Cardiac Valve Defects - Murmurs

Question 1

Give 2 causes of an ejection systolic murmur that gets louder on expiration.

Answer 1

1. Aortic Stenosis.

2. Hypertrophic Obstructive Cardiomyopathy.

Question 2

Give 2 causes of an ejection systolic murmur that gets louder on inspiration.

Answer 2

1. Pulmonary Stenosis.

2. Atrial Septal Defect.

Question 3

Give 1 more cause of an ejection systolic murmur.

Answer 3

Tetralogy of Fallot.

Question 4

Give 3 causes of holosystolic/pansystolic murmur.

Answer 4

1. Mitral Regurgitation (High-Pitched and Blowing).
2. Tricuspid Regurgitation (High-Pitched and Blowing).
3. Ventricular Septal Defect (Harsh).

Question 5

How do atrioventricular valves differ in regurgitation?

Answer 5

Tricuspid regurgitation becomes louder during inspiration, unlike mitral stenosis.

Question 6

Give 2 causes of late systolic murmur.

Answer 6

1. Mitral Valve Prolapse.

2. Aortic Coarctation.

Question 7

Give 2 causes of early diastolic murmur.

Answer 7

1. Aortic Regurgitation (High-Pitched and Blowing).

2. Graham-Steel Murmur (Pulmonary Regurgitation = High-Pitched and Blowing).

Question 8

Give 2 causes of mid-late diastolic murmur.

Answer 8

1. Mitral Stenosis (Rumbling).

2. Austin-Flint Murmur (Severe Aortic Regurgitation - Rumbling).

Question 9

Give 1 cause of a continuous machine-like murmur.

Answer 9

Patent Ductus Arteriosus.

Question 10

What is S1?

Answer 10

Closure of AV Valves at the start of systolic contraction of the ventricles.

Question 11

What is S2?

Answer 11

Closure of the SL valves once the systolic contraction is complete.

Question 12

What is S3?

Answer 12

Rapid ventricular filling causing the chord tendinae to pull to their full length and twang.

Question 13

When is S3 heard?

Answer 13

0.1 seconds after S2.

Question 14

Aetiology of S3 - Age.

Answer 14

1. Young (15-40) : Healthy.

2. Older : Heart Failure.

Question 15

What is S4?

Answer 15

Abnormal sound indicating a stiff or hypertrophic ventricle, caused by turbulent flow from an atria against a non-compliant ventricle.

Question 16

What special manoeuvres can be used to emphasise murmurs (2)?

Answer 16

1. Mitral Stenosis - On their left side.

2. Aortic Regurgitation - Leaning Forward and Holding Exhalation.

Question 17

How are murmurs assessed? (6)

Answer 17

SCRIPT :
S - Site (Loudest?)
C - Character.
R - Radiation.
I - Intensity (Grade?)
P - Pitch (High/Low = Velocity?)
T -Timing (Systolic/Diastolic?)

Question 18

How are murmurs graded? (6)

Answer 18

1. Difficult to Hear.
2. Quiet.
3. Easy to Hear.
4. Easy to Hear with a Palpable Thrill.
5. Audible with Stethoscope Barely Touching Chest.
6. Audible with Stethoscope off Chest.

Question 19

What effects on the heart do stenotic valves cause? (2)

Answer 19

1. Mitral Stenosis - Left Atrial Hypertrophy.

2. Aortic Stenosis - Left Ventricular Hypertrophy.

Question 20

What effects on the heart do leaky valves cause? (2)

Answer 20

1. Mitral Regurgitation - Left Atrial Dilation.

2. Aortic Regurgitation - Left Ventricular Dilation.

Question 21

What can a midline sternotomy scar indicate?

Answer 21

1. CABG.
2. Aortic Valve Replacement.
3. Mitral Valve Replacement.

Question 22

Differences between Bioprosthetic and Mechanical Valves (3).

Answer 22

1. B = Porcine (Pig). M = Metallic.
2. B = 10 Year Span. M = Over 20 Years.
3. B = Lifelong Anticoagulation with Warfarin (INR : 2.5-3.5). M = N/A.

Question 23

Give 3 major complications of mechanical heart valves.

Answer 23

1. Thrombosis.
2. Infective Endocarditis.
3. Haemolysis (Anaemia).