29. Mitral and Tricuspid Valve Disease

Question 1

Describe a pulmonic regurgitation murmur.

Answer 1

an early S2 murmur that decrescendos, heard along the upper left sternal border

Question 1

How is mitral stenosis treated?

Answer 1

1. beta blockers to slow HR 2. diuretics for CHF 3. anticoagulants if A-fib 4. valve replacement 5. percutaneous balloon

Question 1

How do you treat mitral valve regurg?

Answer 1

1. diuretics for CHF 2. ACE inhibitors or ARBs for afterload reduction 3. mitral valve repair or replacement surgery

Question 3

What sound does mitral valve prolapse cause?

Answer 3

a nonejection click that is mid- to late-systolic and then a murmur of regurgitation

Question 3

What are the diastolic murmurs?

Answer 3

1. aortic regurgitation 2.

Question 4

When is S3 abnormal? What does it indicate?

Answer 4

in older people; heart disease, like CHF

Question 4

What are the s/s of mitral regurg?

Answer 4

CHF, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, edema

Question 6

Where is an aortic regurgitation murmur heard?

Answer 6

along the L sternal border

Question 7

Describe an aortic regurgitation murmur.

Answer 7

an early diastolic S2 murmur that decrescendos, heard along the L sternal border

Question 8

How are S3 and S4 heard best?

Answer 8

at the apex in the L lateral decubitus position

Question 8

What is a diastolic rumble?

Answer 8

a low freq decrescendo murmur due to turbulent flow across the stenotic mitral valve during diastole

Question 9

What is aortic regurgitation?

Answer 9

blood comes backwards thru the aortic valve to the LV

Question 9

What is S4?

Answer 9

a pressure overload condition heard due to atrial contraction into concentric hypertrophy of the ventricle; always pathological

Question 9

What is the most common cause of mitral stenosis?

Answer 9

Rheumatic HD

Question 9

How is tricuspid stenosis treated?

Answer 9

1. diuretics 2. surgery

Question 10

What is tricuspid stenosis?

Answer 10

a rare hardening of the tricuspid valve, usually from Rheumatic heart disease

Question 11

____% of mitral stenosis cases are rheumatic.

Answer 11

80

Question 12

When do symptoms of valve dysfunction post-Rheumatic fever present?

Answer 12

10-30 years later

Question 13

What are the echo findings of mitral stenosis?

Answer 13

1. LA enlargement 2. restricted opening of MV during diastole 3. thickened MV leaflets

Question 15

What is mitral valve prolapse?

Answer 15

valve flaps pushed the wrong direction until they’re caught by the chordae tendinae

Question 16

______ leads to chronic rheumatic heart disease.

Answer 16

Inflammation of the vascular endocardium

Question 17

What is JVD with visable systolic V wave, hepatomegaly, and a holosystolic murmur along the sternal border that increases intensity with inspiration indicative of?***

Answer 17

tricuspid regurg

Question 18

______ leads to increased pressure w/I the LA, pulmonary vasculature, and R heart.

Answer 18

Mitral valve stenosis

Question 19

How does tricuspid stenosis sound?

Answer 19

an opening snap followed by a mid-diastolic rumble

Question 19

What causes the loud S1 in mitral stenosis?

Answer 19

forceful closing of the mitral valve

Question 20

How is the severity of mitral stenosis determined?

Answer 20

use echo to measure or visualize

Question 22

Mitral valve stenosis leads to \_\_\_\_\_\_.

Answer 22

increased pressure w/I the LA, pulmonary vasculature, and R heart.

Question 24

What causes an opening snap?

Answer 24

stiff mitral valve flaps shooting open during rapid filling phase

Question 24

What part of the mitral valve is abnormal to cause MV regurg?

Answer 24

any part (annulus, leaflets, chordae, pap muscles)

Question 25

What are the buzzwords for tricuspid regurg?

Answer 25

JVD with visable systolic V wave, hepatomegaly, holosystolic murmur along the sternal border that increases intensity with inspiration

Question 26

Elevated RA pressure leads to \_\_\_\_\_.

