15: Valvular Heart Diseae

Question 1

Two conditions that can increase symptoms in mitral stenosis

Answer 1

1. Pregnancy

2. Afib

Question 2

Systolic vs diastolic murmur: between which heart sounds

Answer 2

1. Systolic: S1->S2

2. Diastolic: S2->S1

Question 3

Six classic systolic vs four diastolic murmurs**

Answer 3

1. Systolic: MR, TR, AS, PS, VSD, ASD

2. Diastolic: AR, PR, MS, TS

Question 4

Where are the four major cardiac listening posts

Answer 4

1. Aortic: R 2nd ICS
2. Pulmonary: L 2nd ICS
3. Tricuspid: L 4th ICS
4. Mitral: L 5th ICS at mid-clavicular line

Question 5

Which breathing phase can cause a splitting of S2 and why?

Answer 5

Inspiration: increased venous return + more time for RV to deliver blood to lung -> delayed P2

Question 6

Where are S1 vs S2 the loudest?

Answer 6

S1: apex
S2: base

Question 7

What is the V wave of the pulsewave?

Answer 7

Atrial filling

Question 8

What two conditions cause prominent V wave in the pulsewave?

Answer 8

TR, pulmonary HTN

Question 9

parvus et tardus

Answer 9

diminished carotid upstroke + weak pulse

Question 10

Five congenital heart defects that are L->R shunts with late cyanosis?***

Answer 10

1. ASD
2. VSD
3. PFO
4. PDA
5. CoA

Question 11

Eisenmenger presentation in kids vs adults

Answer 11

1. Kids: cyanosis, fatigue, right HF

2. adults: cyanosis, clubbing, increased RV impulse, split S2, jugular venous distension

Question 12

signs of pulmonary HTN

Answer 12

syncope, arrhythmias, cyanosis

Question 13

inspiration vs expiration: which causes louder R vs L heart murmur?

Answer 13

inspiration: louder R murmur
expiration: louder L murmur

Question 14

systolic vs diastolic murmurs: which can be benign and which is always pathologic?

Answer 14

1. systolic: can be benign

2. diastolic: always pathologic

Question 15

how is the intensity of P2 (of the 2nd heart sound) determined?

Answer 15

by comparing its intensity of A2 - an increase is suggested its louder than A2