Valvular heart disease - lecture

Question 1

Signs of right heart failure

Answer 1

Raised JVP
Pitting oedema
Hepatic congestion

Question 2

Where is the apex beat normally?

Answer 2

5th intercostal space, mid clavicular line

Question 3

When might you feel a tapping apex?

Answer 3

Mitral stenosis

Question 4

When might you feel a parasternal heave?

Answer 4

Right ventricular overload

Question 5

When might the apex beat be displaced?

Answer 5

In left ventricular dilatation or left ventricular hypertrophy

Question 6

Where would you auscultate the aortic valve?

Answer 6

2nd -3rd right interspace

Question 7

Where would you auscultate the pulmonary valve?

Answer 7

2nd-3rd LEFT interspace

Question 8

Where would you auscultate the tricuspid valve?

Answer 8

Left sternal border

Question 9

Where would you auscultate the mitral valve?

Answer 9

Apex

Question 10

What is the first heart sound

Answer 10

The mitral and tricuspid valve closing - start of systole

Question 11

What is the second heart sound?

Answer 11

Aortic and pulmonary valve closing - start of diastole

Question 12

Where does aortic stenosis radiate to?

Answer 12

Carotids

Question 13

Where does mitral regurgitation radiate to?

Answer 13

Axilla

Question 14

Are right or left sided murmurs louder with inspiration?

Answer 14

Right sided murmurs are louder with inspiration

Question 15

Which type of murmurs are always pathological?

Answer 15

Diastolic murmurs

Question 16

Low volume pulse
Forceful displaced apex
Ejection systolic murmur that can radiate to carotids

Answer 16

Aortic stenosis

Question 17

Treatment for aortic stenosis

Answer 17

Conventional valve replacement (preferred)
Trans catheter aortic valve replacement
Balloon aortic valve replacement

Question 18

Who would you give mechanical valves to? Why might you not give mechanical valve?

Answer 18

Give to longer patients as last longer, but have to give warfarin

Question 19

Who would you give bioprosthetic valves to?

Answer 19

Give to older people, last ten years.

Don’t have to give warfarin

Question 20

Displaced apex

Pansystolic murmur that radiates to axilla

Answer 20

Mitral regurgitation

Question 21

Treatment for mitral regurgitation

Answer 21

Diuretics and ACE inhibitors for heart failure

Question 22

How would you treat a prolapsed valve and how would you treat a degenerative valve?

Answer 22

Prolapsed - repair

Degenerative - fix

Question 23

Malar flush
Tapping apex beat
Mid diastolic rumbling diastolic murmur localised to apex

Answer 23

Mitral stenosis

Question 24

Straight left heart border

Answer 24

Mitral stenosis

Question 25

What is a collapsing pulse associated with?

Answer 25

Aortic regurgitation

Question 26

Collapsing pulse Wide pulse pressure Displaced apex

Answer 26

Aortic regurgitation

Question 27

Narrow pulse pressure

Answer 27

Aortic stenosis

Question 28

Wide pulse pressure

Answer 28

Aortic regurgitation

Question 29

Where would you hear the murmur of aortic regurgitation

Answer 29

Left sternal edge