 20

marfans, turner’s

Question 21

bicuspid aortic valve sounds to auscultation

Answer 21

systolic murmur/click at LSB or apex

Question 22

describe murmur of PS

Answer 22

crescendo-decrescendo at 2-3 ICS LSB, radiate to left shoulder and clavicle

Question 23

what congenital defects are associated with tetrology of fallot

Answer 23

• PS
• VSD
• RVH
• overriding aorta

Question 24

auscultatory findings of VSD

Answer 24

holosystolic mumur at lower LSB w/ thrill

Question 25

auscultatory findings of ASD

Answer 25

systolic mumur upper LSB w/ fixed splitting of S2

Question 26

etiology of MS

Answer 26

- rheumatic heart dz group A strep - congenital - mitral annular calcification

Question 27

MS leads to ____

Answer 27

- pulm HTN - RV failure - left atrial enlargement - a fib

Question 28

sx MS

Answer 28

- dyspnea - orthopnea - palpitations - hoarseness (compression of recurrent laryngeal n.)

Question 29

PE for MS

Answer 29

diastolic murmur, low pitch, rumbling at apex | - increased S1 and S2 followed by opening snap

Question 30

ECG for MS

Answer 30

- LAE if in sinus - a fib - RV hypertrophy - right axis deviation if associated with pulm HTN

Question 31

etiology TS

Answer 31

- rhematic dz** - associated with mitral stenosis - more common in females

Question 32

auscultatory findings for TS

Answer 32

diastolic murmur LSB increases on inspiration (Carvallo sign)

Question 33

effect of TS on jugular venous pulse

Answer 33

prominent A wave

Question 34

ECG for TS

Answer 34

right atrial enlargement

Question 35

acute causes AR

Answer 35

- infective endocarditis - aortic dissection - chest trauma

Question 36

chronic causes AR

Answer 36

- calcific degeneration - bicuspid aortic valve - dilated aortic root - rheumatic

Question 37

AR causes ___ from ____

Answer 37

causes LVH and LHF from volume overload

Question 38

sx of AR

Answer 38

acute: pulmonary edema from infectious endocarditis chronic: dyspnea, orthopnea, angina

Question 39

ausculatory findings AR

Answer 39

diastolic decrescendo murmur 3rd ICS LSB, soft S2

Question 40

PE findings AR

Answer 40

- wide pulse pressure (130/50) - DeMusset sign (head bob***) - Quincke's sign (capillary nail pulsations) - Traube sign (pistol shot sounds over femoral a.) - Duroziez's sign (diastolic murmur over femoral a. w/ compressed w/ bell)

Question 41

ausculatory findings PR

Answer 41

diastolic decrescendo murmur 2nd ICS LSB

Question 42

PR is associated with ___

Answer 42

pulm HTN and increased S2