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CPR II Week 3 > Cardiac Clinical Medicine Part 3: Valvular Heart Disease and Murmurs > Flashcards

Cardiac Clinical Medicine Part 3: Valvular Heart Disease and Murmurs Flashcards

1
Q

What are the most common etiologies of valvular heart disease?

A

1) Myxomatous degeneration (MVP)

2) Congenital (Bicuspid aortic valve)

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2
Q

What do murmurs result from?

A

Turbulence across valve and/or increase blood flow

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3
Q

Sclerosis, fibrosis, and calcifications can all lead to?

A

Stenosis

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4
Q

What does stenosis impede?

What does it result in?

A

1) Forward flow

2) Pressure overload, hypertrophy, and heart failure

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5
Q

What causes regurgitation?

What does it impede?

What does it result in?

A

1) Valves leak or fail to close
2) Reversal of flow
3) Volume overload and dilation

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6
Q

When does a systolic murmur begin and end?

A

During or after the first heart sound and ends before or during the second heart

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7
Q

Which conditions are systolic murmurs associated with?

A

1) MR (Mitral Regurgitation)
2) TR (Tricuspid Regurgitation)
3) AS (Aortic Stenosis)
4) PS (Pulmonic Stenosis)
5) VSD (Ventricular Septal Defect)
6) ASD (Atrial Septal Defect)

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8
Q

When does a diastolic murmur begin and end?

A

Occurs after second heart sound and before first heart sound

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9
Q

Which conditions can diastolic murmurs be heard?

A

1) AI or AR (Aortic insufficiency or regurgitation)
2) PI or PR (Pul insufficiency or regurgitation)
3) MS (mitral stenosis)
4) TS (Tricuspid stenosis)

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10
Q

Describe the murmur grading scale

A

1) Barely audible
2) Faint, soft
3) Louder, easily heard
4) Very loud with palpable thrill (vibration)
5) Heard with stethoscope barely touching the chest with thrill
6) Can hear without stethoscope or can hear with stethoscope close
to chest: palpable thrill

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11
Q

Which murmur grades have no palpable thrill?

Which do?

A

1) 1-3

2) 4-6

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12
Q

Where is mitral regurgitation heard?

Where can it radiate into?

What heart sound is reduced?

A

1) Apex of heart
2) Left axilla
3) S1

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13
Q

What is acute MR due to?

What causes this?

A

1) Ischemic papillary muscle dysfunction

2) MI, ruptured chordae tendineae, or infective endocarditis

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14
Q

What does acute MR lead to?

A

1) Increased LA pressure
2) Pulmonary edema
3) RVF/LVF cardiogenic shock

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15
Q

What is the most common cause of chronic MR?

A

MVP (Mitral valve prolapse)

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16
Q

Mitral Valve Prolapse causes one or both leaflets to prolapse into?

What sex is it more common in?

What causes it?

A

1) Left atrium
2) Women
3) Myxedematous degeneration

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17
Q

How does MVP present?

What palpitations can be associated with it?

Where is the systolic murmur heard?

When does the click/murmur increase?

A

1) Asymptomatic chest pain
2) Supraventricular tachycardia or premature ventricular contractions
3) Apex
4) Valsalva or standing

18
Q

Where can tricuspid regurgitation be heard?

When will it increase?

What can be seen in jugular venous pulse?

A

1) 4th ICS left sternal border
2) On inspiration (Carvallo sign)
3) Prominent V wave

19
Q

What is the most common cause of aortic stenosis?

What are other causes?

A

1) Degenerative calcification

2) Congenital Bicuspid aortic valve and Rheumatic fever

20
Q

What does aortic stenosis lead to?

A

Pressure overload -> LVH

21
Q

A severe aortic stenosis is seen when the aortic valve area is?

A

Less than 1 sq cm

22
Q

What are the cardinal symptoms of aortic stenosis?

A

Dyspnea (DOE), Angina, Syncope

23
Q

Where is the systolic murmur of aortic stenosis best heard?

What is it described as?

Where does it radiate?

Which heart sound is diminished?

