CBL - Aortic Stenosis

Question 1

What is the function of the mitral valve? [1]

Answer 1

Controls blood flow into the left ventricle (LV) from the left atrium (LA)

Question 2

What prevents the mitral valve from prolapsing into the left atrium? [2]

Answer 2

1. chordae tendineae
2. papillary muscles

Question 3

When does the mitral valve open? [1]

Answer 3

when left atrial pressure exceeds left ventricular pressure during diastole, when LV pressures are low because of ventricular muscle relaxation

Question 4

What is the function of the tricuspid valve? [1]

Answer 4

controls blood between the right atrium (RA) and the right ventricle (RV)

Question 5

What is the function of the aortic valve? [1]

Answer 5

controls blood flow from LV into the aorta

Question 6

When does the aortic valve open? [1]

Answer 6

when the systolic pressure in the LV exceeds the end-diastolic pressure in the aorta e.g. 80 mmHg and closes when the pressure falls towards the end of systole

Question 7

What is the function of the pulmonary valve? [1]

Answer 7

controls blood flow between the right ventricle (RV) and the pulmonary artery (PA)

Question 8

Label the following diagram representing the normal pressure/flow relationships for the left side of the heart [9]

Answer 8

1. diastole
2. systole
3. diastole
4. mitral valve closes
5. aortic valve opens
6. aortic valve closes
7. mitral valve opens
8. S₁
9. S₂

Question 9

Define a heart murmur [1]

Answer 9

a sound produced by turbulent blood flow

Question 10

Stenosis of a valve produces turbulent flow during a period of the cardiac cycle when blood does not normally flow across the valve/passes through it in the correct direction

(choose an option)

Answer 10

Stenosis, or narrowing, of a valve produces turbulent flow when blood passes through it in the correct direction

Question 11

Regurgitation through a valve produces turbulent flow during a period of the cardiac cycle when blood does not normally flow across the valve/passes through it in the correct direction

(choose an option)

Answer 11

Regurgitation through the valve (also called incompetence) produces turbulence during a period of the cardiac cycle when blood does not normally flow across the valve

Question 12

What does an aortic stenosis murmur sound like and when does it occur (systolic/diastolic etc)? [2]

Answer 12

low pitched ejection systolic murmur

Question 13

Where is an aortic stenosis murmur best heard? [1]

Answer 13

best heard in the aortic area

Question 14

Where does an aortic stenosis murmur tend to radiate to? [1]

Answer 14

radiate to the neck

Question 15

What does an aortic regurgitation murmur sound like and when does it occur (systolic/diastolic etc)? [2]

Answer 15

high-pitched (blowing) early diastolic murmur

Question 16

Where is an aortic regurgitation murmur best heard? [2]

Answer 16

best heard at the left sternal edge with patient sitting forward in expiration

Question 17

What does a mitral stenosis murmur sound like and when does it occur (systolic/diastolic etc)? [2]

Answer 17

low-pitched (rumbling) mid-diastolic murmur

Question 18

Where is a mitral stenosis murmur best heard? [2]

Answer 18

best heard at the apex with patient lying on their left side

Question 19

What does a mitral regurgitation murmur sound like and when does it occur (systolic/diastolic etc)? [2]

Answer 19

high-pitched (blowing) pan-systolic murmur

Question 20

Where is a mitral regurgitation murmur best heard? [1]

Answer 20

best heard at the apex

Question 21

Where does a mitral regurgitation murmur tend to radiate to? [1]

Answer 21

tends to radiate to the axilla

Question 22

Where is a tricuspid stenosis murmur best heard and when does it occur (systolic/diastolic etc)? [2]

Answer 22

distolic murmur at left sternal edge

(rare)

Question 23

What does a pulmonary stenosis murmur sound like, when does it occur (systolic/diastolic etc) and where can it be found? [3]

Answer 23

soft ejection murmur in the pulmonary area

Question 24

What does a pulmonary regurgitation murmur sound like, when does it occur (systolic/diastolic etc) and where can it be found? [3]

Answer 24

soft early diastolic murmur in pulmonary area

Question 25

When does a murmur caused by ventricular septal defect occur (systolic/diastolic etc)? [1]

Answer 25

pan-systolic murmur

Question 26

What are the typical examination findings of aortic stenosis? [4]

Answer 26

1. ejection systolic murmur,
2. an associated thrill (palpable murmur),
3. a slow-rising (“plateau”) pulse, with reduced pulse pressure
4. a forceful apex beat

Question 27

What are the typical examination findings in aortic regurgitation? [3]

Answer 27

1. early diastolic murmur
2. large volume “collapsing” pulse, with large pulse pressure
3. displaced apex beat

Question 28

What investigations are used for aortic valve lesions? [6]

Answer 28

1. ECG
2. Chest X-ray
3. Echocardiography
4. Doppler Echo
5. Exercise testing
6. Coronary angiography

Question 29

What are the management options for aortic valve lesions? [3]

Answer 29

1. surgical valve replacement
2. percutaneous valve replacement (given to people who are too ill to survive surgery)
3. transcutaneous aortic valve implantation (TAVI)