Cardiac Valve Disease

Question 1

There is a tapping apex beat in ___1___

There is a displaced and diffuse apex beat in ___2_____ There is a heaving and possibly displaced apex beat in ____3____

Answer 1

1 mitral stenosis
2 left ventricular dilatation
3 left ventricular hypertrophy

Question 2

A left parasternal heave suggests

Answer 2

Right ventricular overload due to cor pulmonale or pulmonary hypertension

Pulmonary hypertension can be caused by mitral regurgitation

Question 3

A cardiac murmur is…

Answer 3

Audible turbulence of blood flow

Question 4

Systolic murmurs

Answer 4

Aortic stenosis and mitral regurgitation

Question 5

Diastolic murmurs

Answer 5

Aortic regurgitation and mitral stenosis

Question 6

Patent ductus arteriosus murmur

Answer 6

continuous machinery noise

Question 7

Diastolic murmurs are always ___1____

Innocent murmurs are soft and in ___2__ usually best heard in ___3____ area, innocent murmurs do not __4___

Answer 7

1 pathological
2 systole
3 pulmonary
4 radiate

Question 8

3 common causes of aortic stenosis?

Answer 8

Degenerative (age related)- the valve becomes calcified
Congenital bicuspid valve that degenerates quicker
Rheumatic heart disease- fairly uncommon now

Question 9

Symptoms of aortic stenosis?

Answer 9

chest pain and syncope particularly on exertion

breathlessness

Question 10

Describe aortic stenosis murmur

Answer 10

Ejection systolic murmur that can radiate to the carotids.

Question 11

Mechanical valves tend to be offered to ____1____ as these require ___2____

Tissue valves tend to be offered to ___3___ as these _____4___

Answer 11

1 younger patients
2 lifelong warfarin
3 elderly patients
4 don’t require lifelong warfarin

Question 12

aortic stenosis egg may show

Answer 12

LVH

Question 13

Mitral regurgitation can occur due to abnormalities in (5)

Answer 13

valve leaflets
the annulus
chord tendinae
papillary muscles
left ventricle

Question 14

Most common causes of mitral regurgitation are

Answer 14

degenerative disease (myxomatous)
papillary muscle rupture due to ischaemia
rheumatic heart disease
endocarditis

Question 15

symptoms of mitral regurgitation

Answer 15

palpitations
dyspnoea and orthopnoea
fatigue and lethargy

Question 16

In mitral regurgitation the apex beat will be

Answer 16

displaced

Question 17

In mitral regurgitation the CXR will show, the ECG will show

Answer 17

cardiomegaly

LVH

Question 18

Murmur of mitral regurgitation is

Answer 18

pansystolic murmur that may radiate to the axilla

Question 19

Left sided murmurs are best heard in ?

Right sided murmurs are best heard in?

Answer 19

expiration

inspiration

Question 20

Most common cause of mitral stenosis _____ this is secondary to _____
very rarely caused by _____

Answer 20

rheumatic fever secondary to infection with Group A Streptococcus
congenital heart disease

Question 21

Presentation of mitral stenosis

Answer 21

Breathlessness
Palpitations
Malar flush

Question 22

In mitral stenosis there may be a ____ apex beat

Answer 22

tapping

Question 23

murmur of mitral stenosis

Answer 23

rumbling mid-diastolic murmur localised to the apex

Question 24

Mitral stenosis may cause _____ due to enlargement of ______

Answer 24

AF

left atrium

Question 25

On CXR for mitral stenosis

Answer 25

Straight left heart border due enlargement of the left atrium

Question 26

Causes of Aortic Regurgitation?

Answer 26

Leaflet damage due to endocarditis

Annulus damage due to Marfans or aortic dissection

Question 27

Collapsing pulse with a wide pulse pressure is a sign of

Answer 27

aortic regurgitation

Question 28

Wide pulse pressure and displaced apex is a sign of

Answer 28

aortic regurgitation

Question 29

murmur for aortic regurgitation

Answer 29

early diastolic murmur best heard on the left sternal edge with the patient leaning forwards on expiration

Question 30

What type of pulse do you get in aortic stenosis? Why?

Answer 30

Low volume pulse that is slow rising as ejection is prolonged

Question 31

When will you feel symptoms of Aortic regurgitation? Why does this happen?

Answer 31

Tend not to feel symptoms until you get left ventricular failure, you get reduced coronary perfusion due to reflux through valve during diastole

Question 32

In cardio exam when you sit patient up and hold stethoscope to left sternal edge and listen on expiration what you are listening for?

Answer 32

Aortic Regurgitation

Question 33

When you turn patient to left and listen to apex what are you listening for?

Answer 33

Mitral stenosis

Question 34

All common murmurs as on the left side will be best hear on

Answer 34

expiration