Answer 26

increased venous pressure

Question 27

Where would a tricuspid stenosis murmur be heard?

Answer 27

near the sternum and it would intensify with inspiration

Question 29

What is mitral stenosis?

Answer 29

stiffening of the mitral valve that doesn't allow blood through well

Question 30

When would you treat mitral valve stenosis?

Answer 30

1. when the pt is symptomatic 2. if the pt has pulm HTN 3. if the pt has A-fib

Question 31

What can cause tricuspid regurg?

Answer 31

1. a congenital structure abnormality 2. endocarditis 3. heart disease 4. Rheumatic fever 5. radiation 6. drugs

Question 32

What does a midsystolic click followed by a late systolic murmur indicate?

Answer 32

mitral valve prolapse

Question 34

What is acute rheumatic fever?

Answer 34

an inflammatory condition involving the heart, skin, and/or CT 2a to a group A strep infection

Question 35

What can damage the mitral valve and therefore cause MV regurg?

Answer 35

1. myxomatous degeneration 2. ischemic heart disease 3. endocarditis 4. Rheumatic heart disease 5. LV enlargement (stretches out MV)

Question 36

How does a mitral stenosis murmur sound?

Answer 36

a diastolic murmur starting right after at S2 with an opening snap and then decrescendo with a pre-systolic accentuation

Question 37

When is S3 normal?

Answer 37

in young people

Question 38

The ____ valve opens in diastole, allowing blood to flow from the LA to the LV.

Answer 38

mitral

Question 39

What are the EKG findings of mitral stenosis?

Answer 39

1. LA enlargement 2. RVH if pulm HTN has developed 3. possible A-fib

Question 40

1. LA enlargement 2. RVH if pulm HTN has developed 3. possible A-fib

Answer 40

EKG findings of mitral stenosis

Question 41

What is tricuspid regurg?

Answer 41

tricuspid valve doesn't close completely during systole, allowing blood to flow backwards into the RA

Question 42

What is a loud S1 with an opening snap and a diastolic rumble indicative of?\*\*\*

Answer 42

mitral stenosis

Question 44

1. LA enlargement 2. restricted opening of MV during diastole 3. thickened MV leaflets

Answer 44

echo findings for mitral stenosis

Question 45

When is the opening snap heard?

Answer 45

after S2

Question 46

Name 6 s/s of mitral stenosis.

Answer 46

1. dyspnea 2. hemoptysis 3. pulmonary HTN 4. R sided heart failure 5. A-fib 6. thromboembolism

Question 47

How is a mitral stenosis murmur described?

Answer 47

an opening snap followed by a mid-diastolic rumble

Question 48

Name the 4 parts of the mitral valve.

Answer 48

1. Annulus 2. Leaflets 3. Chordae 4. Papillary muscles

Question 49

What is S3?

Answer 49

a volume overload condition heard in early diastole during the rapid filling phase caused by tensing of chordae tendinae; can be normal in young people

Question 50

What is another name for S3?

Answer 50

a ventricular gallop

Question 52

What is another name for S4?

Answer 52

an atrial gallop

Question 54

Describe the murmur in mitral valve prolapse.

Answer 54

a mid-systolic click with a late-systolic murmur (btw S1 and S2)

Question 55

How is tricuspid regurg treated?

Answer 55

1. treat the underlying cause, if possible 2. diuretics 3. tricuspid repair/replacement surgery

Question 56

What does a holosystoic murmur at the apex with radiation to the axilla indicate?

Answer 56

mitral valve regurg

Question 57

The mitral valve opens in \_\_\_\_\_, allowing blood to flow from the LA to the LV.

Answer 57

diastole

Question 58

What causes the opening snap in mitral stenosis?

Answer 58

opening of the stenotic mitral leaflets

Question 59

What is mitral regurg?

Answer 59

inadequate mitral valve closure, so blood is allowed to flow backward from the LV to the LA

Question 60

Inflammation of the vascular endocardium leads to \_\_\_\_\_.

Answer 60

chronic rheumatic heart disease