2. CV: Valvular Heart Disease

Question 1

You will see several questions r/t valvular heart disease and/or heart sound assessment. Since there are 4 heart valves and each valve may be diseased with either ____ or ____, it would be impossible to memorize whether each problem is a systolic or diastolic murmur. If you can picture which valves are open and which are closed during each phase of the cardiac cycle (systole or diastole), you will be able to decide what problem is being described in each question.

Answer 1

stenosis or insufficiency

Question 2

Normal heart sounds in adults (___ & ____) are due to _____

Answer 2

S1 & S2 …. valve closure

Question 3

How do valves open and close?

Answer 3

Valves open and close based on the pressure changes in the chamber above the valve and below the valve. When the pressure in the chamber above a valve is higher than that below the valve, the valve opens.

When the pressure drops in the chamber above the valve and the pressure is greater below the valve, the valve closes.

Question 4

Systole (what does it mean?)

Answer 4

ejection; high pressure

Question 5

Diastole (what does it mean?)

Answer 5

filling; low pressure

Question 6

Which is longer, systole or diastole?

Answer 6

diastole is 1/3 longer than systole, needs time for filling

Question 7

**When are coronary arteries perfused?

Answer 7

during diastole

Question 8

Why do cardiac output and blood pressure drop with extreme tachyarrhythmias?

Answer 8

No time for filling, therefore less output.

Question 9

Causes of Valvular Heart Disease:

Answer 9

1. Coronary artery disease, ischemia, and acute MI
2. Dilated cardiomyopathy
3. Degeneration
4. Bicuspid aortic valve; genetic
5. Rheumatic fever
6. Infection
7. Connective tissue diseases

Question 10

Simply, what does “insufficiency” mean for murmurs/valves

Answer 10

Regurgitation

Question 11

Murmurs of insufficiency (regurg) occur when the valve is:

Answer 11

CLOSED. (This applies to acute or chronic.)

Question 12

Murmurs of stenosis occur when?

Answer 12

When the valve is open.

Question 13

Murmurs of stenosis develop ___

Answer 13

Over time, it’s a chronic problem (NOT acute)

Question 14

What do systolic murmurs sound like?

Answer 14

Lub…shhhb…Dub

Question 15

With systolic murmurs, semilunar valves are ___ (open or closed) during systole. These murmurs occur with:

Answer 15

Open.
1. Aortic stenosis. 2. Pulmonic stenosis

Question 16

With systolic murmurs, AV valves are ______(open or closed) during systole. Which conditions associated with these murmurs?

Answer 16

Closed.
Mitral insufficiency
Tricuspid insufficiency

Question 17

When pt has a PA cath, what can cause large giant V-waves on the pulmonary artery occlusion pressure tracing?

Answer 17

Mitral insufficiency

Question 18

_____which is most common with an acute MI, may result in a systolic murmur. Where is it heard?

Answer 18

Ventricular septal defect (VSD). Heard at the left sternal border, 5th intercostal space (ICS).

Question 19

What do diastolic murmurs sound like?

Answer 19

Lub…Dub…shhhb

Question 20

With diastolic murmurs, semilunar valves are ____ (open or closed) during diastole? e.g?

Answer 20

closed
1. Aortic insufficiency (AI)
2. pulmonic insufficiency (PI)

Question 21

With diastolic murmurs, AV valves are _____ (open or closed) during diastole? e.g?

Answer 21

Open.
1. Mitral stenosis
2. tricuspid stenosis

Question 22

Mitral stenosis is associated with…

Answer 22

atrial fibrillation due to atrial enlargement that occurs over time.

Question 23

Mitral insufficiency occurs when…

Answer 23

the mitral valve is closed (murmur occurs).

Question 24

Mitral stenosis occurs when the…

Answer 24

mitral valve is open (murmur occurs).

Question 25

Aortic insufficiency occurs when the…

Answer 25

aortic valve is closed.

Question 26

When is the mitral valve open in mitral stenosis?

Answer 26

During diastole.

Question 27

When is the mitral valve closed with mitral insufficiency?

Answer 27

During systole.

Question 28

When is the aortic valve closed with aortic insufficiency?

Answer 28

Diastole

Question 29

Aortic stenosis occurs when the…

Answer 29

aortic valve is open.

Question 30

When is the aortic valve open with aortic stenosis?

Answer 30

Systole

Question 31

Does a murmur due to VSD occur during systole or diastole?

Answer 31

during ejection or systole

Question 32

Tip: If you can picture what the aortic valve is doing, then…

Answer 32

the pulmonic valve is doing the same (opening or closing). If you can picture what the mitral valve is doing, the tricuspid valve is doing the same (opening or closing).

Question 33

Murmurs associated with acute MI:
a) The mitral valve…

Answer 33

-The mitral valve is attached to the Left Ventricular (LV) wall by the papillary muscles and the chord tendineae. Myocardial ischemia or infarction can affect mitral valve function and lead to acute mitral valve regurgitation.

Question 34

Murmurs associated with acute MI:
b) Papillary muscle dysfunction…

Answer 34

Papillary muscle dysfunction (Grade I or II), loudest at the apex

Question 35

Murmurs associated with acute MI:
c) Papillary muscle rupture…

Answer 35

(Grade V or VI), loudest at the apex…surgical emergency!!!

Question 36

Murmurs associated with acute MI:
d) Ventricular Septal defect…

Answer 36

VSD: Sternal border, 5th ICS