Valvular Heart Disease + Murmurs - Dr. Johnston

Question 1

ventricular HD most common reasons

Answer 1

1. Myxomatous degeneration (MVP)

2. Congenital (Bicuspid Aortic Valve)

Question 2

Stenosis and Regurgitation does what to the heart

Answer 2

S : Pressure overload, hypertrophy and HF

R : Volume overload , dilation and arrhythmia

Question 3

6 causes of Systolic murmur

Answer 3

1. Aortic stenosis
2. Pulmonary stenosis
3. Mitral regurg
4. Tricuspid regurg
5. VSD
6. ASD

Question 4

5 causes of diastolic murmur

Answer 4

1. Aortic regurg
2. Pulmonary regurg
3. Mitral stenosis
4. Tricuspid stenosis
5. Atrial Myxoma

Question 5

murmur grading scale

Answer 5

1-6
1 : barely
2. Faint
3. easy to hear
4. loud + palpable thrill
5. heard with stethoscope barley touching + thrill
6. can hear without stethoscope + palpable thrill

Question 6

4 causes of ACUTE mitral regurgitation

Answer 6

1. Ischemic papillary muscle prob (MI, CAD)
2. chordal tendineae rupture
3. Infective endocarditis
4. Volume overload, high LA P, edema, cadiogenic shock

Question 7

4 causes of CHRONIC mitral regurgitation

Answer 7

1. Mitral valve prolapse

2. Myxomatous / degenerative valve / mitral annular calcification

Question 8

Mitral regurgitation ascultation

Answer 8

= blowing at apex
= radiates to left axilla
= low S1
= use diaphragm

Question 9

Mitral Valve Prolapse ascultation

Answer 9

= at apex

= click or murmur increases with Valsalva + standing

Question 10

tx for mitral prolapse

Answer 10

reassure , if sx give BB

Question 11

Tricuspid regurgitation auscultation

Answer 11

= blowing left 4th ICS

= increase with inspiration (Carvallo sign)

Question 12

Tricuspid regurgitation PE ,

Answer 12

prominent V wave in elevated JVP, other then that usually asymptomatic

Question 13

reasons for TR

Answer 13

= pulmonary htn, disease,
= RV MI
= inferior wall MI
= Pacemaker

Question 14

Aortic Stenosis triad sx

Answer 14

1. SOB
2. Angina
3. Syncope

Question 15

Aortic Stenosis ascultation

Answer 15

= crescendo –> decreasendo
= harsh right 2nd ICS
= radiates to sternal notch and carotids

Question 16

Aortic Stenosis PE

Answer 16

weak pulse, and slow (parvus and tardus)

Question 17

Aortic Stenosis EKG

Answer 17

downsloping ST segment

Question 18

Aortic Stenosis associations 3

Answer 18

Aortic aneurysm
Marfans
Turners

Question 19

Pulmonary Stenosis ascultation

Answer 19

= crescendo –> decrescendo left ICS

= radiated to left shoulder and clavicle

Question 20

Pulmonary Stenosis associated with what

Answer 20

Tetralogy of Fallot

= Pulmonary Stenosis is usually congenital

Question 21

Ventricular Septal Defect Auscultation

Answer 21

= Holosystolic murmur LOWER LEFT sternal border
= thrill
= increase with hand gripping (left to right shunt)

Question 22

Atrial Septal Defect auscultation

Answer 22

= UPPER LEFT sternal border murmur
= splitting of S2
= left to right shunt

Question 23

4 causes of Mitral stenosis

Answer 23

1. Rheumatic Heart Disease
2. Strep Group A
3. congenital
4. MAC (Mitral annular calcification)

Question 24

Mitral stenosis can cause

Answer 24

Pulmonary htn, A fib, right V failure

Question 25

Mitral stenosis auscultation

Answer 25

= low pitch BELL = rumbling at apex = Increase S1 and S2 + then opening snap

Question 26

Mitral stenosis sx

Answer 26

= SOB = palpitations (A fib) = hoarseness, compression of left laryngeal N (Ortners Syndrome)

Question 27

Tricuspid Stenosis auscultation

Answer 27

= Left | = increase with inspiration (carvallo sign)

Question 28

Tricuspid stenosis PE

Answer 28

A wave prominent in JVP

Question 29

TS associated with

Answer 29

= Rheumatic disease (MS) | = female

Question 30

Aortic Regurgitation acute 3 causes

Answer 30

1. infective endocarditis 2. aortic dissection 3. chest trauma

Question 31

Aortic Regurgitation (insufficiency) chronic 4 causes

Answer 31

1. calcification degenerative 2. Bicuspid valve 3. dilated Aortic root 4. Rheumatic heart

Question 32

Aortic Regurgitation causes what

Answer 32

volume overload, left HF

Question 33

Aortic Regurgitation acute and chronic SX

Answer 33

ACUTE : pulmonary Edema | CHRONIC : dyspnea, orthopnea, angina

Question 34

Aortic Regurgitation auscultation

Answer 34

= decrescendo 3rd ICS LEFT sternal base (diastole) (Austin Flint) = can sound like Mitral stenosis = soft S2

Question 35

Aortic Regurgitation : DeMusset sign

Answer 35

head bob with beats

Question 36

Aortic Regurgitation Quincke's sign

Answer 36

capillary nail pulsations

Question 37

Aortic Regurgitation : Traube sign

Answer 37

"pistole shot" | = systole and diastole sounds over Femoral A

Question 38

Aortic Regurgitation : Duroziez sign

Answer 38

= diastolic murmur over Femoral A when compressed with (BELL)

Question 39

Aortic Regurgitation tx

Answer 39

reduce afterload = ACE Inhibitor, ARB

Question 40

Pulmonary Regurgitation (insuffiency) auscultation and associations

Answer 40

= decrescendo 2nd ICS LEFT Sternal base (Graham steele) + increased S2 (diastole) = associated with pulmonary htn