12.6 B

Question 1

What is a holo or pan murmur?

Answer 1

one with relatively constant loudness

Question 2

Which mitral and aortic valve related murmurs are systolic?

Answer 2

mitral regurgitation and aortic stenosis

Question 3

Which mitral and aortic valve related murmurs are diastolic?

Answer 3

aortic regurgitation and mitral stenosis

Question 4

The intensity of a murmur is directly related to ___ which is directly related to ___.

Answer 4

• the magnitude of flow across the defective valve

- the pressure gradient across the valve during flow

Question 5

LV afterload is ___ and TPR is ___ in someone with aortic stenosis.

Answer 5

• afterload is increased

- TPR is unchanged

Question 6

What happens to the pressure gradient between the aorta and left ventricle during systole in someone with aortic stenosis?

Answer 6

• the pressure gradient is zero at the time of valve opening by definition
• but then the ventricle continues to contract without a corresponding amount of flow into the aorta, increasing ventricle pressure without increasing aortic pressure
• the gradient increases and then falls

Question 7

Describe an aortic stenosis murmur.

Answer 7

• crescendo-decrescendo

- systolic

Question 8

What happens to arterial pulse pressure in someone with aortic stenosis?

Answer 8

• it is diminished
• because flow into the aorta is slowed, systolic arterial pressure never gets as high as it otherwise would
• systole also takes longer so there is less time for diastole and thus less time for runoff, increasing diastolic arterial pressure

Question 9

What happens to diastolic arterial pressure in someone with aortic stenosis?

Answer 9

it is increased because systole takes longer and there is less time for runoff

Question 10

What chronic changes are seen in someone with aortic stenosis?

Answer 10

• left ventricular hypertrophy

- left atrial hypertrophy since LV hypertrophy will decrease compliance of the LV

Question 11

What effect does aortic stenosis have on exercise?

Answer 11

it greatly restricts the bodies attempts to increase cardiac output and individuals may faint during exercise

Question 12

Which chambers are likely to hypertrophy in someone with aortic stenosis?

Answer 12

• LV because it’s working against more valvular resistance

- LA because LV hypertrophy limits compliance

Question 13

Describe an aortic insufficiency murmur.

Answer 13

a diastolic decrescendo murmur

Question 14

Why is an aortic insufficiency murmur a decrescendo?

Answer 14

because as the left ventricle fills during diastole and the aorta loses blood to the ventricle, the pressure difference between the two is diminished

Question 15

What happens to arterial diastolic pressure in someone with aortic insufficiency?

Answer 15

it will greatly decrease because there is now an additional route for runoff

Question 16

What happens to arterial pulse pressure in someone with aortic insufficiency?

Answer 16

• systolic pressure increased due to increased SV

- diastolic pressure decreased due to additional route for runoff

Question 17

How does LV hypertrophy so often lead to LA hypertrophy?

Answer 17

the LV hypertrophy diminishes compliance, so the LA must compensate

Question 18

How does LV hypertrophy lead to pulmonary edema?

Answer 18

LV hypertrophy causes an increase in EDP, which increases pressure back upstream, including in pulmonary capillaries

Question 19

Describe the murmur associated with mitral valve insufficiency.

Answer 19

a holo/pan systolic murmur

Question 20

Why is a mitral valve insufficiency murmur a pan murmur?

Answer 20

because as the LV contracts and the pressure rises, blood flows back into the LA where pressure also rises, thus the pressure gradient remains roughly constant

Question 21

Which chambers hypertrophy in mitral valve insufficiency?

Answer 21

• LA due to increased volume with return from LV

- LV due to increased volume due to increased LA filling

Question 22

Which valve will never hypertrophy in mitral valve stenosis?

Answer 22

the left ventricle because it will constantly struggle to fill

Question 23

Describe a mitral valve stenosis murmur.

Answer 23

a diastolic decrescendo-crescendo

Question 24

Why is the mitral valve stenosis murmur a decrescendo-crescendo?

Answer 24

• initially, the ventricle fills as the atrium empties passively and the pressures converge
• towards the end of diastole, though, the atrium contracts and there is an increase in atrial pressure that is greater than the increase in ventricular pressure due to resistance to flow and the pressure gradient increases

Question 25

Which valves are expected to hypertrophy in someone with mitral valve stenosis?

Answer 25

right ventricle

Question 26

Why would the right ventricle hypertrophy in mitral valve stenosis?

Answer 26

• high left atrial pressure increases pressure in pulmonary veins
• this causes edema in the pulmonary veins which leads to hypoxia
• hypoxia triggers vasoconstriction
• vasoconstriction increases pulmonary artery pressure
• the right ventricle has a greater afterload

Question 27

How does mitral valve stenosis show up on an EKG?

Answer 27

• LA hypertrophy creates a notched P wave

- RV hypertrophy causes a right axis shift

Question 28

Aortic stenosis has what effect on S2?

Answer 28

paradoxical splitting

Question 29

Pulmonic stenosis has what effect on S2?

Answer 29

wide splitting

Question 30

Left heart murmurs get louder during (inspiration/expiration).

Answer 30

expiration

Question 31

Right heart murmurs get louder during (inspiration/expiration).

Answer 31

inspiration