Valvular Heart Disease

Question 1

Patent ductus arteriosus

Answer 1

Continuous murmur in the L parasternal location
S3 gallop - L ventricular volume overload
P2 normal - with no pulmonary hypertension
Carotid pulses - brisk due to increased stroke volume
Pulse pressure - increased with diastolic runoff into pulmonary artery

Question 2

Atrial septal defect

Answer 2

Systolic murmur without an opening snap
Widely fixed splitting of S2
Best heard at left sternal border

Question 3

Ventricular septal defect

Answer 3

harsh systolic murmur and palpable thrill

Question 4

Mitral valve prolapse

Answer 4

Loudest over mitral valve
Radiates to apex
Proceeded by one or more clicks

Question 5

Ventricular outflow obstruction

Answer 5

Late peaking systolic murmur

Question 6

Causes of MR

Answer 6

Pregnancy

Question 7

Mitral regurg

Answer 7

Pansystolic murmur
- radiation to the axilla and back
Widely split S2

Question 8

Mitral stenosis

Answer 8

Opening snap
Rumbling diastolic murmur accentuated with atrial constriction
Parasternal lift

Question 9

Aortic stenosis

Answer 9

Crescendo-decrescendo murmur best heard at upper right sternal border
Radiation to carotid arteries
Diminished and delayed carotid pulsation

Question 10

Aortic regurg

Answer 10

Regurgitant diastolic:
- Blowing, early decrescendo at the base of the heart - accentuated to with sitting/leaning forward
Second right and third left interspaces

Question 11

Tricuspid regurg

Answer 11

Holosystolic murmur

Louder with inspiration