Valvular Heart Disease

Question 1

How are murmurs graded?

Answer 1

On a scale of 1-6

Question 2

1. Grade I
2. Grade II
3. Grade III
4. Grade IV
5. Grade V
6. Grade VI

Answer 2

1. S1, S2 are louder than the murmur
2. S1, S2 are equal to the murmur
3. S1, S2 are softer than the murmur
4. The murmur has a palpable thrill
5. Hear the murmur without a stethoscope
6. Hear the murmur without a stethoscope (very rare)

Question 3

When do you do a workup for a murmur? (Systolic and diastolic).

Answer 3

Systolic murmur graded at level 3

Any diastolic murmur

Question 4

What do you use to diagnose a murmur?

Answer 4

Echocardiogram, dilated L atrium.

Question 5

Mnemonic for recalling which murmurs are systolic

Answer 5

MR. ASS
Mitral Regurgitation
Aortic Stenosis
Systolic

Question 6

Mnemonic for recalling which murmurs are diastolic

Answer 6

MS. ARD.
Mitral Stenosis
Aortic Regurgitation
Diastolic

Question 7

What physiologic processes (2) drive the symptoms for mitral stenosis?

Answer 7

Atrial stretch and fluid in the lungs

Question 8

In mitral stenosis, you see _____ patients than in aortic stenosis

Answer 8

Younger 20s-30s

Question 9

The pathology of Mitral Stenosis is

Answer 9

Rheumatic heart disease

Question 10

Which type of stenosis is due to calcification?

Answer 10

Aortic stenosis

Question 11

Which type of stenosis is due to inflammation of the mitral valve?

Answer 11

Mitral stenosis

Question 12

What type of symptoms will patients with mitral stenosis present with? (Name 2).

Answer 12

CHF symptoms

(1) Dyspnea on exertion
(2) Paroxysmal nocturnal dyspnea

Question 13

Signs of mitral stenosis (Name 2).

Answer 13

(1) From CHF symptoms: Crackles

(2) From atrial stretching: a-fib

Question 14

Describe the auscultation findings of mitral stenosis

Answer 14

Blood flows across the mitral valve during diastole, so this is a diastolic murmur.

Question 15

Where can you hear mitral stenosis the best?

Answer 15

Cardiac apex. 5th intercostal space midclavicular line

Question 16

What is a sign of mitral stenosis on auscultation?

Answer 16

Opening snap

Question 17

What is the treatment for mitral stenosis

Answer 17

Balloon valvuloplasty (L heart cath, prior to a-fib or CHF symptoms). You can do a valve replacement but don’t jump to it, it’s open heart surgery and valves don’t last that long.

Question 18

What are the two diastolic murmurs?

Answer 18

MS. ARD.
Mitral Stenosis
Aortic Regurgitation
Diastolic

Question 19

What are the causes of aortic regurgitation ? (3)

Answer 19

Infection, infarction, aortic dissection.

Question 20

How is aortic stenosis diagnosed?

Answer 20

On auscultation, R 2nd intercostal space. Diastolic murmur

Question 21

What is the treatment for aortic regurgitation?

Answer 21

Valve Replacement

Question 22

What is the acute symptom of aortic regurgitation ?

Answer 22

Chest pain

Question 23

What are the chronic symptoms of chest pain? (3)

Answer 23

CHF symptoms:

(1) Dyspnea
(2) Chest Pain
(3) Paroxysmal nocturnal dyspnea

Question 24

Describe the murmur for aortic regurgitation .

Answer 24

NO OPENING SNAP. Rumbling. Diastolic.

Question 25

What is the other term for aortic regurgitation ?

Answer 25

Aortic insufficiency

Question 26

Describe what is going on in aortic stenosis.

Answer 26

Stiff aortic valve due to atherosclerosis. The heart responds by dilating which pools blood and you end up with heart failure.

Question 27

Describe the murmur in aortic stenosis.

Answer 27

"Crescendo decrescendo."

Question 28

Where do you auscultate to diagnose aortic stenosis?

Answer 28

R sternal border at the base.

Question 29

Blood is trying to LEAVE the ventricle and go to the aorta, this is a

Answer 29

Systolic murmur

Question 30

What is the treatment for aortic stenosis?

Answer 30

Valve replacement

Question 31

In mitral regurgitation, what is going on with the blood flow in the heart?

Answer 31

Blood leaves the ventricle through the mitral valve and the aorta. Dilated atrium. Normal L ventricle. Blood goes back into the lungs. L atrial stretch.

Question 32

Echocardiogram finding in mitral regurgitation

Answer 32

Increased EF

Question 33

What causes mitral regurgitation?

Answer 33

Infection, infarction.

Question 34

Treatment for acute mitral regurgitation vs Chronic mitral regurgitation.

Answer 34

Emergent valve replacement for acute

Question 35

In chronic mitral regurgitation what can you see on the ecg?

Answer 35

a-fib

Question 36

Where are aortic murmurs located?

Answer 36

Base, right sternal border

Question 37

Where are mitral murmurs located?

Answer 37

Apex, 5th intercostal space midclavicular line

Question 38

(1) More blood in the heart = more murmur, how can you hear the murmur more/makes it worse? (2) And what makes you hear it less?

Answer 38

(1) Hear it more by squatting or doing a leg lift | (2) Hear it less by doing a valsalva maneuver

Question 39

On a physical exam how do you differentiate a murmur between AS, MS, AR, MR and HCM/mitral valve prolapse.

Answer 39

Doing a leg lift/squat with AS, MS, AR, MR will make the murmur sound worse.

Question 40

More blood in the heart, but less murmur...which 2 valve disorders fit into this description?

Answer 40

(1) Hypertrophic cardiomyopathy (HCM) | (2) Mitral valve prolapse

Question 41

In HCM

Answer 41

Atria is normal, mitral valve is normal. Unilateral septum hypertrophy which covers the aortic opening, leading to L ventricle obstruction. More blood and less murmur because the ventricle is expanded. Loss of the ventricle outlet death

Question 42

Pathology of HCM

Answer 42

Sarcomere mutation, young, athlete.

Question 43

Symptoms of HCM

Answer 43

SOB, syncope with exertion

Question 44

Risk factor for HCM

Answer 44

Family history

Question 45

Describe the murmur sound of HCM.

Answer 45

Sounds like aortic stenosis, you'll hear a systolic murmur BUT "MORE BLOOD MAKES IT BETTER"

Question 46

Treatment for HCM (3)

Answer 46

``` Avoid dehydration Beta blockers (slow down heart rate, decrease diastole) Don't workout or increase HR ```

Question 47

The other condition besides HCM that has more blood in the heart but less murmur is...

Answer 47

Mitral valve prolapse

Question 48

Describe the valves in mitral valve prolapse.

Answer 48

Mitral valve leaflets don't touch because they're too big. During systole, they're suppose to close and touch, but they blow through, don't close properly. But when the ventricle stretches, it closes better so the murmur gets better.

Question 49

The murmur of mitral valve prolapse sounds like

Answer 49

Mitral regurgitation, but it's mitral valve prolapse

Question 50

Pathogensis of mitral valve prolapse.

Answer 50

Congenital. Young women.

Question 51

Diagnosis of mitral valve prolapse.

Answer 51

Mitral regurgitation, but better with more blood

Question 52

Treatment of mitral valve prolapse.

Answer 52

Avoid dehydration | Beta blockers

Question 53

In HCM and mitral valve prolapse your goal is to ____ in diastole.

Answer 53

Improve diastolic filling, more time to fill the ventricle.