A

1) 2nd ICS right sternal border
2) Crescendo-decrescendo
3) Sternal notch/carotids
4) S2

24
Q

What is seen on ECG for aortic stenosis?

A

1) LVH

2) Down-sloping of ST segment that blends into T wave (Strain pattern)

25
Q

What is bicuspid Aortic Valve (BAV) associated with?

It has a predisposition to?

Where is it best heard?

75% of them develop into?

What syndromes is it associated with?

A

1) Aortic root dilation (aneurysms)
2) IE
3) Apex or left sternal border
4) Aortic stenosis
5) Marfans, Turners

26
Q

Pulmonic stenosis may be associated with?

The systolic murmur is heard where?

Where does it radiate?

What is the murmur described as?

A

1) Tetralogy of Fallot
2) 2-3 ICS left sternal border
3) Left shoulder
4) Crescendo-decrescendo

27
Q

Where is the holosystolic murmur best heard with ventricular septal defect?

The murmur increases with?

What type of shunt is it?

A

1) Left lower sternal border
2) Handgrip
3) L to R

28
Q

Where is the systolic murmur best heard with atrial septal defect?

What is the hallmark of ASD?

What type of shunt is it?

A

1) Upper left sternal border
2) Fixed splitting of S2
3) L to R

29
Q

What is the most common etiology of mitral stenosis?

Severe MS is defined as the area of mitral valve being equal to?

What does it lead to?

A

1) Rheumatic heart disease caused by group A step
2) 1-1.5 squared cm
3) Pulmonary HTN and RVF

30
Q

What symptoms are seen with mitral stenosis?

A

1) Dyspnea
2) Afib palpitations
3) Hoarseness (compression of left recurrent laryngeal nerve: Ortner’s Syndrome)

31
Q

Where is the diastolic murmur of mitral stenosis best heard?

What is the murmur described as?

Why do you use the bell?

The heart sounds are followed by?

A

1) Apex
2) Rumbling
3) It is a low pitch
4) Opening snap

32
Q

What is found on ECG for mitral stenosis?

A

1) LAE

2) Afib

33
Q

What is tricuspid stenosis caused by?

What is it associated with?

What sex is it more common?

A

1) Rheumatic disease
2) Mitral stenosis
3) Women

34
Q

Where is the diastolic murmur of tricuspid stenosis best heard?

What does it increase on?

What can be seen in jugular vein?

What is seen on ECG?

A

1) Left sternal border
2) Inspiration (Carvallo sign)
3) Prominent A wave
4) RAE

35
Q

Acute aortic insufficiency is due to?

A

1) IE
2) Aortic dissection
3) Chest trauma

36
Q

Chronic aortic insufficiency is due to?

A

1) Calcific degeneration
2) Bicuspid aortic valve
3) Dilated aortic root
4) Rheumatic

37
Q

What does aortic insufficiency lead to?

A

Volume overload -> LVH -> Left heart failure

38
Q

What symptom is seen with acute aortic insufficiency?

Chronic?

A

1) Pulmonary edema

2) Dyspnea, orthopnea, angina

39
Q

Where is the diastolic murmur of aortic insufficiency best heard?

How is it described?

What can it mimic?

Which heart sound is described as soft?

A

1) 3rd ICS left sternal border
2) Decrescendo
3) Mitral stenosis
4) S2

40
Q

How does aortic insufficiency affect the BP?

A

Wide pulse pressure (Greater than 40)

41
Q

What is DeMusset sign which is associated with aortic insufficiency?

What is the Quincke’s sign?

What is the Traube’s sign?

What is the Duroziez’s sign?

A

1) Head bobs with each beat
2) Capillary nail pulsations
3) Pistol shot sound over femoral artery
4) Diastolic murmur over femoral artery when compressed with bell of stethoscope

42
Q

Where is the diastolic murmur of pulmonary insufficiency best heard?

How is it described?

What is it associated with?

Which heart sound is increased?

A

1) 2nd ICS left sternal border
2) Decrescendo
3) Pulmonary HTN
4) Increases S2

CPR II Week 3 (11 decks)

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